Letter: Questioning CMS's P4P results

I had to laugh when I read that the CMS study on P4P produced "positive results." I would have bet the mortgage on "positive results," because I've seen this year after year, at both state and federal levels. When the government wants to do something, they produce studies that show it will work. It's remarkable how what they want to do never fails those initial tests. It's all oh so tiring..

My favorite example is when Tommy Thompson was governor in Wisconsin and his administration set up pilot programs for a Medicaid "reform" called Family Care. The language they used in creating the pilots was unusually honest: They said the pilots were being created to show that Family Care would work. I noted that they did NOT say that the pilots were being created to test whether Family Care would work.

By the way, the great business writer and consultant, Peter Block, says point-blank that there are no studies that show P4P works for anything other than the most mindless tasks. He notes that business headlines over the past few years show that P4P's main contribution is to encourage corruption. For those interested in knowing more about the basic weakness of P4P, I recommend Alfie Kohn's book Punished by Rewards: The Trouble with Gold Stars, Incentive Plans, A's, Praise and Other Bribes.

-- Russell King
Wisconsin Homecare Organization

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