P4P Comments

This is my letter to the editor posted on the Modern Healthcare website:

P4P makes perfect sense, conceptually. Practically it’s not working for a number of reasons.  

Most providers are uneducated and uninformed. 

• Clinicians have neither the time nor inclination to monitor all of the ever-changing quality initiatives mandated by an ever-increasing number of agencies and payers.
• They are not sure of the measures that apply to their specialty or practice this week, month, or year. 
• They are not sure how to report or the implications of reporting (or not reporting).
• They are not sure if a measure applies to them or the hospitals they staff or have admitting privileges 
• In the hospital the nurses caring for patients do not know what reportable measures apply to their department or the patients they care for not to mention how it might impact the delivery patient care.

• The quality data is not actionable, there is very little “if this than this”. It appears to be (is) just another task added to a large number of required documentation elements that distract providers from actually delivering quality patient care.
  

• Many providers look at this as a socially acceptable way to push out payment reform. Who would argue that quality is bad? Certainly not patients or their families. Many providers feel they are on the short end of the stick because thus far the data does not suggest that these measures do anything other than add another layer of administrative hassle and expense.
  

As PQRI has evolved I have watched as providers shyly stay on the sidelines as their coding and billing professionals or compliance teams bear the burden of “quality” data extraction, reporting and follow-up.

Why not use the measures to drive protocols or evidence based medicine? I have pushed evidence-based protocols that could be implemented by actually using the quality data to impact patient care and outcomes.

Finally if a measure does not drive decreasing utilization variability (ergo cost variability) or demonstrably improve patient outcomes, what is the point? It is just another layer of complexity and expense. Lets not kid ourselves at some point the expense associated with delivering this “quality” is passed on to the patients. Increasing expense without evidence of better outcomes or decreased utilization variability or decreased cost just doesn’t feel like “Quality” to me.