Opportunities, Not Incentives, Drive PCPs to Do Better


Nearly two-thirds of the boxes physicians have checked to demonstrate quality have not been validated with any degree of certainty. I shudder to think of how many hours physicians have wasted collecting this data throughout the past decade. Every minute took away from crucial time that could’ve been spent face-to-face with a patient.

“Not to worry, though. To reduce the ever-expanding administrative burden, there are calls and concessions to simplify the gathering of quality metrics. CMS has even started using the mantra of “Patients Over Paperwork.” Although it’s great to see people recognizing this problem, slightly reducing unhelpful paperwork isn’t going to be a game-changer for primary care physicians (PCPs) or patients.

Also, in an attempt to take a broader view, measuring patient outcomes as a proxy of quality care has become fashionable. We see several examples of this in value-based payment programs already: incentive-based payments (the Physician Quality Reporting System and the Merit-based Incentive Payment System), capitation programs (the Comprehensive Primary Care program), and risk-bearing arrangements (accountable care organizations).

Intuitively, turning to these programs may seem wiser than counting smaller beans. A move away from fee-for-service payments might make sense at some levels. However, in many respects, basing payments on health outcomes is more complicated and fraught with potential hazards.”


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