Collateral Damage: Pay-for-Performance Initiatives
Authors: Steffie Woolhandler, David U. Himmelstein
Journal: Annals of Internal Medicine (2016)

Letters19 April 2016Collateral Damage: Pay-for-Performance InitiativesSteffie Woolhandler, MD, MPH and David U. Himmelstein, MDSteffie Woolhandler, MD, MPHFrom City University of New York School of Public Health at Hunter College, New York, New York.Search for more papers by this author and David U. Himmelstein, MDFrom City University of New York School of Public Health at Hunter College, New York, New York.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L15-0572 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE:Dr. Galishoff points to McNamara's body count–driven planning during the Vietnam War as an early, failed example of a pay-for-performance–like strategy. We agree.Medical pay-for-performance rests on several dubious assumptions: 1) Quality metrics accurately reflect clinician performance, not the characteristics of their patients, or efforts to game the measures; 2) lack of motivation is an important cause of poor performance; 3) bonuses and penalties will add to motivation, not undermine it; 4) hospitals and physicians delivering poor-quality care should get fewer resources; and 5) the current payment system is too simple. None of these assumptions rests on evidence ...References1. Himmelstein DU, Ariely D, Woolhandler S. Pay-for-performance: toxic to quality? Insights from behavioral economics. Int J Health Serv. 2014;44:203-14. [PMID: 24919299] CrossrefMedlineGoogle Scholar2. Hogan H, Zipfel R, Neuburger J, Hutchings A, Darzi A, Black N. Avoidability of hospital deaths and association with hospital-wide mortality ratios: retrospective case record review and regression analysis. BMJ. 2015;351:h3239. [PMID: 26174149] doi:10.1136/bmj.h3239 CrossrefMedlineGoogle Scholar3. Gilman M, Hockenberry JM, Adams EK, Milstein AS, Wilson IB, Becker ER. The financial effect of value-based purchasing and the hospital readmissions reduction program on safety-net hospitals in 2014: a cohort study. Ann Intern Med. 2015;163:427-36. [PMID: 26343790]. doi:10.7326/M14-2813 LinkGoogle Scholar4. Rosenbaum L. Transitional chaos or enduring harm? The EHR and the disruption of medicine. N Engl J Med. 2015;373:1585-8. [PMID: 26488690] doi:10.1056/NEJMp1509961 CrossrefMedlineGoogle Scholar5. Himmelstein DU, Jun M, Busse R, Chevreul K, Geissler A, Jeurissen P, et al. A comparison of hospital administrative costs in eight nations: US costs exceed all others by far. Health Aff (Millwood). 2014;33:1586-94. [PMID: 25201663] doi:10.1377/hlthaff.2013.1327 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From City University of New York School of Public Health at Hunter College, New York, New York.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-1393. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoCollateral Damage: Pay-for-Performance Initiatives and Safety-Net Hospitals Steffie Woolhandler and David U. Himmelstein Collateral Damage: Pay-for-Performance Initiatives Mitchel L. Galishoff Metrics 19 April 2016Volume 164, Issue 8Page: 573KeywordsDeath ratesDisclosureElectronic medical recordsGamesInternational Classification of DiseasesMammographyMortalityMotivationPatientsStatistical data ePublished: 19 April 2016 Issue Published: 19 April 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...