P4P

Two points:

1. Measuring something is not the same as improving it. 
2. Improving something requires thinking of quality as a process rather than a product.

Before we think about how these two principles apply to medicine, let’s consider two approaches to coaching basketball: one using incentives tied to outcome metrics, and one using interventions designed to identify and address process problems.

A recent conversation about an institution’s use of the A1c (a measurement of average blood glucose levels over the preceding 100 days) to grade clinician performance and adjust compensation frustrated me. The issue was the misunderstanding and misuse of surrogate markers, those things we measure when we can’t measure what we really want to know.

There is a push afoot to use evidence based medicine (EBM) to generate standards of care and then use pay-for-performance  (P4P) to Nudge people towards better behavior.