What is performance?

Nupe - you bring up a good point about reforming health care reimbursement. Some random thoughts -

Leapfrog has put together a list of pay for performance programs in their Incentives and Rewards Compendium.

If you look at the list, you find that there is a dizzying array of programs. As of 2007, there were 148 different P4P programs, growing historically at a CAGR of 21% and projected to grow to 160 programs by 2009.

These programs come from all sources: federal government, employers, medicaid-only plans, commercial health plans.

And the programs utilize a number of different metrics to measure "performance"

-Experience based metrics such as volume targets for PCI and CABGs
-Outcome metrics suck as mortality, complications and readmission rates
-Binary process or structural metrics such as the presence of an electronic medical record, or submission or Rx through e-prescribing
-Classic process metrics such as percent of acute myocardial infarction patients receiving aspirin on arrival
-Process metrics with time sensitivity such as PCI within 90 minutes of acute myocardial infarction

Physicians invariably interacting with numerous payers, and payers are all defining "performance"through a wide variety of metrics .

It's only becoming more difficult as a provider when you are faced with numerous, often conflicting metrics from a number of payers.

Side note: interestingly enough, most of the metrics are around payer cost centers - i.e. pneumonia, cardiovascular disease, diabetes - but other large cost centers such as depression and GERD don't have many metrics. Harder to measure quality using most of the five broad categories from above, and unclear if you can drive down cost and increase quality by implementing metrics on these 'lifestyle' conditions.

More on this to come...