A major hurdle to insurers implementing payment reform models like pay-for-performance is getting providers to change their behaviors and how they've practiced medicine their whole careers.
As insurers search for ways to lower healthcare costs, pay for performance is often one of their goals. That's because paying doctors to achieve certain quality goals decreases wasteful spending, thereby lowering costs, reported the New York Times.
Despite the seemingly simple approach to revising payments, studies have shown pay for performance has had some disappointing results.
That's partly due to the challenge of reaching a universal definition of quality, particularly when it comes to measuring quality of life and improvements in functioning. An Obama administration report found that measurers for quality of care, for example, may be skewed because they fail to recognize the difficulties in treating patients who have lower levels of income or education, FierceHealthPayer previously reported.
Another study published in The New England Journal of Medicine found that hospitals participating in a pay-for-performance program didn't improve conditions explicitly linked to incentives, including heart attacks and coronary artery bypass grafts, the Times noted.
The NEJM also published a separate study showing that withholding payment for bad outcomes didn't lead to quality improvements. The researchers determined that refusing to pay for certain hospital-acquired conditions had no measurable effect on reducing those conditions.
Based on these studies, insurers must incorporate real drivers for doctors to change their behavior if they want pay-for-performance programs to succeed.
To learn more:
- read the New York Times article