Paying physicians for their performance on quality and patient outcomes has become popular as the industry attempts to bend the cost curve and improve patient outcomes. But, just because pay-for-performance is widespread does not mean the concept is wholly agreed upon in healthcare.
In a Wall Street Journal opinion piece, two experts argued for and against paying physicians for performance.
Argument for
Fee-for-service incentivizes physicians for providing services, but for some patients, especially patients with chronic diseases, the point is to avoid providing more services, Francois de Brantes, executive director of the Health Care Incentives Improvement Institute, argued in the piece. "Paying doctors for how well they perform can reduce those bad incentives," he wrote, and can also improve patient health.
Mr. de Brantes cited the Bridges to Excellence Program, run by the Health Care Incentives Improvement Institute, in which physicians are rated by performance against benchmarks, and the top physicians are then rewarded, usually with a financial bonus. Studies show that patients treated by the top physicians have fewer avoidable complications, he wrote.
While he supports pay-for-performance for physicians, Mr. de Brantes did note some potential flaws, such as letting physicians set their own benchmarks — they usually set them too low and are then rewarded for poor care. To fix these problems, he said, physicians should not be allowed to set their own benchmarks.
Argument against
Steffie Woolhandler, MD, a physician and professor at City University of New York School of Public Health, argued against pay-for-performance as a solution to physician reimbursement, citing analysis from the Cochrane Collaborative which found "no evidence that financial incentives can improve patient outcomes."
"Measurement is distorted once you pay doctors based on the data they create," she wrote, and also noted that it is hard to quantify physician performance.
Additionally, Dr. Woolhandler said rewarding physicians' performance financially "ignores the complexity of human drive, particularly the role of intrinsic motivation — the desire to perform an activity for its own inherent rewards."
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