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
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
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
"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
However that has proven not to be the case, which
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
blood pressure because it is a common, symptomless problem that can
have very serious consequences.
In their research, 141,609 patients were
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
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
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
assessment of the impact of co-existing conditionson quality of care,
while also assessing the patient's perceptions of the care they
The findings are no doubt reassuring for
concerned that P4P could penalize those caring for medically complex
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.