Bioethics Discussion Blog: Pay for Performance: Doctors, Hospitals and Pills

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Saturday, July 14, 2007

Pay for Performance: Doctors, Hospitals and Pills

So you want a change in the way medicine is practiced? You are not satisfied with the way doctors and hospitals perform their duties? Do you want to find a way to get treatment from “better” doctors; doctors who are able to do a better job to cure you but with less risk of complications? Would you like to see all doctors and hospitals required to follow protocols and achieve benchmarks for the results of treatments based on evidence based medicine studies or statistically achievable norms? Should their report cards be made public regarding how well they are following the rules ad how well they are doing?

Would you like to select from a list of doctors and hospitals who are better than others and know which doctors and hospitals one should avoid? Should doctors and hospitals be paid by patients, insurance companies and the government based on where on the list of acceptable performance they are located?

How about pills and other medicines? Would you like for pharmaceutical companies to be held responsible through selective payment based on results? Would you like to have the ability to pay for them only if they prove to be effective in improving your very own condition and not pay for them or get full refund of your money if you they show no results for you personally?

You may not be aware that all this is not some futuristic dream but is already by little spurts going into practice. It has a name: Pay for Performance. The question is when all medical care is practiced this way will there be a net benefit for the patient and society in general. Are there any problems, flaws or something unethical that you can see in this concept of improving medical care? Let’s hear from you. After all, Pay for Performance is all being done for you. ..Maurice.

Read more about this:

Report cards and benchmarks for doctors and hospitals:”Is Zero the Ideal Death Rate?” by Thomas H Lee, M.D.,David F. Torchiana, M.D., and James E. Lock, M.D., New England Journal of Medicine, July 12, 2007 issue page 111.

AMA: Delegates Want Principles First with Pay for Performance (MedPage Today)

Pricing Pills by the Resuts (New York Times)

6 Comments:

At Monday, July 16, 2007 12:19:00 PM, Blogger LisaMarie said...

Might that create perverse incentives for doctors to avoid very ill patients, like ones who have multiple comorbidities, or patients who are very difficult to treat such as schizophrenics who have trouble staying on their meds?

 
At Monday, July 16, 2007 1:58:00 PM, Blogger Maurice Bernstein, M.D. said...

LisaMarie, you hit the nail right on the head. Yes, perverse incentives issue represents one of the arguments against report cards and one of the difficulties which has been considered in how to fairly evaluate the performance of physicians when benchmarks are established. ..Maurice.

 
At Thursday, July 19, 2007 6:55:00 AM, Blogger MY OWN WOMAN said...

"He said that state regulations and marketplace pressures make it virtually impossible for an insurer to refuse to pay for a drug that has been approved by the Food and Drug Administration, regardless of its price." (Dr. Lee N. Newcomer). Dr. Newcomer, there is one misnomer to your comment, the drug company will pay for drugs as long as it is the drug THEY want you to take; the cheaper and perhaps the less effective drug. For instance, my insurance company will pay for Diovan, but not Avapro, yet Avapro controls my blood pressure much better; but it's ok, they'll pay for the HCTZ that I have to take now in addition to the Diovan. I guess it all equals out huh? (and no, I was not put on HCTZ for CHF, but merely to help control my BP)

 
At Saturday, July 21, 2007 7:17:00 PM, Blogger Levi said...

I understand some of the questions you raised are somewhat similar to each other, but some of them raise very real issues (feedback on the effectiveness of different doctors) and others seem much less realistic (not paying for pills unless they work).

The main issue I see with feedback on the effectiveness of doctors is that unless there is some kind of norm for their specialty we can judge their rate against that the usefulness to the average public is greatly reduced. Of course the guy treating terminally ill cancer patients will not have as good a success rate, but that should not influence his pay.

lisamarie is right that if it comes down to a pure success rate then hard to treat patients, such as those at high risk of having co-morbid disorders (so, for them, I would not want to touch anyone with a drug addiction given their high rate of co-morbid psychological disorders), may not receive the best care. So I surely hope organizations like the AMA make decisions based on evidence rather than pleas from the peanut gallery, like me I guess.

 
At Friday, August 17, 2007 9:52:00 AM, Anonymous Anonymous said...

jFor MyOwnWoman: HCTZ _should_ be prescribed for those with hypertension unless there is a contraindication. It is not only a cheap medicine to use, it is the best studied and best proven at preventing the complications of HTN, a "win-win" for care and costs.

 
At Friday, August 17, 2007 11:08:00 AM, Blogger Maurice Bernstein, M.D. said...

Although Anonymous from today is correct that hydrochlorthiazide (HCTZ)is a relatively inexpensive and commonly used medication for hypertension, it should be prescribed for a specific patient who has hypertension but without known contraindications.

I should put a disclaimer here that no visitor should take medical advise for disorders written on this blog as appropriate or accurate or safe for that visitor. The visitor should talk to his or her doctor for information specific to his or her disorder. ..Maurice.

 

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