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Home / News & IndustryManaged Care Insight and Analysis
Updated: September 15, 2009
Caring For Very Sick Patients Seem Not To Hinder P4P Incentives

The sicker the patient, the better the care, new research has found.

This finding dispels the previously held notion of many physicians and health policy makers on whether pay-for-performance reimbursements would be fair toward doctors with the sickest patients.

"Many clinicians are concerned that when they care for patients with multiple medical conditions, their performance on measure of healthcare quality is going to suffer due to that complexity," said Laura A. Peterson MD, M.P.H., lead author and director of the VA Health Services Research and Development Center of Excellence and an associate professor of medicine at Baylor College of Medicine in Houston, Texas (BCM).

"The concern is that the time spent treating other unrelated conditions would take away time from treating high blood pressure, causing performance on measures of quality to suffer," she said.

However that has proven not to be the case, which came as a good surprise to Peterson, also chief of Health Services Research at Baylor College of Medicine. "What we found was that doctors do a good job of taking care of a lot of complex conditions, even better than they think they do."

Researchers from BCM chose to study patients with high blood pressure because it is a common, symptomless problem that can have very serious consequences.

In their research, 141,609 patients were identified with high blood pressure. Of these, 22,595 had no other serious health conditions; 70,098 had concordant conditions; 12,283 had discordant conditions; and 36,633 had both.

A Veterans Affairs database was used for the study, which includes a few key differences from that of civilian care. The VA system has a nationwide computerized medical records system, which provides clinicians with reminders and alerts about medication interactions, allergies, and other important patient information.

When researchers evaluated the high blood pressure treatment provided to patients with other serious health conditions, they found that such patients were more likely to receive high quality care than patients with no co-existing health problems, and that the quality of care actually increased with the number of other conditions the patient had.

Overall, 90 percent of the high blood pressure patients treated for additional medical conditions received high-quality care.

Patient satisfaction remained positive among those being treated for more complex health issues, researchers found.

The study is believed to be one of the first to attempt assessment of the impact of co-existing conditionson quality of care, while also assessing the patient's perceptions of the care they receive.

The findings are no doubt reassuring for physicians concerned that P4P could penalize those caring for medically complex patients.

The research results were published in the journal Circulation. Funding for the work came from the U.S. Department of Veterans Affairs, the National Institutes of Health, The Robert Wood Johnson Foundation and the American Heart Association.

Address: Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030; (713)-798-4951, www.bcm.edu.


  This article was taken from:
Pay-For-Performance Reporter

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