I agree that it is not really pay for performance, but pay for charting - If I provide the same care as JOE BLOW, but his chart has more templates about warnings, recommmendations, etc. He will get a better rating. It isn't fair, life isn't fair, but we all do the best we can to provide good pt. care.
Leslie's note about WalMart scrips hits home, but most insurers when you really get an audit will accept the fact that I have referred, advised, prescribed and ordered tests/meds/other issues - at least here on the West Coast. It is sad that I actually write letters to patients advising them that there refusal to have an eye exam for a diabetic is an issue - I would love to just tell them and move on, but liability says I have to cross my T's and dot my I's.
Unfortunately primary care is undervalued and if that is going to bother you then you have to change jobs, professions, specialties, etc. because it is unlikely to change. The west coast has a lot of HMO insurances, various PPO's -- it is still possible to make a very good living, but you have to work. I personally work in the hospital, in the ER and in my office.
