Pay for performance vs Cutting what's not working

Pay for performance is not new, it's been around as a business concept for decades, but it's being thrown around by everyone from Medicare to the candidates as a means of improving the quality of health services and reducing costs of health services. Why not use the approach of getting rid of what's not working? Most working people live in that world, reorganization, substandard performance, get rid of the worker, the department.

As consumers, pay for performance is an expensive experiment that though tossed around does not bring about the revolutionary results it promises. In the eighties, hospitals, laboratories went for pay for performance...how's that working out for consumers? Teachers also have to some extent or another been part of such incentive systems. Pay for performance depends on oversight. In a system where the failure to effectively oversee the health services providers and health insurers has resulted in micromanaging consumers to reduce the need for health services providers and insurers, it makes little to no sense to recycle and repackage the idea of pay for performance.

Coddling the perpetrators of the health services crisis is a misplaced action that seeks to appease these players into more reasonable conduct. Like any policy of appeasement with parties that have become unreasonable, the slippery slope of more and more appeasement does not and will not work. Throwing more money and more bureaucracy at a health services industry that is failing is ridiculous...good money after bad.

The key issues for consumers that can be addressed are fraud, overutilization, and insufficient help in paying for medical services. Fraud, first and foremost. Expanding the bureaucratic complications of the health services industry provides increased opportunity for fraud, therefore it is not part of a solution for consumers.
An examination of websites of stakeholders other than consumers shows that most fraud detection and reporting is left to consumers. Therefore, in every case where a consumer report relates information that is used in discovery of fraud, it is the consumer who should get the performance pay, not the health services provider who actually does his job at some minimal level to pass the low-bar of standards imposed by some bureaucracy.

Overutilization, the endless parade of sending consumers for tests, retests, and subsequent tests which results from increased technology, defensive medicine, and insurer coverage of such testing as preventive, is another area where consumers can make a statement. Talking with your neighbors, your friends and your own experience shows that more and more people are saying no. Physicians who write pads worth of prescriptions for testing may not realize that consumers are putting the brakes on the endless tests. The only time this cycle is not broken by the consumers is when consumers are sick and afraid that skipping one of those tests will be a critical error. Soon, even the sick will put the brakes on this practice. Any time a consumer does not fill one of these prescriptions he/she should have the opportunity to submit a copy of the prescription to the insurance company and should receive payment for reducing the costs of over-utilization. Consumers who do not use their insurance during the year should be entitled to rebates of premium.

The third and most lethal area for consumers is the unavailability of sufficient help in paying for medical care. This is the insurance arm of the mess. Insurers who do not cover any procedure, service or treatment that a consumer and his physician believe are necessary should immediately be responsible for damages for breach of contract. Regardless of any fine print, this breach should immediately entitle the consumer to damages. This requires a shift of the onus of non-coverage after the payment of premiums. In the event an insurer does not cover something, that should be prima facie proof, proof on its face that the insurer has breached its contract. In order to avoid the immediate entitlement of patients to damages, insurers would have to prove how, why, and what documentation they used in making the decision. In the event the advice of medical personnel is part of this record, those individuals should be part of the liable individuals for their decisions.

So why, of all the actions that could be taken to oversee the health services providers and health insurers is pay for performance the idiotic notion of rewarding the perpetrators that is taking shape? That's because of the political arena. Unwilling to take on its own role in ennabling the corruption and expansion of the bureaucratic mess that is health services, governments continue to throw more money at health services providers, and more protections for health insurance companies that provide less and less insurance. It is up to the consumers to address the system. We have already seen that because of the brazen disregard for the consumer, the citizen and the customer that are the American people that we are paying for the perpetuation of this system. Competition in the health services industry has whittled down to individuals arguing that they're healthier than their citizen neighbor.

Pay for performance is the old rewrapped recycled nonsense of paying people for doing their jobs. If they don't do their jobs, get rid of them. It is not some simplistic free market economy idea of supply and demand that has created our health services crisis, it is unfettered greed, corruption and government support of the medical and health insurance industries that has created this environment...hardly free market, hiding behind the skirts of an accommodating government.