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Physician-level P4P--DOA? Can quality-based payment be resuscitated?
Am J Manag Care. 2007 May; 13(5):233-6.AJ

Abstract

Unlike many areas of the economy where value is relatively easy to measure and reward, healthcare is "messy." Patients bring both clinical heterogeneity and illness-severity complexities to the interchange with their physician. The measurable outcomes or process measures are as likely to be due to patient characteristics as they are to be due to the actions (or inactions) of the patient's provider. Moreover, data suggest that the simplest fix for providers with bad metrics is to "dump" their sickest patients. Perhaps the most pernicious consequence of physician-level pay-for-performance (P4P) systems is how these systems can affect the neediest patients and their providers. As patient characteristics (eg, illness severity, preferences, resources) are more likely to be an issue in our poorer and minority communities, these patients' physicians will be at a financial disadvantage in a P4P system. It is likely that the widespread adoption of P4P systems will further limit these necessary resources.

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Publisher Full Text

Authors+Show Affiliations

McMahon LF
Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA. lmcmahon@umich.edu
Hofer TP
No affiliation info available
Hayward RA
No affiliation info available

MeSH

Disease ManagementHumansManaged Care ProgramsPhysician Incentive PlansQuality Assurance, Health CareQuality Indicators, Health CareReimbursement, IncentiveUnited States

Pub Type(s)

Journal Article

Language

eng

PubMed ID

17488186

Citation

McMahon, Laurence F., et al. "Physician-level P4P--DOA? Can Quality-based Payment Be Resuscitated?" The American Journal of Managed Care, vol. 13, no. 5, 2007, pp. 233-6.
McMahon LF, Hofer TP, Hayward RA. Physician-level P4P--DOA? Can quality-based payment be resuscitated? Am J Manag Care. 2007;13(5):233-6.
McMahon, L. F., Hofer, T. P., & Hayward, R. A. (2007). Physician-level P4P--DOA? Can quality-based payment be resuscitated? The American Journal of Managed Care, 13(5), 233-6.
McMahon LF, Hofer TP, Hayward RA. Physician-level P4P--DOA? Can Quality-based Payment Be Resuscitated. Am J Manag Care. 2007;13(5):233-6. PubMed PMID: 17488186.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Physician-level P4P--DOA? Can quality-based payment be resuscitated? AU - McMahon,Laurence F,Jr AU - Hofer,Timothy P, AU - Hayward,Rodney A, PY - 2007/5/10/pubmed PY - 2007/6/6/medline PY - 2007/5/10/entrez SP - 233 EP - 6 JF - The American journal of managed care JO - Am J Manag Care VL - 13 IS - 5 N2 - Unlike many areas of the economy where value is relatively easy to measure and reward, healthcare is "messy." Patients bring both clinical heterogeneity and illness-severity complexities to the interchange with their physician. The measurable outcomes or process measures are as likely to be due to patient characteristics as they are to be due to the actions (or inactions) of the patient's provider. Moreover, data suggest that the simplest fix for providers with bad metrics is to "dump" their sickest patients. Perhaps the most pernicious consequence of physician-level pay-for-performance (P4P) systems is how these systems can affect the neediest patients and their providers. As patient characteristics (eg, illness severity, preferences, resources) are more likely to be an issue in our poorer and minority communities, these patients' physicians will be at a financial disadvantage in a P4P system. It is likely that the widespread adoption of P4P systems will further limit these necessary resources. SN - 1936-2692 UR - https://www.unboundmedicine.com/medline/citation/17488186/Physician_level_P4P__DOA_Can_quality_based_payment_be_resuscitated L2 - https://www.ajmc.com/pubMed.php?pii=3311 DB - PRIME DP - Unbound Medicine ER -