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    Monday, November 30, 2009

    Section III of III The Debate between Doctors and Insurance carriers about “pay for performance” [P4P] reimbursement plans

    Section III of III The Debate between Doctors and Insurance carriers about “pay for performance” [P4P] reimbursement plans

    The idea of paying physicians more for providing guideline-based care has taken the American health system by storm in the last decade. Today, more than 150 pay-for-performance programs are centered on the notion that rewarding evidence-based care is key to improving health care quality.

    Does evidence based research show that P4P is efficacious and improves quality care? No. At least not yet.

    Some P4P efforts have shown beneficial results, according to the Centers for Medicare & Medicaid Services. An evaluation of its Physician Group Practice Demonstration found that all 10 participating practices hit or exceeded targets on at least seven of 10 quality metrics of diabetes care. A Feb. 1, 2007, New England Journal of Medicine study found that Medicare's pay-for-performance demonstration project was associated with a modest improvement on quality metrics, compared with hospitals not in the project.

    Steven D. Pearson, MD, president of Harvard Medical School's Institute for Clinical and Economic Review says that "Unless you look at a control group of some kind, you may be misled about what's really happening."

    There appears to be a fundamental problem with current P4P programs. They have had little to no impact on quality. That is the conclusion of many studies, including an analysis of quality incentives, published in the July/August, 2008 of Health Affairs. It compared 81 Massachusetts physician groups eligible for quality incentives with 73 that were not. The study did find, however, that overall performance from 2001 to 2003 improved on 73% of preventive care measures such as diabetes hemoglobin A1c testing, breast cancer screening and well-child visits. But the performance of the 5,350 physicians analyzed was statistically indistinguishable. Everyone's quality improved, regardless of whether the physician group stood to earn a bonus, which ranged from $200 to $2,500 per quality measure for an individual physician, depending on the health plan.

    Another study that examined the CMS hospital P4P data also wasn't positive about P4P. A June 6, 2007, Journal of the American Medical Association study of heart attack care found no significant improvement for 54 hospitals in the CMS P4P demonstration, compared with 446 nonparticipating hospitals.

    And a systematic review of 17 studies, published in the Aug. 15, 2006, Annals of Internal Medicine, found positive or partially positive effects of P4P programs, but the impact was usually small.

    We actually have remarkably few evaluations that have a comparison group of any kind, so the evidence on pay-for-performance is rather spotty.
    Overall the P4P programs evaluated over the last five years have been largely unimpressive in their results.

    Please remember, as with all our articles we provide information, not medical advice.
    For any treatment of your own medical condition you must visit your local doctor, with or without our article[s]. These articles are not to be taken as individual medical advice.

    *Tune in later for Acid reflux foods.

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