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Robert Galvin Pay-For-Performance: Too Much Of A Good Thing? A Conversation With Martin Roland Health Affairs, September/October 2006; 25(5): w412-w419. [Abstract] [Full Text] [PDF] [Reprints & Permissions]

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Pay-for-Performance: Too Much of a Good Thing - or Too Worried about the Wrong Things?

Peter Basch   ( 10 September 2006 )

Pay-for-Performance: Too Much of a Good Thing - or Too Worried about the Wrong Things? 10 September 2006
Peter Basch, Medical Director, eHealth MedStar Health Send comment to journal: Re: Pay-for-Performance: Too Much of a Good Thing - or Too Worried about the Wrong Things? peter.basch{at}medstar.net Peter Basch	Policymakers should be concerned about the unintended consequences of pay-for-performance. However, neither the remarkable first-year success demonstrated by the UK’s general practitioners, nor the money spent on achieving that success, should be considered as a negative. In the US, it is well understood that the economics of primary care pay-for-performance are to add cost up-front for ambulatory services and to expect savings in future years –- from reducing the cost of expensive and preventable sequelae of chronic diseases, unnecessary procedures, ER visits, and hospitalizations. Another concern in the US has been that physicians (at least physicians in solo or small practice) are only suited for caring for patients in the reactive medical model and that proactive care, chronic care, and care coordination could only be successfully provided by large groups and/or disease management companies. The first-year experience in the UK, however, proves otherwise. Modify reimbursement to support the infrastructure and ongoing maintenance of a proactive and reactive care model focused on quality, and physicians in all size practices can (and will) successfully participate. Lastly, both Galvin and Roland appear to miss what may be the most relevant finding for US policymakers: that sufficient pay-for-performance can help reverse the rapidly declining interest in primary care medicine, which without such support may soon collapse. Reframing pay-for-performance as a vehicle to “right-fund” primary care may help revitalize internal medicine and family practice, as well as refocus the care delivered from the metric of volume to that of quality.