Once again, our “esteemed”  bureaucrats in Washington, this time at CMS and Medicare, have come up with a great idea, while sitting behind a desk – not the place to find out what changes in care for patients need to be made.  This is a GREAT example of the potential massive failures that would be exhibited in a fully government run health system.  Making rules about disease in general, when disease effects human beings specifically, is both dangerous and foolish.  Doctors MUST be allowed to practice medicine.  Oversight is fine.  Review is great.  Hold folks accountable.  Make sure everyone is learning and keeping up to date.  But paying physicians to meet an artificial bar is NOT where we should be focusing our attention.  This encourages attempts at gaming the system when the focus should be on providing the best care possible to all patients . . . jomaxx

The Pitfalls of Linking Doctors’ Pay to Performance

Sandeep Jauhar, M.D., writes in a NY Times piece that these days, patients often receive “antibiotics without solid evidence of an infection. And, part of the blame lies with a program meant to improve patient care.” This “program is called pay for performance, P4P for short,” and “employers and insurers, including Medicare, have started about 100 such initiatives across the country.” It is intended “to reward doctors for providing better care.” For instance, physicians “receive bonuses if they prescribe ACE inhibitor drugs to patients with congestive heart failure.” Dr. Jauhar argues that this may seem like a sound idea, but “in a survey [conducted] in New York State, 63 percent of cardiac surgeons acknowledged that because of report cards, they were accepting only relatively healthy patients for heart bypass surgery.” In addition, while Medicare requires that “antibiotics be administered to a pneumonia patient within six hours of arriving at the hospital,” physicians “often cannot diagnose pneumonia that quickly.” Dr. Jauhar concludes that the program’s “deep flaws must be addressed before patient care is compromised in unexpected ways.”

Link to the full article by Dr. Jauhar in the NY Times @ . . . http://www.nytimes.com/2008/09/09/health/09essa.html?_r=1&scp=1&sq=%2bmedicare&st=nyt&oref=slogin