Physicians shouldn't have to report their own pay-for-performance data

LETTER — Posted April 10, 2006

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Regarding "Don't penalize doctors for patient behavior that can't be controlled" (Letters, Feb. 20): The problem with tracking only those pay-for-performance measures that are fully in the control of physicians is that such measures can be captured only at the doctor's office. This means that physicians would be responsible for reporting our own performance. This would cost already strained physician practices money and time.

Better to report through the insurance companies' billings. These are already computerized data points that are easily captured and at the expense of the insurance companies.

To use the insurance companies' billings, however, you have to be satisfied with endpoints that are partially under the control of patients. This is because when a physician orders a test, it isn't billed until the patient actually gets the test done. But when you compare physicians with regard to such endpoints, since no physician will approach 100%, the results still will be comparable.

Conceivably, two physicians who order the appropriate tests on all of their patients could have different pay-for-performance results because one physician's patients are more compliant than the other's. But the physician whose patients are more compliant is probably better at motivating his patients to care for their health.

Electronic health record vendors want the pay-for-performance to be based on in-office-captured actions, because this would motivate more physicians to buy EHR products that track pay-for-performance data. But keeping track of pay-for-performance data points in the office requires more mouse clicks by the physician during the patient encounter. The physician who simply always remembers to order a HbA1c on his diabetic patients, and doesn't want to have to buy an EHR to keep track of every time he counsels a patient on diet and exercise, will not earn the pay-for-performance incentives. But his patient care is as good as the next doctor's -- and possibly better, because he's not spending his patient encounters at his computer.

Matt Beckwith, MD, Hagerstown, Md.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2006/04/10/edlt0410.htm.

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