'Deep Flaws' With Pay-For-Performance Model Need To Be Addressed To Provide Quality Health Care, According To Commentary

The "general intent" of pay-for-performance programs "is to reward doctors for providing better care," but as they gain "momentum, the initiative[s] may be having untoward consequences," Sandeep Jauhar, a New York-based cardiologist and author, writes in a New York Times commentary. "To get an inkling of the potential problems," Jauhar discusses another quality-improvement program: surgical report cards.

The program, which was introduced in the early 1990s, was intended "to improve the quality of cardiac surgery by pointing out deficiencies in hospitals and surgeons; those who did not measure up would be forced to improve," according to Jauhar. However, studies on the program "demonstrated there was a significant amount of 'cherry-picking' of patients in states with mandatory report cards," Jauhar writes. "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," he writes, adding, "Pay for performance is likely to have similar repercussions."

Norman DeLisle, MDRC
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