DOC News July 1, 2004
Volume 1 Number 1 p. 18
© 2004 American Diabetes Association
Pay for Performance: An Uneven Playing Field
Financial incentives aim to improve diabetic care
A growing number of payers, particularly managed care plans, are employing
"pay for performance" programs that link financial incentives to
clinical outcomes for patients with diabetes. In some arrangements, for
example, a bonus or withhold may be based on an objective measure such as
hospitalization rate or levels of glycated hemoglobin (A1C).
In theory, everybody wins under pay for performance. Payers raise the bar
on the standard of quality for their beneficiaries, and perhaps even reduce
the cost of medical care for diabetic patients. Clinicians are further driven
to make an effort to provide high-quality evidence-based care. Patients with
diabetes receive better medical care that improves their chances of avoiding
the devastating consequences of the disease.
Sounds good, but how does pay for performance work in real life? Here's
what readers have to say: I get referred real sick patients who have been
diabetic a long time. They have combined illness and are suffering what may be
years of bad care, whether due to their part or the physician's. They're sick
by the time they get to us, and there's a lot of care involved. How am I
supposed to provide care and become responsible for things that occurred up to
that point? My performance is going to look poor because I get referred the
sicker people.
Joseph Giangola, MD
Diabetology
Hackensack, N.J.
It's a mixed bag. I think it's a good idea to practice evidence-based
medicine. But there is a real concern that it may just overburden an already
burdened system, especially when you consider that you may need to upgrade
your data acquisition technology to fine-tune outcome measures. With high
overhead, many practices won't be able to do that, and you can't trust the
insurers to come up with clean data. They're providing the bonuses; there's no
incentive for them. It's a losing situation for most people in a small office.
It should be a winning system for the patient if the system they come up with
is a better way than the current pay for performance model.
Jay Issac, MD
Internal medicine
Gloucester, Mass.
It's an interesting idea, but there are issues that cause concern. Groups
that are already involved in information technology, have electronic records,
and can track some of these variables will be at a competitive advantage
against groups that aren't at that level. There are a lot of issues that need
to be worked out. The idea is intriguing. I think that if you're taking better
care of patients it makes sense to be rewarded for that. But there may be some
disincentive for practices that aren't as far along in terms of looking at
quality outcomes.
Wendell Miers, MD
Endocrinology
Lexington, Ky.
Footnotes
What do you think? Send your comments to
docnews{at}diabetes.org.
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