Being rewarded for meeting pre-established targets for delivery of healthcare services represents a fundamental change from the traditional fee for service payment model.
A rapidly aging population and the never ending increases in healthcare costs has brought P4P to the forefront of current health care policy but pilot studies in a number of large healthcare systems have shown no cost savings due to increased administrative costs and only modest improvements in specific outcomes and increased efficiency.
Under the current fee for service model, many healthcare payers will not reimburse for efforts specific to reducing errors while allowing providers to bill for services required as a result of mistakes. It has been speculated that this model may actually reward less-safe care.
The reality is that in early studies there was shown to be very little gain in quality of care for the money spent as well as evidence suggesting the unintended consequence of avoidance of high risk patients then compensation was linked to improved outcomes.
For the most part, in the United States, professional medical societies have been marginally supportive of the pay for performance model.
While the AMA has published detailed guidelines for implementing P4P programs many other professional organizations have expressed skepticism. “…multitude of organizational, technical, legal and ethical challenges…”, “unintended adverse consequence for sicker and non-compliant patients’, must target not only care for specific diseases but also care that addresses multiple, concurrent illnesses and tested among vulnerable older adults”, “current P4P standards represent a misaligned incentive system, encouraging diagnostic tests over thoughtful and skilled patient care.”
CMS currently has several P4P demonstration projects underway which have shown only moderate impact on quality of care and sometimes significant increases in administrative costs. CMS has also proposed eliminating payments when negative consequences occur and other private health payers are considering taking the same steps.
These disincentives may prove to be powerful incentives for healthcare providers to dismiss or refuse to accept patients whose outcome measures fall below quality standards and ultimately worsen the provider’s assessment.
The jury seems still to be out on the future of P4P but it appears obvious that whatever standards are eventually adopted will need to address a number of problems that have yet to be solved.
A rapidly aging population and the never ending increases in healthcare costs has brought P4P to the forefront of current health care policy but pilot studies in a number of large healthcare systems have shown no cost savings due to increased administrative costs and only modest improvements in specific outcomes and increased efficiency.
Under the current fee for service model, many healthcare payers will not reimburse for efforts specific to reducing errors while allowing providers to bill for services required as a result of mistakes. It has been speculated that this model may actually reward less-safe care.
The reality is that in early studies there was shown to be very little gain in quality of care for the money spent as well as evidence suggesting the unintended consequence of avoidance of high risk patients then compensation was linked to improved outcomes.
For the most part, in the United States, professional medical societies have been marginally supportive of the pay for performance model.
While the AMA has published detailed guidelines for implementing P4P programs many other professional organizations have expressed skepticism. “…multitude of organizational, technical, legal and ethical challenges…”, “unintended adverse consequence for sicker and non-compliant patients’, must target not only care for specific diseases but also care that addresses multiple, concurrent illnesses and tested among vulnerable older adults”, “current P4P standards represent a misaligned incentive system, encouraging diagnostic tests over thoughtful and skilled patient care.”
CMS currently has several P4P demonstration projects underway which have shown only moderate impact on quality of care and sometimes significant increases in administrative costs. CMS has also proposed eliminating payments when negative consequences occur and other private health payers are considering taking the same steps.
These disincentives may prove to be powerful incentives for healthcare providers to dismiss or refuse to accept patients whose outcome measures fall below quality standards and ultimately worsen the provider’s assessment.
The jury seems still to be out on the future of P4P but it appears obvious that whatever standards are eventually adopted will need to address a number of problems that have yet to be solved.