I had a following the progression of this topic since its inception. because I'm somewhat biased, having worked in developing a P4P program, I wanted to make sure that I have a balanced evaluation before I wrote anything.
Paul's comments are mostly accurate. Insurance companies motivation for P4P probably varies from truly accentuating quality to trying to minimize payment.
Unfortunately, P4P HAS come about partially because of poor charting, there is also an element of poor doctoring. Then there is the issue of greed, both on the insurance side as well as a physician side.
Sure, there are things that P4P requests that are not appropriate, but many of the items have a sound basis in medical management, and are appropriate things to do.
The question becomes, 1) how to do the right thing and 2) how to make it easy to track the right thing.
Some things, such as diabetic management, are significantly aided by using graphs, spreadsheets, and flow sheets. A good P4P program should reward this.
Then there is the issue of the insurance companies, and ultimately the money. On the one hand, the insurance companies are looking for the most appropriate (cheapest) method of care, as well as looking for an out to wait having to pay for services.
This is compounded by having multiple insurance companies looking in multiple ways for multiple things, with all the multiples that multiplies.
P4P is not inherently evil, but it can be used in ways. It should reward physicians who adequately document. It should help a physician practice more efficient medicine. Currently the entire P4P processes in its infancy, and therefore there are good and bad examples of how it is being used.
I have been involved in a PHO where we developed our own P4P program. With our program we have selected physician and put on the front end, developed a methodology for scoring and information gathering, checked for medical validity for the items being evaluated, and have the staff's doing online information input. The physicians were involved on every aspect of the process. We currently have over 98 items that we measure affecting a variety of specialties. The process is very much, heavily weighted towards the PCP's, but over the last year and a half, we have attempted to increase the requirements for the specialists. It is a burdensome process, both from the development of the process, the implementation and maintenance of the process, as well as the and put out information and analysis of scoring, ultimately leading to points towards payment.
Having gone through this process, I have noted that even with the best intentions, there are staff, who are anti-physician, or do not give physicians the benefit of the doubt. This entry at our own bureaucracy, which is every bit as burdensome as working with an insurance company at times, however we are more flexible. if that can happen in an organization as heavily position weighted as ours, it would be frightening to consider how it operates an insurance company where there is minimal physician input. Having over 400 adversaries in different insurance companies, makes the likelihood that most systems would be physician friendly highly unlikely, unless the process is created by physicians.
Without a doubt, having an easier way to input information would make the process much simpler. This is an area where an electronic medical record can help.
One goal of electronic medical record is to make the process more streamlined. If they can transfer information more efficiently, that would be good.
As to the whole process of CCHIT with its mandated information up link, this is far too Orwellian and lacks the ability for us to control the flow of information. The physician should have the ability to control any release of information, although by the same token, the information should be recorded and available. Better charting should be rewarded more handsomely. ultimately the ability to provide the information back to the position to make an intelligent choice should also be readily available. Again, that is the goal of an electronic medical record, and is one area where Amazing Charts seems to outstrip its competitors.
It goes without saying that primary care should be rewarded much more as it has the ability to control finances more than specialist care
