No matter how well intentioned, government meddling in health care produces unintended consequences for patients. And these consequences are rarely good. For anyone still in denial about that, the Health Affairs blog highlights an article that discusses one of the inevitable effects of Medicare’s “Pay-for-Performance” initiative:
P4P and public reporting could actually worsen care for the poor and minorities. Physicians might avoid poor and minority patients if they perceive them, rightly or wrongly, as less likely to have good outcomes from treatment, or less likely to adhere to treatment recommendations.
For those who don’t understand incentives, P4P sounds like a pretty good idea. Providers are rewarded or punished according to how well their patients respond to treatment. What’s not to like? Well, guess what, some patients don’t follow the advice of their doctors. And, surprise, these patients have poor outcomes.Because poverty and lack of education go hand-in-hand, poor patients have a relatively high rate of noncompliance. And, if you punish the physician for the resultant outcomes, some of the docs are going to stop treating such patients. See this post at Kevin, MD for more on this pointCasalino and Elster, the authors of the Health Affairs piece, offer the following solution to this dilemma:
Using “stratified analysis” to compare physicians’ performance against that of physicians treating similar patients, and risk-adjusting quality scores for health status, as well as for race/ethnicity and/or socioeconomic status.
For my money, this misses the point. The problem here is government meddling. So, the solution is to get CMS out of the outcomes business. Throttle P4P in the cradle before it does serious harm to poor patients and the health care delivery system in general.
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