April 18, 2012 | 1:27 PM |

Should Your Doctor Grade You And Pay You For Good Health?

FILED UNDER: Money, Personal Health, pay-for-performance

 

In health care circles, “pay for performance” for doctors is a hot topic. But how about pay for performance for patients? Wouldn’t that be the ultimate “skin in the game?” (Aside from our literal skin, that is.) Isn’t it what many employer wellness programs are doing, or beginning to do, already? Why not use money as both carrot and stick to induce better health behaviors? And is that enough questions for one introduction?

Dr. Steward Segal, an Illinois family physician, has a provocative post on KevinMD.com about his plan to create “PP4P” — patient pay for performance. He writes:

Recently, I have reassessed my P4P stance and believe that a system that pays patients for performance could work.  Yes, “patient pay for performance (PP4P)” would be a good thing.  As I envision PP4P, patients would be given performance guidelines and be graded on adherence to treatment plans, consistency in taking medications, participation in timely follow up visits, weight loss, and appropriate exercise.  Of course, there are many other performance standards that could be set for patients depending on what ails them.

A diabetic could be graded on his/her blood sugar control.  A patient with hypertension could be graded on his average blood pressure.  An obese patient could be graded on continued weight loss.  Paying patients for performance makes a lot of sense.  All we need is a grading system.

Dr. Segal writes that he’s developing that system, and “It’s time to grade patients so that those with low grades can realize the errors of their ways and have a chance to improve their performance.”

Readers? Would you want to be one of Dr. Segal’s patients?

  • Mitzi

    As a non-smoking, non-drinking vegetarian except for fish who exercises regularly, I would welcome getting some credit for it. But I also have a connective tissue disorder for which the only effective treatment is physical therapy, and that is a real problem. The drugs and procedures by which the docs earn a living are downright harmful to people like me. We have to work it out the hard way, and many doctors give up on believing a patient is capable of self-managed rehab (with an occasional boost from a pro) for decades. I would count as a non-compliant patient because I refuse to take a pain reliever for a partially dislocated rib. If you pop it back into place, the pain is gone immediately, but most docs (even in physical medicine and rehab) can’t do that. So I have to go to chiropractic care, with a really good practitioner, to get what I need. For the common chronic disorders, this would be great. But there would have to be an allowance for those of us with a genetic defect that causes problems despite our best efforts.

  • blakery

    It seems pretty naive to think that, if someone’s own health isn’t giving them enough incentive, paying them money will somehow work. Especially since the amount of money involved would likely be relatively low, otherwise where would the money come from? Would they be essentially paying to have someone paying their doctor, to have their doctor give them back money? I guess that would be more like a ‘rebate’ than a ‘payment’, but it still seems more than a little convoluted.

  • Alexander Ernest Lewis

    Incentivized pay may be the wave of the future but how would the system work, don’t you think there are just so many things to create a system, and so many ways to cheat that system?

  • Evpankey

    I think this is a good idea, but doctors are probably not well suited to execute PP4P.
    Doctors are educated to diagnosis and treat acute and chronic conditions with drugs and procedures.  However increasing evidence is showing that many prevalent health conditions can be thwarted with lifestyle modifications.  Doctors recieve no serous treating in encouraging and motivating behavioral change and the medical business model (FFS or ACO) does not fit preventive care.

    Example let’s say an ACO pays 1000 per year for a caring for type 2 diabetic patient.  If the doctor and staff put in a lot of effort with the patient and symptoms resolve (no diabetes), then the next year the practice will lose money.  They’d make more by treating the diabetic with standard care.over many years.

    Fee for Service incentives treatment
    Bundled Payments encourages maintenance of conditions at low cost..
    We don’t have a business model for prevention or reversal of chronic conditions in US health care…..
    We don’t have professionals organized to do the job either.