Physician Compensation

The other P4P

The concept of pay-for-performance has been discussed repeatedly in this blog. But what about the other P4P: pay-for-participation?

In the pay for participation model, payers compensate physicians to add infrastructure or partake in data collection. For instance, a health plan may pay providers to implement an electronic medical records system. Providers may also compensate physicians to set up data collection systems where performance can be measured. One difference between pay for performance and pay for participation is that P4Performance measures are generally distributed to the public whereas P4Participation metrics are kept confidential between the payers and providers. While the lack of openness reduces the information the public has about quality, it also diminishes a hospital’s or physician’s incentive to game the system.

As an example of pay for participation, an article by Birkmeyer and Birkmeyer (NEJM 2006), looks at the case of Blue Cross -Blue Shield of Michigan (BCBSM). The BCBSM program targets cardiac surgery, bariatric surgery and other general and vascular surgery. “[H]ospitals are compensated for data collection and participation in improvement activities in the form of supplements to reimbursements according to the diagnosis-related group for surgical care.” Since the data collected are not publicly report, physicians have less of an incentive to ‘juke the stats.’ For instance, when P4P performance measures are publicly available, surgeons may decide to forgo surgery on the sickest patients in order to decrease their surgery mortality rate, even though it is just these types of patients who likely could benefit most from surgery. With their flaws not open to public scrutiny, physicians may be more open to admit errors or work with the payer to improve the quality of care.

The authors do note that pay for participation is difficult to implement and requires large amounts of organization and coordination. While the payers do cover the cost of implementing the data collection, neither hospitals nor surgeons “[profit] financially from the pay-for-participation program,” which may limit provider enthusiasm for P4Participation efforts.