P4P in primary care

Family Practice Management has an update article on pay for performance in their July/August 2006 issue, including some interesting statistics and graphs on the rise of P4P programs in primary vs. specialty care and among public and private insurers. There's also a nice checklist for docs to consider before signing up for their local P4P.

I've written before on why performance measures don't work well in primary care; attempts to focus on individual disease markers in patients with multiple comorbid conditions is a byproduct of specialist "disease oriented" rather than "patient oriented" care. The result of this thinking is P4P programs that promote physician behaviors that detract from the demonstrably valuable task of balancing complex competing co-morbidities to achieve improved outcomes. Want more? See Barbara Starfield's editorial in Annals. This unending focus on disease rather than patient is one of the greatest failures of US healthcare.

The New York Times has written about P4P. It's also all over the blogosphere:

Retired doc's thoughts: To see what P4P is really all about, look at the Seattle Blue Shield experience

Roy Poses, a decision analysis maven and fellow generalist: Health Care Renewal: Implementing P4P in the Real World: the Case of Regence BlueShield

KevinMD's thoughts

And even some specialists are aggravated by P4P: Aggravated DocSurg: A(nathe)MA, part the second