Over the past few years, insurers and Medicare officials have fostered the idea that physicians should be reimbursed on a pay for performance (P4P) basis.  Many articles, both pro and con, have been written regarding P4P.  I have been strongly opposed to P4P, believing that the sole purpose of the performance indicators designed by the government and insurers is to reduce payments to docs and hospitals.  I also believe that the establishment of performance guidelines will lead to the mechanization of medical care as physicians and hospital administrators will learn what they need to do to “perform” and practice guideline-based medicine as opposed to providing personalized care.

Recently, I have reassessed my P4P stance and believe that a system that pays patients for performance could work.  Yes. “patient pay for performance (PP4P)” would be a good thing.  As I envision PP4P, patients would be given performance guidelines and be graded on adherence to treatment plans, consistency in taking medications, participation in timely follow up visits, weight loss, and appropriate exercise.  Of course, there are many other performance standards that could be set for patients depending on what ails them.

A diabetic could be graded on his/her blood sugar control.  A patient with hypertension could be graded on his average blood pressure.  An obese patient could be graded on continued weight loss.  Paying patients for performance makes a lot of sense.  All we need is a grading system.

If getting an “A” on your blood pressure control made money for you, wouldn’t you be more likely to control your BP?  If getting a “D” on your blood sugar control cost you money, wouldn’t you strive to get a better grade at your next visit?

PP4P already exists. Yes, controlling your blood pressure and blood sugar already saves you money.  Complying with your treatment plan and managing your disease saves a lot of money.  If you think your BP meds are expensive, wait until you see the bill for your first heart attack.  Complying with your treatment plan saves you money by keeping office visits and medication to a minimum.  Reducing risk factors, modifying diet, and exercise may even prevent you from future healthcare expenses.

Yes, PP4P works.  It would work even better if your government and insurers would pitch in.  If your insurer would reduce your premiums for an “A” performance, wouldn’t you be more likely to work for an “A?”  Of course you would.  If Medicare would pay recipients for good health by reducing deductibles and co-pays, wouldn’t they save money in the long haul.  I would think so.

I’m working on a grading system for my patients.  It’s time to institute PP4P.  It’s time to grade patients so that those with low grades can realize the errors of their ways and have a chance to improve their performance.

Stewart Segal is a family physician who blogs at Livewellthy.org.

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