Health Affairs, 26, no. 6 (2007): 1563 doi: 10.1377/hlthaff.26.6.1563 © 2007 by Project HOPE	New Online   House Health Reform Bill   Paying for Reform   Vetting AHIP's Report   HIV/AIDS Costs   Brief: Insurance Reform   HA Blog Top 10

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Extending P4P

PROLOGUE

Extending The Pay-For-Performance Agenda

For a generation, John Wennberg, the Peggy Y. Thomson Chair in the Evaluative Clinical Sciences and a professor of medicine and of community and family medicine at Dartmouth Medical School, and his colleagues at Dartmouth have led this drumbeat provoking the CMS and the health policy community to address enormous variations in quality and cost in U.S. health care. High expense and intensive resource use seem to make little difference in outcome or quality, so what is a patient—or a country—to do? In these two papers, Wennberg and colleagues propose wholesale changes in how we inform and empower patients and how Medicare should reward hospitals that best care for them.

In the first of the two papers, Wennberg and his colleagues take on variations from a patient perspective. How often do patients just delegate a decision about back surgery or appropriate breast cancer treatment to their surgeons without really understanding their options? Why do certain regions of the country have five times the number of joint replacements compared with others? Furthermore, if patients were truly informed of all of their options, would they choose the procedures done to them? The authors challenge the CMS to address this issue through its pay-for-performance (P4P) program, to standardize information tools and ensure that patients are both informed and empowered to choose appropriate discretionary treatments.

If we can inform patients about how to choose the best treatments for their discretionary health conditions, can we also inspire or prod hospitals to provide the best treatments for chronic conditions? That is the subject of the second paper. Noting that at times we pay prices equivalent to Maseratis but get lemons, Wennberg and colleagues propose a strategy that would address major structural problems that plague the care of America’s chronically ill: inadequacies in clinical science, poor coordination of care, and overuse of care, particularly in acute care hospitals. The goal is to institute a prospective payment system that would reward hospitals that improve efficiency, while penalizing those that do not.

These are the bold sketches drawn by the authors. They challenge policymakers to join in building patient knowledge and hospital reform, to create a high-quality U.S. health care system.

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