Sim­plify doc pay­ment sys­tem and make it in­cen­tive-neu­tral

Modern Healthcare - - COMMENT -

Re­gard­ing the re­cent fea­ture “Physi­cian qual­ity pay not pay­ing off” (ModernHealth­, June 1, p. 20), sev­eral re­views have shown no im­prove­ment in pop­u­la­tion health mea­sures or cost sav­ings from pay-for-per­for­mance or pay-for-qual­ity. It is time to face the fact that this is not a case of per­for­mance mea­sure­ment of in­di­vid­ual physi­cians be­ing in a “fledg­ling state.” The re­al­ity is that health­care, by its na­ture, is too com­plex and re­quires too much in­di­vid­u­al­iza­tion to be amenable to man­age­ment through stan­dard­ized qual­ity met­rics for in­di­vid­ual physi­cians. The met­rics that any­one can come up with gen­er­ally lack va­lid­ity or are too nar­row to have much mean­ing or value.

In­stead of ever greater and more ex­pen­sive ef­forts to mea­sure in­di­vid­ual physi­cians’ per­for­mance, let’s move to physi­cian pay­ment that is com­men­su­rate with the train­ing and ex­per­tise nec­es­sary to do what physi­cians do, but is as sim­pli­fied and in­cen­tive-neu­tral as pos­si­ble. Then rely on pro­fes­sion­al­ism and in­trin­sic mo­ti­va­tion for qual­ity im­prove­ment, which worked well for years with­out any fi­nan­cial in­cen­tives at all. The road to achiev­ing the triple aim goals is not through pay-for-per­for­mance tar­get­ing in­di­vid­ual physi­cians, but through ad­min­is­tra­tive sim­pli­fi­ca­tion lead­ing to re­duced health­care prices and im­proved ac­cess to care for ev­ery­one who needs it in the most cost­ef­fec­tive (usu­ally out­pa­tient) set­tings.

Dr. Stephen Kem­ble As­sis­tant clin­i­cal pro­fes­sor of medicine John A. Burns School of Medicine Uni­ver­sity of Hawaii, Honolulu

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