Geese, ganders, and pay-for-performance (P4P)

Like most employees of large institutions, I am subject to a variety of ‘incentives’ that are designed to meet institutional needs, which may or may not be well aligned with my needs, to say nothing of the needs of my patients. 

These include pay-for-perfomance incentives, volume incentives, and various ‘safety and quality’ incentives. I use the scare quotes because for many of the metrics, it is hard to see how they relate to safety or quality. An example is the motley collection of ‘iCare modules’ we are expected to complete (during our spare time) every year. They are independent online video casts followed by a quiz, and cover such vital subjects as the labels for hazardous materials and a very superficial treatment of how to code office visits to avoid audit. 

I have been more and more irritated by the waste of time and effort, and this year I decided my priorities were family time. I simply stopped doing the assigned iCare modules. As the year drew to a close, I got increasingly frantic reminders from management about the coming deadline.  The day before they were due, an administrator pointed out to me that if I didn’t do them, it would be a black mark on management’s record. In fact, she siad, it counted against her.

What I thought was: Not my pig, not my farm. Welcome to my world where clinicians are routinely held accountable by pay-for-performance programs for the behaviors of others, something we obviously cannot control, and ethically should not try to control.

What's good for the goose is good for the gander. Happy New Year.

 


 

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