Do this right and we'll give you a cookie.

That's my assessment of Pay for Performance.

What's that you say? You normal, non-hospital person.

Weeeeelll, let's get into it. (Yes, I'm mixing homework and blog time.)

Pay for Performance.

Essentially, there are some "Quality Indicators" set up based on your presenting complaint. If the healthcare team hits these indicators the hospital gets "rewarded" for your visit. Sounds like a pretty good idea. I mean, everyone likes cookies. :D

Its purpose is to align payment incentives to encourage ongoing improvement in a way that will ensure high-quality care for all.

-http://books.nap.edu/openbook.php?record_id=11723&page=3#

For all. That would be nice. Unfortunately, an unintended effect has been the avoidance of "high-risk" patients. Those with multiple problems that would make meeting these "quality indicators" very difficult.

Then there's also fee for service. You basically get a bill for each test or procedure run, submit it to your insurance and hope they cover it. Also costs more, for you.

So it feels like this to me.

You can either order a #5 Cheeseburger that comes with lettuce, pickle tomato, fries, and a shake.

OR you can individually select what toppings and sides you want and pay the extra $0.50 per selection.

There's the argument that managed care, and care plans, and quality indicators are making medicine to be less of an art, more of a one size fits all. I hear grumblings that doctors can't make their own clinical judgement anymore. While I understand this frustration. I also like protocols. I feel they hit the high points. You cover the bases and check out all the reasonable possibilities.

I've heard the story one too many times about the 25 year old marathon runner presenting with chest pain and dying from an MI because no one thought it necessary to do an EKG on her.

Call me a freak, but zebras exist.

The problem is, as it always is, payment. How are we going to afford this mess?

Pay for Performance, doesn't make it cheaper.

Arg, so many problems, not enough solutions.

It's at this point in playing Sim City or Caesar I would generally quit and do something less stressful.

Now I have to reword all that in a professional sense and submit it as my assignment. Too bad I can't use hyperlinks...