tag:blogger.com,1999:blog-6076839327674215825.post9054093718013051585..comments2024-03-27T05:14:34.288-04:00Comments on Medinnovation And Health Reform: Electronic Medical Records - EMRs and Pay For Performance (P4P)Richard L. Reece, MDhttp://www.blogger.com/profile/03446550629857699574noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-6076839327674215825.post-35460017219258345272012-03-06T00:02:06.432-05:002012-03-06T00:02:06.432-05:00Using Electronic Medical records in managing medic...Using Electronic Medical records in managing medical practices provides a number of benefits, especially in smaller practices where it is much easier to introduce.<br />Krisha | <a href="http://www.acrendo.com/" title="ehr software" rel="nofollow">ehr software</a>KrishaLivahttps://www.blogger.com/profile/02760868672190859926noreply@blogger.comtag:blogger.com,1999:blog-6076839327674215825.post-23139137235691315062007-07-20T05:21:00.000-04:002007-07-20T05:21:00.000-04:00I think I have a slightly different take on P4P th...I think I have a slightly different take on P4P than most...I think its too little and too mandated to really make a difference.<BR/><BR/>Where some believe that docs and hospitals should be doing a good job anyway, I'm on the side of disproportionate rewards-- Medicare/Medicaid can be a breakeven business for most providers, but I think those saving the health system real dollars through <B>lean healthcare</B> can be rewarded somewhere on the order of 2-3X while still saving the system money.<BR/><BR/>Lets make amazing performance something people are willing to put capital investment into, rather than the . <A HREF="http://consumerfocusedcare.blogspot.com/2007/06/poor-study-design-makes-medicare-p4p.html" REL="nofollow">1-2% windowdressing it currently is</A><BR/><BR/>Of course, for this to work, the focus would have to be on <I>lean</I> outcomes rather than somewhat vague process metrics.Anonymoushttps://www.blogger.com/profile/03214069880720585895noreply@blogger.comtag:blogger.com,1999:blog-6076839327674215825.post-80589360832157896592007-07-18T21:44:00.000-04:002007-07-18T21:44:00.000-04:00A couple of observations: First, P4P, almost by de...A couple of observations: <BR/><BR/>First, P4P, almost by definition, can work to change provider behavior with respect to a defined universe of things they do for particular types of patients for a limited time. If the P4P incentives are built right, everyone will do what they're incentivized to do, and then there will be little or no room for further improvement. <BR/><BR/>Consider the <A HREF="http://healthblawg.typepad.com/healthblawg/2007/02/valuedriven_hea.html" REL="nofollow">Premier demonstration project</A> (most providers are trending upward in their performance, since their names are being published and there's some $$ on the table). <BR/><BR/>Second, if the British NHS paid bonuses on top of standard rates as P4P incentives, then shame on them -- they should have budgeted better, a la the Premier demo. While providers would certainly prefer bonuses on top of standard rates, and everyone talks about expanding the pie vs. talking zero-sum game, the truth is that cash is a limited resource, and we can't just print more money to make incentive payments. That money has to come from somewhere. In P4P-world, it comes from avoided expenses. (I'm not saying that makes perfect sense; it's just part of the internal logic.)<BR/><BR/>Finally (for now), outcome measures may not be harder to define and measure, but they sure are less palatable. Who gets the financial benefit of the improvement in health status 6 months or 12 months down the road? The doc who's no longer your doc? The surgeon, when a lot of the good done is thanks to your rehab therapist?<BR/><BR/>At some point, HMOs and docs could capitate and be capitated in part because of the longevity of patient and subscriber relationships. (If you're capitated and you figure the extra preventive care you provide inures to the benefit of the next guy, you have a financial disincentive to offer comprehensive preventive care.) So given the fact that we all tend to flit about across health plans and docs, who should reap the financial rewards of patient health improvement over the long term?<BR/><BR/><A HREF="http://www.harlowgroup.net/" REL="nofollow">David Harlow</A><BR/><A HREF="http://healthblawg.typepad.com/" REL="nofollow">HealthBlawg</A>Anonymoushttps://www.blogger.com/profile/10691960521953922676noreply@blogger.com