The Pay-for-Performance Problem

Aaron Carroll, a pediatrics professor at the Indiana University School of Medicine, writing for the New York Times’ health blog, TheUpshot, has a problem with pay-for-performance, noting that it is meeting with mixed results and some fear that it could even backfire.

Taking a look at a litany of recent studies on pay-for-performance, Carroll writes:

“One of the reasons that paying for quality is hard is that we don’t even really know how to define “quality.” What is it, really? Far too often we approach quality like a drunkard’s search, looking where it’s easy rather than where it’s necessary. But it’s very hard to measure the things we really care about, like quality of life and improvements in functioning.”

Figuring out how to quantify quality is not an easy task, but a new article in Becker’s Hospital Review echoes what our own Doctors Council members stated in our recent white paper, namely:

“A monetary incentive to doctors who are not given the power to make institutional changes, provide resources and lead the health care delivery team is set up for failure.”

Maureen Ladouceur, writing for Hospital Review, states:

“Acknowledging the basis of engagement science is vital for health systems seeking clinical alignment and performance optimization with their physician partners. The reason is rooted in how physicians think and what drives behavior. A 2011 McKinsey & Company physician survey identified four key barriers to strong physician engagement and performance improvement. A key finding in this survey was that health systems incorrectly assume that compensation alone will change behavior. It doesn’t. What ultimately changes physician behavior is an understanding of the basis for the change. Physicians need that information to be communicated using a highly consumable and evidenced-based approach as well as being afforded an opportunity to interact on the subject matter.”