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      Payment for Performance: In Sickness and in Health. For Better or for Worse?

      review-article
      Blood Purification
      S. Karger AG
      Payment for reporting, ‘Payment for performance’, Clinical practice guidelines

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          Abstract

          American consumers and payers are increasingly questioning the value of health care as costs increase amid reports of poor quality. Rewarding health care providers who apply evidence-based, clinical practice guidelines (CPGs) to obtain desired patient outcomes seems an intuitive, innovative method to improve health care value. Although there are many unanswered questions about payment for performance (P4P), Congress and the Centers for Medicare and Medicaid Services are developing a rapid timetable to begin P4P. Many private payers have already begun P4P programs. Currently, we lack randomized, controlled studies proving the safety, effectiveness, and patient centeredness of P4P. Many see publicly reporting provider performance as a surrogate for P4P. There is a growing literature documenting the effect of publicly reporting provider performance on the medical community and patient outcomes. It changes provider behavior, but occasionally, in undesirable ways (for example, adverse risk selection, or ‘cherry picking’). Publicly reporting or rewarding provider performance based on applying evidence-based CPGs may also have unforeseen negative patient outcomes. P4P should proceed carefully while considering unintended consequences for patients and providers. P4P should be pilot tested in the proper target patient and provider populations. Thus, we need to study how CPGs interact with one another in specific patient populations. The updating process for CPGs should include evidence-based statements concerning their impact on real patients with multiple chronic illnesses.

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          Most cited references3

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          Is there time for management of patients with chronic diseases in primary care?

          Despite the availability of national practice guidelines, many patients fail to receive recommended chronic disease care. Physician time constraints in primary care are likely one cause. We applied guideline recommendations for 10 common chronic diseases to a panel of 2,500 primary care patients with an age-sex distribution and chronic disease prevalences similar to those of the general population, and estimated the minimum physician time required to deliver high-quality care for these conditions. The result was compared with time available for patient care for the average primary care physician. Eight hundred twenty-eight hours per year, or 3.5 hours a day, were required to provide care for the top 10 chronic diseases, provided the disease is stable and in good control. We recalculated this estimate based on increased time requirements for uncontrolled disease. Estimated time required increased by a factor of 3. Applying this factor to all 10 diseases, time demands increased to 2,484 hours, or 10.6 hours a day. Current practice guidelines for only 10 chronic illnesses require more time than primary care physicians have available for patient care overall. Streamlined guidelines and alternative methods of service delivery are needed to meet recommended standards for quality health care.
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            The influence of public reporting of outcome data on medical decision making by physicians.

            Public disclosure of physician-specific performance data is becoming increasingly common. However, the influence that public reporting of outcome data has on the delivery of care by physicians who are being assessed is not well understood.
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              Linking Compensation to Quality — Medicare Payments to Physicians

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                Author and article information

                Journal
                BPU
                Blood Purif
                10.1159/issn.0253-5068
                Blood Purification
                S. Karger AG
                978-3-8055-8052-6
                978-3-318-01301-6
                0253-5068
                1421-9735
                2006
                December 2005
                23 December 2005
                : 24
                : 1
                : 28-32
                Affiliations
                Richard S. Goldmann, Albuquerque, N. Mex., USA
                Article
                89433 Blood Purif 2006;24:28–32
                10.1159/000089433
                16361837
                f656c0d4-cc88-4120-9041-dd7eeffe56f8
                © 2006 S. Karger AG, Basel

                Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

                History
                Page count
                References: 14, Pages: 5
                Categories
                Paper

                Cardiovascular Medicine,Nephrology
                Payment for reporting,‘Payment for performance’,Clinical practice guidelines

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