Saturday, May 3, 2014


P4P is a term that has been around for several years and is being adopted throughout the health care industry for providers and hospitals.  Accountable Care Organizations are meant to provide the tools for improving outcomes, and reducing cost of health care.

CMS has already discovered that performance and cost vary greatly across the United States.  The range of cost for hospitalizations varies from McAllen, Tx to Omaha Nebraska, two extremes in the analysis.

A newly recognized phenomenon will take place as the newly insured enter the risk pools and effect costs and outcomes.  Cost will be driven upward, and statistical figures for outcomes will decrease, because of more severe illness, and lack of compliance by new patients.  Health illiteracy amongst the newly insured and will be a category with whomt providers, hospitals and insurers will be challenged. This will drive care costs upward unless dealt with during their initial contacts with providers.  Fortunately technology has advances so that webinars, tutorials, and even video conferenceing will aid in this process at little cost. Bilingual souces are critical since many patient will be ESL of Spanish speaking only..

  • Those entering the market will be sicker and have more chronic disease. They are less informed about prevention and health diets.
  • Their outcomes, length of hospitalizations, and readmission rates will also reflect the lack of compliance, lack of understanding of health care process, and lack of socioeconomic power to chose wisely.
  • Many ACA provisions look to boost care by linking Medicare payments to the performance of doctors, hospitals and health plans.  Doctors and hospitals that treat “poorer people” are more likely to face financial penalties, which will diminish resources providers need to administer and improve care.

Healthcare experts say the payment system must evolve and adapt to the changing market so that payments and volume based reimbursement can change to value-based benefits.

In a recent study, sixty-five percent of 170 C-level payer executives said they will launch pay for performance programs over the next three years (this according to Fierce Health Players in a Health Edge Survey released last fall (2013)

The only item left out is patient accountability.  Patient performance can be measured in many ways, incentives and penalties can also be implemented on the demand side of analysis and outcomes.  If a patient is non-compliant, does not keep appointments and fails to follow discharge instructions, providers and hospitals must not be penalized for patient failure.

Poor outcomes may not be due to  physician non compliance, and they should not be punished because a patient fails to get well, or not comply.  Providers and hospitals cannot be expected to bear the entire burden of patient disease…..some diseases mayn be ameliorated, but not cured.  

Outcome and treatment paradigms evole with time and the P4P analysis must be fine tuned for these inevitable changes.
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