Carrying the World on Your Shoulders

Is Easier Than Meaningfully Improving Medicare

The NEJM has just published an article that calls into question the value of Medicare’s 20 year journey with pay-for-performance (P4P) programs.

To quote the article: “Returns have been disappointing with only moderate documented

improvements in our health outcomes, despite substantial administrative burden and costly

demands on clinicians time. We believe the health care system’s overreliance on P4P to drive

quality is problematic…all three core elements of this approach - measurement, scoring, and

financial incentives - have inherent shortcomings that cannot be resolved with incremental

refinement."

These programs include Hospital Value-Based care, the Merit-Based Incentive Payments System (MIPS), and the Medicare Advantage star ratings. The article also notes "Achieving meaningful quality improvement at scale will require rethinking the paradigm…The cost and the limitations of the measurement - scoring - pay paradigm that have shaped U.S. policy for generations are becoming increasingly apparent.”

Thank you the NEJM for this bold and accurate commentary on Medicare. These same

concerns also apply to the Medicare payment model. It is exceedingly complex, costly, and

rewards the wrong behavior. Just look at the fraud and costs of U.S. healthcare, which is a natural result of relying too much on coding instead of common sense.

Medicare must acknowledge these flaws and make fundamental, not incremental, change.