What does the new phrase “pay for performance” mean? It certainly does not mean pay for services provided. It is a term whose definition is in flux. It essentially means that someone is going to read your EMR records (or a computer algorithm will) and decide if you have “performed” better or worse than other docs in similar care. If your performance is worse you will be paid less; if it is better you will get a bonus. There are very divergent opinions on the value of this growing and currently be tested system. It sounds good at first sight but is it? Performance is measured by “outcomes.” Outcomes often means how quickly a patients issues are resolved and with how little services. So providing less services and quicker resolution will ideally be rewarded.
At the end of this post you will see several hyperlinks with articles you may choose to read. For now let me share one interesting viewpoint.
Unless things change, it appears that the quickest, cheapest solution is drugs. Symptomatic relief. It is true that long term this will not be the best as many chronic diseases are lifestyle created and so require behavior modification for long term results. Some ACOs are betting on providing counselling but will the time spent be rewarded? If so this could be a real benefit! If the present situation is any predictor of the future, I would be skeptical but still hopeful. Skeptical because HMOs, Health Maintenance Organizations, are not about health maintenance because they know a company will drop them in a year for a new low bidder! They have no long term interest in your longevity. Like Wall St. traded corporations, that dances to the quarterly review of of investors, HMOs have no real vision of health that depends upon patient longevity.
It is a new paradigm and a positive sounding concept but can it be made to work? Will we provide counselling and education?
I reserve judgement and hope it can. Nevertheless I suggest we recognize that adding another layer of bureaucracy to medical care, those assessing outcomes, can only mean adding another expense that comes out of the doctors pocket. Will it come down to drugging away the symptoms, as we currently do in America or resolving long term health issues by counselling and lifestyle changes? Perhaps putting the burden of the expenses on the patients themselves may be a solution, that is not often discussed and certainly not popular with those who are elected to office. These patients may need to pay more for a policy if they smoke or choose to be obese! These issues are the biggest expense in America as they relate to heart surgery, stents, diabetes, strokes, joint failure of knees and hips from obesity and much more. A shot or a pill will not fix it and there are a lot of powerful food lobbyists and drug companies out there. What does this have to do with optometry’s future? Lots!
Can we doctors unite in this new health care paradigm and make a difference through ACOs and PCMHs? Only time will tell. We at the NYIPA plan to help you be involved as this is your future. We can easily diagnose diabetic retinopathy’s progression or regression. We can and do take BP’s and weights and photo document nicking or its regression. We will be part of the PCPs team that helps the PCP get a good rating by knowing better how their patients are really doing. Where there is a challenge there is opportunity for doctors who are untied by a network. The NYIPA, is your network and Unity is your empowerment!
References to opinions of interest:
- Should Physician Pay Be Tied to Performance?
- Paying Doctors For Patient Performance
- Will Paying Doctors for Performance Improve Patient Outcomes?