UK Study: P4P isn't improving patient care
Pay-for-performance programs, which reward doctors for quality care and patient outcomes, may not be improving patient care, according to a new study.
Published January 26 in the British Medical Journal, the study, which focused on hypertention, indicated P4P measures didn't offer any benefit to patients, despite the enormous administrative costs required to maintain such a system.
"No matter how we looked at the numbers, the evidence was unmistakable; By no measure did pay-for-performance benefit patients with hypertension," said lead author Brian Serumaga, formerly of Harvard Medical School and the Harvard Pilgrim Health Care Institute and now at the University of Nottingham Medical School in the UK.
Working with researchers at Harvard, Nottingham and the University of Alberta in Canada, Serumaga and his colleagues focused on how P4P might affect outcomes in patients with hypertension, a condition where other interventions such as patient education have shown to be effective.
The United Kingdom implemented a P4P program called "Quality and Outcomes Framework" in 2004. Analyzing data from the UK's Health Improvement Network, a large database of primary care records from 358 UK general practices, the international research team identified 470,725 patients diagnosed with hypertension between January 2000 and August 2007, spanning four years prior and three years after P4P was implemented.
The researchers looked at various measures including blood pressure measurements over time, rates of blood pressure monitoring and hypertension outcomes as well as illnesses.
Analysis showed that even after allowing for a number of variations, there was no identifiable impact on the cumulative incidence of stroke, heart attacks, renal failure, heart failure or mortality in both patients who had started treatment before 2001 and patients whose treatment had started close to the implementation of P4P.
"Governments and private insurers throughout the world are likely wasting many billions (of dollars) on policies that assume that all you have to do is pay doctors to improve quality of medical care," said senior author Stephen Soumerai, professor in the Department of Population Medicine at Harvard Medical School and Harvard Pilgrim Health Care Institute. "Based on our study of almost 500,000 patients over seven years, that assumption is questionable at best."
According to Anthony Avery of the University of Nottingham Medical School, "Doctor performance is based on many factors besides money that were not addressed in this program: Patient behavior, continuing MD training, shared responsibility and teamwork with pharmacists, nurses and other health professionals. These are factors that reach far beyond simple monetary incentives."
"Policymakers sometimes legislate large and expensive policies based on their beliefs without the requisite hard evidence," said Soumerai. "Policy makers in the U.S. and in Canada who are attempting to enact such programs need to think hard about other more effective approaches."
[See also Industry expert says P4P movement needs leadership; My forecast: a sad conclusion to the health care bubble...]
