Doctor bemoans pay-for-performance

In an essay in the New York Times, Dr. Sandeep Jauhar says that pay-for-performance programs being adopted by employers and insurers, including Medicare, are pressuring doctors to treat patients without a firm diagnosis (Source: “The Pitfalls of Linking Doctors’ Pay to Performance,” New York Times, Sept. 9, 2008).

Jauhar said P4P may create some of the same unintended consequences as surgical report cards, a concept that was introduced in the early 1990s. Some studies have found that the surgical report card concept failed because doctors would refuse to treat the sickest patients for fear that a negative outcome would reflect poorly on the report card.

“Whenever you try to legislate professional behavior, there are bound to be unintended consequences,” he wrote. “With surgical report cards, surgeons’ numbers improved not only because of better performance but also because dying patients were not getting the operations they needed. Pay for performance is likely to have similar repercussions.”