I would like to suggest that every provider in the country step up and take a stand against P4P. First off it implies that you don't already try to do everything you can to take the best care that you can for your patients laready. That in itself is very Rude.
2nd, does anybody really think that Aetna (the P4P carrier in our area) or anybody else really cares about the outcomes of our patients? Think about it, if all our non-compliant patients suddenly came in regularly for managment of their complicated issues and therefore had all their labs done, and their Rx's filled, and saw us more regularly, at least for the first year or two all of these carriers would see a significant increase in their costs. The savings that would be realized from such perfect care, would probably not come into play for at least 6 months to a few years. Plus they would then have to start paying all of these top performing providers better for their top notch services. I am not so nieve as to think that this is what these, quarterly bean counters care about. This is just another form of legalized insurance fraud against the providers of this country. Do you really think that these folks who swap patients back and forth every year really care about long term outcomes, no less creating a way to pay any of us better?
Also, we do not live in Orwellian times, at least not yet; althought the present administration has done its very best at trying to accomplish such. Yeah, habius corpus! We can lead horses to water, advise them, poke and prod them, but in the end, we have little or no control over our patients final behaviors once they leave this office. Will they get their bloodwork done, will they fill their Rx's, will they modify their diets and get more rest and exercise? No less the financial pressures put on them by the carriers themselves and their employers who buy the insurance policies. Co-pays, consumer driven healthcare (now there's a real joke), deductables, co-insurances, work hours, over-time and all the rest. We're supposed to fight all this? I have a P4P patient today that the doctor and I must confront because she is demanding free over the fax and phone healthcare and managment for her out of control DM, because she claims she has trouble paying for her simple $5 copay on her Aetna Medicare plan!!! Their & her copay, not ours, their design and choice not ours...And yesterday two of our P4P patients, husband and wife, booked back to back on a busy day, simply stood us up, no call no nothing, this is our fault. And those were the valuable, end of the day slots that lots of people want, now we had nobody in there. We don't doublebook except for sick kids and medical emergencies, where it can't be helped.
But back to 1984, do we have final control over these patients as they go food shopping, eat out, buy their meds? Do we have big brother cameras in their kitchens, bathrooms, bedrooms and cars? Do we, should we have that type of total control over another human being and their lifestyle choices? To eat well or hit the drive thru; to exersice or buy a pack of cigarettes? You better all pray we never see the day, let me tell you...
But the real stupidity of P4P is that we are shocking the wrong rat here; Good old basic conditioning. We are going to shock a rat (providers, with increase or decrease in fees), whose behavior doesn't need much if any modification, we already want to do the best we can by our patients, right??? But worst yet, in complete isolation from and unknown to the rat (the patient) whose behavior that we are really trying to influence and modify! That is just insane. If such a program were ever going to have a chance of succeeding then it is the patient and the employer who needs to be rewarded or shocked. It's really their behavior that needs the serious modification here. Better work hours and conditions, good food at the company lunchroom, exercise and lifestyle modification programs. And then there is still the issue of getting the horse to drink the water. Even in good companies that try to accomplish such good things, there is still a stubborn percentage of folks who just don't get on-board. Oh but there is that George Orwell thing again. That sticky little thing called democracy and free will. We will always have that hard to quantify, qualify and control for variable called the free thinking human animal in the middle of all of this, and that is the way it always should stay.
Sorry for going on so, but this "little" issue is coming to a head in our office yesterday and today. Really, P4P is the stupidest thing to come along since, what???? HMO's??? Sustainable Growth Formulas??? Be well all.
Paul
