Why P4P can hurt patient care

For years I have railed against P4P.  The concept seems so right to the wonks and politicians. The concept seems right if you have shallow thinking.  If you ask practicing physicians to do a pre-mortem analysis on how P4P would fail, they would have understood. Last week in my favorite thought provoking blog (Farnam Street), they published a wonderful piece that explains the problem well – The Distorting Power of Incentives.  While I hope you read that post, I will provide the essence. Understanding incentives comes through second-and-third-level thinking. Many incentive systems have backfired because people failed to consider other interests and incentives. P4P rewards physicians or systems for meeting certain measurements.  First level thinking involves identifying a guideline, learning that adherence to that guideline varies, and then providing rewards for certain percentage of adherence.  Second and third level thinking looks at the entirety of patient care.  It asks whether shining the light on a set of measures might detract from other aspects of patient care. Good incentives acknowledge recognition, public perception, and the value of pursuing work that we can be proud of. So yes, if we want to persuade, we should appeal to interests not reason. But when it comes to interests, appeal not just to net worth but also to self-worth. While money has great importance, most physicians value more than money.  We want to do what is best for the patient.  We ha...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs