Talk:Pay for performance (healthcare)

Good information here.....I corrected a few very minor typos, but this is Wiki at its finest!!

Buddpaul 19:50, 4 January 2007 (UTC)

Human resources
Pay for performance is also a concept in human resources. It is the idea that if compensation is tied to productivity, productivity should increase. (Examples are the CEO that gets stock options, or a car salesman earning commission.) We need a disambiguation page and a AFC for pay for performance - human resources.)
 * Good idea. I found a recent reference here. If an article is put together for Pay for performance (human resources), we can move this page to Pay for performance (healthcare), and use this page for the disambiguation page. Ryanjo 03:37, 19 March 2007 (UTC)

Merge proposal, March 2009
Patient safety has more information than this entire article and includes information that has been copied wholesale from here (or the other way round). Most of the text needs to come to this article and the section at Patient safety be summarised. Millstream3 (talk) 14:52, 1 March 2009 (UTC)
 * Go ahead Ryanjo (talk) 02:33, 3 March 2009 (UTC)
 * Concur make the merge. JeepdaySock (AKA, Jeepday) 18:56, 29 September 2010 (UTC)


 * I deleted the merge tag, it's been three years, and I frankly don't know if the merge has been done. This is why sections shouldn't be proposed for merging. I instead tagged the section as off-topic. D O N D E groovily   Talk to me  02:56, 4 April 2012 (UTC)

Current research on P4P
Most of the citations in this entry are old (up to 2007), and they're discussing proposals for p4p demonstration projects, and optimistic speculations about what p4p would be like. Since that time, a lot of controlled studies have been published, and they mostly say p4p doesn't work. Here's a good review of the latest research in a NYT blog, which summarizes a lot of the studies I've been reading. The blog had a lot of links to the journal articles.

http://www.nytimes.com/2014/07/29/upshot/the-problem-with-pay-for-performance-in-medicine.html

The New Health Care: The Problem With 'Pay for Performance' in Medicine

Aaron E. Carroll

JULY 28, 2014

(Pay for performance has brought) disappointingly mixed results. Sometimes it’s because providers don’t change the way they practice medicine; sometimes it’s because even when they do, outcomes don’t really improve. (Studies reviewed.)

For instance, a study published last fall Effect of Pay-for-Performance Incentives on Quality of Care in Small Practices With Electronic Health Records: A Randomized Trial found that paying doctors $200 more per patient for hitting certain performance criteria resulted in improvements in care. It found that the rate of recommendations for aspirin or for prescriptions for medications to prevent clotting for people who needed it increased 6 percent in clinics without pay for performance but 12 percent in clinics with it. Good blood pressure control increased 4.3 percent in clinics without pay for performance but 9.7 percent in clinics with it. But even in the pay-for-performance clinics, 35 percent of patients still didn’t have the appropriate anti-clotting advice or prescriptions, and 38 percent of patients didn’t have proper hypertensive care. And that’s success!

A study published in Health Affairs examined the effects of a government partnership with Premier Inc., a national hospital system, and found that while the improvements seen in 260 hospitals in a pay-for-performance project outpaced those of 780 not in the project, five years later all those differences were gone.

The studies showing failure are also compelling. A study in The New England Journal of Medicine looked at 30-day mortality in the hospitals in the Premier pay-for-performance program compared with 3,363 hospitals that weren’t part of a pay-per-performance intervention. (No difference, even among conditions linked to incentives.)

In Britain, a program was begun over a decade ago that would pay general practitioners up to 25 percent of their income in bonuses if they met certain benchmarks in the management of chronic diseases. (No difference.)

Even refusing to pay for bad outcomes doesn’t appear to work as well as you might think. A 2012 study published in The New England Journal of Medicine looked at how the 2008 Medicare policy to refuse to pay for certain hospital-acquired conditions affected the rates of such infections. (No difference.)

There have even been two systematic reviews in this area. (One found that it could change physicians' behavior, but no evidence on outcome. The second found no evidence on behavior.)

(We don't even know how to define quality. We use the drunkard's search.)

--Nbauman (talk) 03:35, 22 August 2014 (UTC)

Definition not in Lede
The lede doesn't define "Pay for performance," but rather immediately jumps into a discussion of its benefits. There needs to be a solid explanation of what the term means in the first paragraph. -Thucydides411 (talk) 05:29, 9 April 2016 (UTC)

Systematic review
Annals 10.7326/M16-1881 JFW &#124; T@lk  10:35, 10 January 2017 (UTC)