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Reader Remarks on:

Pay for Performance in England: Some Surprising Results

• Surprise Impacts of P4P
• performance measures
• P4P study in the UK
• P4P in England
• P4P - Punishment 4 Providers - & the Sick!
• p4p
• P4P Study
• SURPRISE IMPACTS OF P4P
• Pay for Performance

Surprise Impacts of P4P

JM Jenkins, 24 Jul 2009 9:14 AM EST

Competing interests: None declared

It would be interesting to know when the shift to a P4P system was announced to the doctors, in order to correlate with the pre P4P ramp up of quality measures. Not surprising, but troubling, that the non rewarded measures fell after P4P was instituted and very surprising that no improvement of subjective perceptions and decrease in continuity of care.

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performance measures

Sheldon S Ball, Veterans Administration, 24 Jul 2009 11:44 AM EST

Competing interests: None declared

One problem with pay for performance is the performance measures themselves. Do they really measure 'performance' or 'quality of care'. A case in point is glycemic control in type 2 diabetes or tight blood pressure control in the very old. Do the performance measures improve outcomes, or better yet, mortality? Too little effort may be put into the 'continuous quality improvement' model of evaluating perfomance measures.

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P4P study in the UK

D E Lighter, 24 Jul 2009 11:55 AM EST

Competing interests: None declared

Translating the results of this study to the U.S. is pretty difficult, and a number of issues are extant. First, the method of payment in the UK is different than in the U.S. Secondly, what other incentives were in existence prior to P4P - did they harvest the "low hanging fruit", making significant improvements after P4P started more difficult? Third, how were the incentives perceived by the practitioners? Too little, not worth the investment to implement quality improvement efforts? Many questions remain.

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P4P in England

John J. Messmer, M.D., Penn State Hershey, 24 Jul 2009 1:19 PM EST

Competing interests: None declared

It seems to me that the indicators very likely improved before P4P in England because the GP's were aware of published criteria and instituted them without being paid for the improvement. They are not GP's because they are stupid. As in the US, most primary care docs really want to deliver the best care. They just needed evidence and guidelines. In the US, we need the extra pay so we can take the care to the next level and improve outcomes even more.

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P4P - Punishment 4 Providers - & the Sick!

Hans Dersch, 24 Jul 2009 4:17 PM EST

Competing interests: None declared

(P4P) payments depend on meeting Quality Standards.

According to this study, P4P decreases Quality of Care.

Meaning worse care for the sick, AND lower pay for doctors.

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p4p

a.a. genut, GBMC, 24 Jul 2009 6:27 PM EST

Competing interests: None declared

p4p takes time from patient care and transfers it to record keeping which we all know can be slanted. p4p will most often result in lower quality of care. most of us try our best to perform just as well for non paying charity patients as for full paying patients. any introduction of a specific profit motive into medical care is wrongheaded and may be a perverse incentive

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P4P Study

Martin W. Denker, VA Outpatient Clinic, 27 Jul 2009 8:53 AM EST

Competing interests: None declared

1. The report assumes that we agree on the measures of quality of care -- they were not explained. 2. The report suggests that incentives were responsible for changing the scores. The incentives were not explained. Were they, in fact, fear of punishment? Would that process actually improve health care? 3. The costs of decline in continuity of care were not addressed. I suspect they are HUGE. 4. I would recommend the continuity issue get the primary focus, not some derived scores which may be of questionable clinical importance.

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SURPRISE IMPACTS OF P4P

Robert R. Brooks, The VIP Group, 17 Aug 2009 9:28 PM EST

Competing interests: None declared

P4P inherently involves setting performance standards. As a management consultant, I can tell you that both research and experience show that setting standards, whether meeting them is rewarded or not; leads to two unintended consequences. First, it causes people to focus disproportionatel on those activities for which their performance will be compared to the standards. Second, it encourages minimally acceptable performance relative to those standards. To effectively manage the American health care "process", we will need to be very careful in the selection of performance metrics.

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Pay for Performance

Carol B Wilhelm, 5 Jul 2010 2:31 AM EST

Competing interests: None declared

Because pro and con advocates are equally represented in the P4P debate, P4P statements must be supported by ongoing data as we remain open to individual observations that can contribute to the discussion and help design new studies.

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