Editor's Corner

Pay-for-performance schemes are making the news these days, notably spearheaded by Wellpoint subsidiary Blue Cross of California, which just announced that it was paying out $65 million in bonuses to providers who had demonstrated good outcomes. Wellpoint is also working with the Society of Thoracic Surgeons to develop a program under which doctors that have good cardiac care outcomes are rewarded.

Focusing on outcomes is all well and good--after all, patients care how they feel, not whether a provider met the prevailing standard of care!--but it's still in question whether such programs create counter-productive incentives to avoid super-sick patients whose outcomes are likely to be worse overall. Even adjusting outcomes rating for acuity, the psychological pressure to avoid the harder cases is there. Not that doctors, hospitals, nurses and other clinicians aren't under personal pressures to make outcomes good, but cash rewards can't help but cause more risk avoidance. And I'm not so sure that's a good thing.

All told, it will be very interesting to see how Wellpoint and other managed care firms do with P4P programs, and whether they find themselves with very sick patients "on the fringes" that providers would rather not touch. I'm eager to see what the data suggests. If you want to share your experiences in this area, meanwhile, I'd love to hear from you and learn more on this issue. Please feel free to drop me a line anytime. - Anne

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