While pay-for-performance programs are great Human Resource recruitment strategies, can they really improve clinical outcomes, quality of care, contain costs, and improve patient satisfaction?  Absolutely.   Coupled with wellness, behavior modification and preventive healthcare programs and consistent, accurate, quantitative data analysis; pay-for-performance programs can achieve the desired results for both patients and healthcare organizations alike.  The challenges that exist are healthcare providers are churning and burning to meet demand management.  With the focus on increasing RVUs and revenue, providers are treating more patients per day, which leaves little time for providing wellness education or referring patients to preventive healthcare programs.  Providers end up treating their patients’ current symptoms, providing medication and advising them to schedule follow up appointments.  Consequently, obese patients are less likely to self-refer to weight management classes or take necessary steps to lose 10-15 pounds which studies have shown decrease pressure on the heart and significantly lowers high blood pressure.  This type of patient/provider relationship also lowers the chances of diabetic patients getting bi-yearly tests for glaucoma, AC1 testing, and leaning about the benefits of healthy eating to decrease the devastating effects of the disease.   This often results in obese and diabetic patients requiring extensive inpatient care and numerous costly but possibly avoidable surgeries.  If healthcare organizations do not change this behavioral pattern for providers and patients, pay-for-performance programs will continue to stagger or fail altogether.

Other challenges facing healthcare organizations today are: measuring the effectiveness of quality and accurately trending decreasing costs.  What is quality?  Some healthcare organizations define quality as timely, accessible, healthcare; others define it is patient-centered with an emphasis on wellness and prevention.  Which definition is correct and if followed which leads to quality healthcare?  Little research and data shows that pay-for-performance reduces costs.  Without a two-fold approach of combining timely healthcare and wellness-related programs, the high cost of inpatient care will far out-weigh any perceived decrease in costs associated with diseases such as obesity and diabetes.

Most patients demand and all deserve quality healthcare.  Healthcare organizations should offer pay-for-performance to providers and managers who are optimizing quality care, educating and referring patients to wellness-related programs and containing costs for their most prized assets, patients.  Conversely, healthcare organizations and providers with an alarmingly high number of patients with poorly managed obesity, diabetes, heart disease, hypertension, and other manageable diseases should be penalized.  If there is a price to pay for quality care (pay-for-performance), there should be a price to pay for poorly managed care, termination or reduction-in-pay.