If the patient doesn't want to take his medicine, it's now the doctor's fault and his reimbursements will be decreased. So doctors will stop seeing uncooperative patients to keep their numbers up? What are your thoughts?
Some will for sure, depending on the bonuses or sanctions imposed by CMS. This type of "gaming the system" is characteristic of top-down bureaucratically controlled systems (see
Pay for Performance: Is Medicare a good candidate? , by Michael Cannon in the Yale Journal of Health Policy, Law & Ethics, page 12). Doctors who are monitored by such limited criteria as medication compliance have a powerful incentive to
deselect (dismiss or refuse to accept) patients whose outcome measures fall below the quality standard and therefore worsen the doctor's "rating". You can see that people are thinking of this already in the
link that Sandeep provided.
There is already a large scale example of how poorly these physician rating systems work. In the United Kingdom, the NHS began a pay for performance initiative in 2004, known as the Quality and Outcomes Framework (QOF). General practitioners received bonuses for meeting 146 quality indicators for 10 chronic diseases and patient experience. The program was a financial shock for NHS. The 8,000 family practitioners included in the study earned an average of ?28,000 more by collecting nearly 97% of the points available. The new GP contract as a whole cost ?1.76 billion more than the Government had expected. Moreover, the QOF has been
criticized for not meeting quality goals: "concerned that the QOF has diverted attention to what it targets and set GPs up in a 'game' to get points that can damage professional integrity and the GP/patient relationship."
A
review done 2 years after the QOF was implemented concluded that the initiative had failed to meet 2 of its 3 overall goals and commented: "Radical change to payment systems will always risk perverse and unintended consequences, but at least some of these can and should be avoided ... by more rigorous testing before implementation."
But here in America the only testing so far for the ACA has been in the courts. Sorry about this rant, but I am passionate about my practice being experimented on by politicians and the medical elite that advises them in Washington.
