Friday, June 30, 2017

The fallacies of Pay for performance

The Fallacies of Pay for performance

The quality measures used in pay-for-performance generally fall into the four categories described below.

• Process measures assess the performance of activities that have been demonstrated to contribute to positive health outcomes for patients. Examples include whether or not aspirin was given to heart attack patients or whether patients were counseled to quit smoking.( No siree number of patients who really quit smoking no amount of nagging  from me will help

• Outcome measures refer to the effects that care had on patients, for example, whether or not a patient's diabetes is under control based on laboratory tests. Use of outcome measures is particularly controversial in pay-for-performance because outcomes are often affected by social and clinical factors unrelated to the treatment provided and beyond the provider's control. For example, providers may follow practice guidelines regarding monitoring blood sugar levels and counseling diabetic patients regarding their diet, but ultimately, the patients' eating and exercise behaviors will determine control of their diabetes. Increasingly, outcome measures also include cost savings.

• Patient experience measures assess patients' perception of the quality of care they have received and their satisfaction with the care experience. In the inpatient setting, examples include how patients perceived the quality of communication with their doctors and nurses and whether their rooms were clean and quiet.
see my blogpost Press who? Catering to Patients Can Be Harmful to Their Health!
See the  forbes article

• Structure measures relate to the facilities, personnel, and equipment used in treatment. For example, many pay-for-performance programs offer incentives to providers to adopt health information technology.
The pentagon and the VA have been using HIS for decades has it made a dent ?



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