Pay-for-performance programs: Are they worth it?

Pay-for-performance programs are proliferating: A projected 155 P4P programs are expected to be in place this year, compared with just 39 in 2003, according to data from the health-care informatics group Med-Vantage and the Leapfrog Group. Yet some question the value of this growth.

Government officials, for example, have taken issue with these programs: New York State Attorney General Andrew Cuomo expressed concern that these programs could "steer patients to less-expensive rather than high-quality providers," reported Modern Healthcare (9/3/2007). And many physicians already oppose P4P programs; they see these programs as a means to pay doctors less.

Arguably, a report from PricewaterhouseCoopers puts an even bigger ding in the P4P movement. The researchers reviewed 10 different P4P programs and found that they used 60 different physician performance indicators, not one indicator was used by all programs, and no two programs rewarded physicians the same way. The report states, "the wide variation in program structures, performance metrics, and rewards structures mutes (the plans') potential impact." (See the editorial in our November 2007 issue, "Pay for performance: Ready or not, here it comes!" pp. 16-18, or visit our Web site at: http://www.contemporaryobgyn.net/.)