Pay-for-performance may benefit doctors who care for very sick
June 1, 2009Physicians who treat patients with multiple health problems will fare well under pay-for-performance, which bases physician reimbursement on the quality of care provided, said researchers at Baylor College of Medicine (www.bcm.edu) and the Michael E. DeBakey Veterans Affairs Medical Center in Houston in a report in the current issue of the journal Circulation.
When the researchers evaluated the high blood pressure treatment provided to patients who had other serious health condition, they found that such patients were more likely to receive high quality care than patients who had no co-existing health problems.
"Pay-for-performance raises a lot of fears and assumptions that the reimbursement will not be fair toward doctors who care for the sickest patients," said Dr. Laura A. Petersen, the study's lead author and director of the Houston VA Health Services Research and Development Center of Excellence and an associate professor of medicine at BCM. "What we found was that doctors do a good job of taking care of a lot of complex conditions, even better than they think they do."
Petersen, who is also chief of Health Services Research at BCM, said the result surprised her.
"When a patient comes in with many problems, there is often less time to address any single one," she said. She and her colleagues found, however, that physicians appear to identify the problems that present the most risk and deal with them effectively.
"This is good news and should be reassuring to doctors and health policy makers," she said.
The research team chose to study high blood pressure because it is a common, symptomless problem that can have serious consequences, affecting the heart, brain and kidneys.
In their study, the researchers identified 141,609 patients with high blood pressure in a VA database. Of these 22,595 had no other serious health conditions; 70,098 had conditions that could be related to the high blood pressure (concordant), 12,283 other health conditions not related to high blood pressure (discordant) and 36,633 had both.
Blood pressure was controlled for 12,956 (57.3 percent) of patients with no other health conditions, 45,334 (64.7 percent) of those with concordant or related health conditions and 7,742 (63 percent) of those with other conditions not related to blood pressure. Of those with both concordant and discordant condition, 25,339 or 69.2 percent had blood pressure controlled.
The researchers noted that quality of care increased with the number of other conditions the patient had. In other words, the sicker the patient, the better the care, even after statistically controlling for the numbers of visits with a doctor.
"Our results should be reassuring for policy-makers who have faced crticism that performance measures, public reporting, and pay-for-performance initiatives may penalize health care providers of patients with multiple co-existing chronic conditions," they wrote.
Source: Baylor College of Medicine (news : web)
Nov 10, 2008 |
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Chronic and incurable conditions, particularly vexing progressive ones will punish physicians who enter fields for which management of these problems is the best they can hope for with the toolbox currently available to them. This will decrease the incentive for physicians to enter these already stressed specialty practices.
The unintended consequences are easily seen if one cares to look at needs versus the economics which have decreased the ability of providers to provide quality care and STANDARD care in the current economic paradigm.
The 'free market" "competitive" philosophy in health care delivery initiated decades ago failed and failed miserably to provide better quality of care at less cost.
Time for some new thinking.
(Ever wonder why Canada has 20% of the NA auto manufacturing industry, even though from a logistical standpoint it makes no sense whatsoever to manufacture a single vehicle in Canada rather than in the US? Non-existent healthcare costs for the corporation, baby;).)