Unintended Consequences of Pay for Performance

Monday, September 10th, 2007
This post was written by Melanie Matthews

Unintended consequences. According to Wikipedia, the free online encyclopedia and everyone’s new favorite news source, these are “situations where an action results in an outcome that is not (or not only) what is intended.” In discussing the unintended consequences of public reporting and pay for performance (PFP) in healthcare this week, Dr. Dale Bratzler said incentives that stimulate and accelerate quality improvement often result in direct or indirect harm to patients. If attention shifts to incentive-based conditions, he warned, some providers might turn away high-risk patients or treat payment-based rather than life-threatening cases first. This week, we report on Cardinal Health’s new reporting method for PFP that relies on clinical rather than administrative data, a step toward enriching reported data and reporting transparency.

More unintended consequences: Relying on public data to track Medicaid clients that may not keep pace with this transient population means some clients miss out on much-needed care. So sometimes unorthodox resources — like delivery records from a pizza service — can be the key to locating elusive clients. This worked for one health plan that surmised (correctly) that transient clients often order takeout meals. To share your strategies and find out how your colleagues track down and engage hard-to-reach clients, take this month’s online survey .

Respond by September 30 and we’ll email you a free summary of the results so you can get these types of innovative strategies for tracking down hard-to-reach members and patients.

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