Tuesday, October 15, 2024
Hawai'i Free Press

Current Articles | Archives

Thursday, April 28, 2011
Pay-for-Performance in Medicare Could Do More Harm Than Good
By Heritage Foundation @ 11:40 AM :: 5877 Views :: Health Care

www.Heritage.org

Liberals’ solution to rising health care costs has consistently been to take control of health care decisions away from patients and their doctors and to place it in the hands of government. Obamacare does this by allowing unelected bureaucrats to define and reward value in the Medicare program, and the President’s proposal for deficit reduction would further empower government to interfere in the practice of medicine.

This is the wrong way to reduce costs, and will have severe consequences for patients, physicians, and the quality of health care in the United States.

In 2012, Obamacare will create the “Value-Based Purchasing Program” in Medicare. Using a pay-for-performance scheme, the program will reimburse hospitals and other health care providers at different rates based on how they score on performance measures chosen by the Secretary of Health and Human Services. Proponents of pay-for-performance see it as a way to use financial incentives to streamline and improve the quality of health care while attempting to reduce costs. But the fact is that standardization of the practice of medicine costs patients and physicians tremendously, and evidence shows it does very little to improve health outcomes.

Years of research, including early warnings from The Heritage Foundation, indicate that Obamacare’s Value-Based Purchasing Program and schemes like it will be unsuccessful and result in more harm than good. Studies have since provided evidence to support expectations that pay-for-performance would hurt the doctor-patient relationship, threaten physician autonomy, and deteriorate the quality of patient care in several other ways.

In 2005, Richard Dolinar, M.D., and S. Luke Leininger wrote for Heritage that pay-for-performance would:

  • Dump patients into a system of top-down, “cookbook” medicine that is incompatible with high professional standards of patient care;
  • Spawn an increasing number of Medicare rules, regulations, and guidelines, further undercut­ting the physician’s professional autonomy and integrity, as well as patient choice and access to care;
  • Undermine the more desirable goal of high quality, which requires personalized care;
  • Retard medical innovation and introduce unproductive gaming by doctors to secure higher Medicare reimbursement; and
  • Further weaken the traditional doctor-patient relationship.

Researchers for the University of Manchester’s National Primary Care Research and Development Centre in the United Kingdom examined the effects of pay-for-performance programs in the United Kingdom and California for primary care physicians. They concluded that the programs had unintended effects on care and physician motivation, including “encouraging physicians to avoid sicker patients, exacerbating disparities, and neglecting types of care for which quality is not measured.”

Financial incentives to meet certain performance targets led to the deterioration of the doctor-patient relationship, as physicians “expressed resentment about patients who refused to comply with their advice.” According to the authors, “interviews contained reports of seriously dysfunctional or coercive behavior” by doctors in cases where patients were noncompliant. In extreme cases, doctors threatened to disenroll their patients, accused patients of hurting their rating, or lied about the consequences for failure to comply. Physicians even reported disregarding informed consent procedures to meet screening targets for certain diseases.

Finally, the study found that pay-for-performance was perceived by physicians as a challenge to their professional autonomy, and that the care they provided was imposed upon and managed externally. The authors write, “The system was viewed by many as unfair and opaque because it failed to take account of variations in practice populations, comprised indicators that were not amenable to control by physicians, withheld money that was due to physicians, and added to workload.”

Rising health care costs are a serious concern that must be addressed, and lawmakers are correct to look for solutions that solve the problem without damaging the quality of health care in the United States. However, creating a pay-for-performance program within Medicare will do the opposite, as will any other changes to the program that give bureaucrats—not patients and doctors—more control.

---30---

Links

TEXT "follow HawaiiFreePress" to 40404

Register to Vote

2aHawaii

Aloha Pregnancy Care Center

AntiPlanner

Antonio Gramsci Reading List

A Place for Women in Waipio

Ballotpedia Hawaii

Broken Trust

Build More Hawaiian Homes Working Group

Christian Homeschoolers of Hawaii

Cliff Slater's Second Opinion

DVids Hawaii

FIRE

Fix Oahu!

Frontline: The Fixers

Genetic Literacy Project

Grassroot Institute

Habele.org

Hawaii Aquarium Fish Report

Hawaii Aviation Preservation Society

Hawaii Catholic TV

Hawaii Christian Coalition

Hawaii Cigar Association

Hawaii ConCon Info

Hawaii Debt Clock

Hawaii Defense Foundation

Hawaii Family Forum

Hawaii Farmers and Ranchers United

Hawaii Farmer's Daughter

Hawaii Federation of Republican Women

Hawaii History Blog

Hawaii Jihadi Trial

Hawaii Legal News

Hawaii Legal Short-Term Rental Alliance

Hawaii Matters

Hawaii Military History

Hawaii's Partnership for Appropriate & Compassionate Care

Hawaii Public Charter School Network

Hawaii Rifle Association

Hawaii Shippers Council

Hawaii Together

HiFiCo

Hiram Fong Papers

Homeschool Legal Defense Hawaii

Honolulu Navy League

Honolulu Traffic

House Minority Blog

Imua TMT

Inouye-Kwock, NYT 1992

Inside the Nature Conservancy

Inverse Condemnation

July 4 in Hawaii

Land and Power in Hawaii

Lessons in Firearm Education

Lingle Years

Managed Care Matters -- Hawaii

MentalIllnessPolicy.org

Missile Defense Advocacy

MIS Veterans Hawaii

NAMI Hawaii

Natatorium.org

National Parents Org Hawaii

NFIB Hawaii News

NRA-ILA Hawaii

Obookiah

OHA Lies

Opt Out Today

Patients Rights Council Hawaii

Practical Policy Institute of Hawaii

Pritchett Cartoons

Pro-GMO Hawaii

RailRipoff.com

Rental by Owner Awareness Assn

Research Institute for Hawaii USA

Rick Hamada Show

RJ Rummel

School Choice in Hawaii

SenatorFong.com

Talking Tax

Tax Foundation of Hawaii

The Real Hanabusa

Time Out Honolulu

Trustee Akina KWO Columns

Waagey.org

West Maui Taxpayers Association

What Natalie Thinks

Whole Life Hawaii