Doctors have always been skeptical about the real meaning of the health policy term " quality". On the face of it, quality medicine seems like an incontrovertibly good thing. It is also called "performance". It means the absence of problems in one's patients. It also means having patients with shorter stays, fewer diagnostic tests and fewer readmissions. The assumption behind all this is that quality medical care leads to less ill patients. Fair enough, at least in a few circumstances where doctors can control the majority of the variables. The strange thing is that government and insurance companies then infer that the converse is true: that ill patients means doctors are performing less well, and that their medical care has lesser " quality". They then reason they can justify paying caregivers less for less "quality" and poorer "performance" . This is the real meaning of " Pay for Performance" or P4P.
Government and insurance companies are the third party payers in this scheme. The patient is the first party, the doctor the second, and the payor is the third party. These payors want to pay out as little as possible, not only to the doctors, but altogether on behalf of the patients. Patients with shorter stays, fewer diagnostic tests and fewer readmissions are CHEAPER patients. So if a doctor wants to keep her " quality " and her " performance " up, she had better shy well away from older, sick, or high risk patients. Not only would she have more work, more heartache, more complications, but less pay too, and a designation of being a poorly performing low quality doctor. Talk about adding insult to injury.
Don't worry. Most of us signed up to take care of people who need us. Most of us actually prefer practicing at the higher end of our skills, which means taking challenging cases. Additionally, most of us don't mind looking at our own statistics or " performance". We prefer to. We want to know our own rates of infection, primary C section, or length of stay. Most of us are not going to change how we take care of patients because of the bean counters. We know our own data is best used to help us make ourselves better doctors. It should not be used by third party payors to justify pressuring us to take care of patients more cheaply. I was glad to see this New York Times article on my home page. It's just nice to know that this discussion about " quality "and " performance " is out in the open.
