Physician Profiling, Pay-for-Performance, and Doctor Burnout


Physician Profiling, Pay-for-Performance, and Doctor Burnout

I have been speaking out against P4P for over 10 years. What is P4P? It is pay-for-performance or what I call “Physician Profiling”. Here is an example from my blog in 2012 and again in 2015. So, why was it started and continued? Because the Ivory tower docs, who don’t actually practice medicine, thought it was a brilliant idea. They figured by measuring different quality metrics they could really make medicine better. They made it worse. We knew that 10 years ago but no one would listen. Now we have this:

Pay for performance, the catchall term for policies that purport to pay doctors and hospitals based on quality and cost measures, has been taking a bashing.

Last November, University of Pittsburgh and Harvard researchers published a major study in Annals of Internal Medicine showing that a Medicare pay-for-performance program did not improve quality or reduce cost and, to make matters worse, it actually penalized doctors for caring for the poorest and sickest patients because their “quality scores” suffered. In December, Ankur Gupta and colleagues reported that a Medicare program that rewards and punishes hospitals based on arbitrary limits on the number of hospital admissions of heart failure patients may have increased death rates. On New Year’s Day, the New York Timesreported that penalties for “inappropriate care” concocted by Veterans Affairs induced an Oregon hospital to deny acute medical care to its sickest patients, including an 81-year-old “malnourished and dehydrated” vet with skin ulcers and broken ribs.

And just three weeks ago, the Medicare Payment Advisory Commission recommended that Congress repeal a Medicare pay-for-performance program, imposed by Congress in 2015, because the program is costly and ineffective.

I remember being on a leadership committee back in Maine around the year 2011. I explained in a meeting then why quality metrics and P4P were flawed. I went through the studies and then the medical director stood up and yelled, “What’s wrong with quality!?!”

Ummm, I just spent the whole meeting telling you.

No one listened. These quality metrics, bonuses, and awards that go with them were only exciting to the administrators. Doctors hated the idea. Again, no one listened.

And the whole thing failed. And doctors burned out.

Listen to your doctors. They can smell BS from a mile away. You just may save yourself some heartache with the side effect of doctors feeling valued. That makes them stay with you longer.

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