Tuesday, April 17, 2007

Dear Patient: P4P is Here

Dear Mr. and Ms. Patient,

I regret to inform you that I will be spending less time focusing on your heart problem because I have decided to focus on the heart and medical problems that Medicare deems important to assure I get paid. They call this initiative "Pay for Performance (P4P)."

You see they published a list of 74 criteria that will be measured to see if I give good care, so I will get paid appropriately. Fortunatelty for cardiologists, we only have to do four things:
The ACC (American College of Cardiology) is asking cardiologists to report on these Physician Consortium for Performance Improvement (PCPI), National Quality Forum (NQF)-endorsed measures, which include at this time:
• ACE or ARB therapy for heart failure patients with LVSD (left ventricular systolic dysfunction)
• Antiplatelet therapy prescribed for CAD (coronary artery disease) patients
• Beta-blocker therapy prescribed for CAD patients with prior MI (myocardial infarction or heart attack)
• Beta-blocker therapy prescribed for heart failure patients with LVSD
And the specifications for how we should do this providing and documenting good care can be found here (Caution, this pdf file is 181 pages long!).

So, dear patient, I'm sorry if you have pericarditis or heart block. I'm gonna need to focus on my heart attack and heart failure patients a bit more to make sure my office staff can still return your calls.

I hope you understand.




Anonymous said...

I appreciate your frustration, but why don't you take it up with Medicare or with your congresspersons instead of taking it out on the patients? We didn't ask for this cr@p any more than you did.

DrWes said...

Dear anony 4:46PM CDT -

The point here is not to take anything out on patients - that is the farthest thing any doctor wants to do. But where are the prospective studies that have demonstrated that any such "performance" initiatives have actually improved patient care?

My colleague put it best. "It's not pay for performance. On the contrary, it's under-payment that rewards minimal performance."