Health care is riddled with ideas, usually generated by academics with no sense of the real world and adopted by government officials with even less of that sense, that supposedly will make a dramatic change in spending and/or quality. These programs inevitably fail to even come close to what they were promising to deliver. One such set of programs falls under the rubric of pay for performance. Under these efforts health care providers were to be paid a bonus or penalized depending on their performance on outcomes–did patients get healthier, did spending remain under some target and so on.
An article in the New England Journal of Medicine describes the usual result of these programs–no real change, certainly not in spending. These programs impose a heavy burden on clinicians and other staff, who already have too much time spent on non-patient interactions. The authors point out issues with the measures and the obvious fact that if you are tying pay to performance on certain outcomes, then they will get focussed on and other equally important ones may get ignored. The incentive for any one measure tends to be small; too small for many clinicians to feel it is worth the effort. The authors suggest several improvements but I think the whole concept may be flawed. We need to unburden physicians. (NEJM Article)
