Dr. Rich of The Covert Rationing Blog has done an excellent job with the latest edition of Grand Rounds, and it’s well worth your time to stop by and check it out. I found this article by Doug Perednia to be particularly interesting. Doug looks at a variety of research data regarding pay-for-performance reimbursement systems for physicians, and the results of the various studies indicate that pay-for-performance doesn’t seem to have an impact on overall outcomes (or much of anything else for that matter). The descriptions of the studies that were done reminded me of the trend in the education system to focus on standardized testing, forcing teachers to gear their lesson plans towards one-size-fits-all tests rather than the needs of individual students.
Doug notes that while pay-for-performance systems have little impact on patient health, they do increase costs thanks to the added paperwork and bureaucracy. There has been much debate recently about what is the most efficient and cost-effective method of reimbursing doctors and hospitals. While most providers now are paid on a fee-for-service model, there’s concern that such a model tends to encourage over-utilization. ACOs might pose a possible solution, although their designers would be wise to ponder the data regarding pay-for-performance, since much of the success of ACOs could hinge on providers’ ability to “perform” in terms of keeping their patients healthy and avoiding costly hospitalizations.