Pay for performance, which rewards physicians and hospitals for improvements in the care they provide, is considered key to healthcare payment reform, but so far it’s been only a Band-Aid on a fundamentally broken payment system, according to a report on pay-for-performance programs among 10 of the nation’s largest commercial health insurers released Aug. 22 by PricewaterhouseCoopers. Pay for performance would get an “incomplete” report card right now, says PwC’s Health Research Institute, which found a lack of agreement about the definition of quality or cooperation on standards, resulting in a ballooning number of diverse measures, and insufficient financial incentives to change physician behavior.
For example, nearly 60 different indicators of physician performance are being used among the 10 plans surveyed. Of those indicators, not a single indicator was used by all 10 plans. No two plans reward providers for performance in the same way, and all the plans administer their programs in widely different ways.
According to the PwC report, Keeping Score, the industry must agree on a universal set of quality measures and take an all-payer approach, wherein all hospitals and physicians strive for the same set of quality goals and receive equal incentives to care for all patients, regardless of whether a patient has health insurance or not.
