Chicago Medical Malpractice Lawyer Blog

Does linking Chicago doctors’ pay to performance mean better healthcare? That’s essentially the question posed by Dr. Sandeep Juahar this week in the New York Times. Apparently, employers and insurers, including Medicare, have started about 100 initiatives across the country that reward health care providers by paying for performance-- called P4P for short--with the general intent to reward doctors for providing better care.

For example, doctors are now being encouraged to voluntarily report to Medicare on 16 quality indicators, including prescribing aspirin and beta blocker drugs to patients who have suffered heart attacks and strict cholesterol, for prescribing ACE inhibitor drugs to patients with congestive heart failure and administering antibiotics to pneumonia patients in a timely manner. The doctors and hospitals who perform well receive cash bonuses.

On the surface, it seems like a good idea to reward doctors and hospitals for quality, not just quantity. But there may be unintentended consequence to P4P. For example, Medicare requires that antibiotics be administered to a pneumonia patient within six hours of arriving at the hospital. The problem is that doctors often cannot diagnose pneumonia that quickly. It takes blood tests and chest X-rays to detect pneumonia, but the Medicare standard pressures doctors to treat an illness that they don’t have the solid test results to confirm. So as a result of the guidelines, ER patients are taking more antibiotics despite the risk of dangers of antibiotic-resistant bacteria and antibiotic-associated infections, like colitis.

Juahar claims that with P4P giving out bonuses, many doctors have expressed concern that they feel pressured to prescribe “mandated” drugs, even to elderly patients who may not benefit, and to cherry-pick patients who can comply with pay-for-performance measures. Juahar claims that whenever you try to legislate professional behavior, there are bound to be unintended consequences. And at this point, it is not clear that pay for performance will actually result in better care, because it may end up only benefiting physicians who already meet the guidelines.

The Chicago Medical Malpractice attorneys at Hurley McKenna & Mertz, P.C. think that Doctors and hospitals should never have to take a financial hit for trying provide innovative healthcare that the guidelines have not had the opportunity to address. If they can collect bonuses by maintaining the status quo, what is the incentive to improve?