Can Health Care Pay Its Way to Success?

Posted on | June 11, 2007 | Comments Off on Can Health Care Pay Its Way to Success?

I’ve spent more than 30 years in health care and have run the gamut from non-profit to for-profit, from rural to urban, from clinical care to management, from doctor to patient. Along the way, I’ve been exposed to all sorts of incentives. And, looking back, I have to say that beyond the basics of fundamental financial security, monetary rewards have not been a strong motivator for me. Rather, working with colleagues I respected, within an organization that really cared for “the people,” and going to bed each night feeling that (at least, in some small way) my life mattered and that I had made a positive contribution to another human being’s health and welfare — that’s what kept my juices flowing. Money? Not so much!

This is why I’ve been somewhat skeptical about the concept of “pay for performance.” So I read with interest the recent JAMA article reporting on a pilot Medicare study of 500 hospitals including 446 “controls” and 54 that received financial incentives in return for following treatment guidelines for five conditions, including heart attacks.

More than 105,300 patients were treated over the past 3 years. All participating hospitals were encouraged to use the protocols and “do the right thing.” The singled-out 54 were given a total of $17.6 million as a financial “pat on the back” as well.

The results?

Compliance with protocols in PFP hospitals rose from 87% to 94.2%. Compliance with protocols in non-PFP hospitals rose from 88% to 93.6%.

The conclusion? According to the JAMA article authors: “..overall, there was no evidence that improvements in in-hospital mortality were incrementally greater at pay-for-performance sites.”

Not surprising to me, nor, I would think, to most doctors, nurses, caregivers, and hospital professionals. A caring spirit (at least in health care) will trump “privatization” most of the time. And if it doesn’t, something is wrong.

My father (a doctor) told me when I was a boy, “Be a good doctor and the money will follow.” Over three decades, that has not always been the case for me, especially when caring for the poor, the uninsured and the disenfranchised. But still, he was on the right track. If you’re in health, you do the right thing by your patient, regardless. That’s the deal you made. That’s the life you chose. I’d rather get a bag of home-grown tomatoes from my patient or a hug from their spouse than a bonus from an insurer (public or private) for doing a good job. That’s just me. How about you?