Pay for Performance ? “P4P”

I was in Washington, DC, this week, and was able to meet with several senior leaders on the national health policy scene.

I talked, separately, with Glenn Hackbarth, chairman of the Medicare Payment Advisory Commission, with Mark McClellan, MD, the administrator of the Centers for Medicare and Medicaid Services, and with Alex Azar, the deputy secretary of Health and Human Services.

While Hurricane Katrina and its aftermath was top of mind for everyone, each of them was also very interested in talking about the emerging health policy headliner ? Pay for Performance.”

I believe P4P, as it is already known in DC circles, is going to be huge. It has the potential to transform, not only how we pay for health care services, but the health care delivery system itself.

Now back here in Chapel Hill, I am dealing with the practical, daily issues of how we position the UNC Health Care System to do well in an environment that rewards superior performance. P4P is not just some abstract notion of a few health policy wonks, it is a powerful kick in the butt for those of us trying to improve how we care for patients and their families.

1 thought on “Pay for Performance ? “P4P”

  1. Keith Kocis

    P4P—It’s a mantra that no American (or Capitalist) would argue with…But at the crux of the problem is HOW DO YOU MEASURE PERFORMANCE???. Tying into your earlier comments regarding patients and their expections, different sectors (patients, MD’s, RN’s, administrators, payors etc) view “high Performance” very differently. Metrics such as Survival, days in ICU, hospital days, etc are typical benchmarks. But as you know, these raw metrics must be risk stratified. What are we doing at UNC to measure performance…..for our inpatient and outpatient encounters? for our medical and surgical outcomes? from the perspective of the patient, physicians, and staff (satisfaction)? and finally for our efficiency in delivering compassionate, kind, and outstanding care (costs)??

    My personal experiences in trying to gather such data for my patients in the Pediatric ICU is not good. Our group has been unable to benchmark ourselves against other PICU’s around the country. We are VERY CONFIDENT that we are surpassing those PICU’s and are willing to be transparent about it (ie posting our results LIVE on a web page)… This idea too has not been embraced by the institution. Obtaining data on efficiency has been requested and denied outright.

    If the institution expects to be paid for performance it must demonstrate that. Press Ganey is the standard reply to patient satisfaction, but it misses all the other dimensions of performance that are atleast AS IMPORTANT.

    Keith C. Kocis, MD
    Chief, Pediatric Critical Care Medicine


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