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Home > Medical Professionals > Health Policy and Government Relations > Concerns, Conclusions, and Recommendations

P4P: Concerns, Conclusions, And Recommendations

As P4P systems are being devised, vascular surgeons need to recognize issues of concern that need to be addressed. These include the lack of testing and validation of performance measures and the paucity of level 1 or even level 2 evidence on which to base performance measures for the majority of surgical and vascular procedures. In addition, attention should be paid to developing process measurements that assess the complete surgical experience and continuum of care and not only short-term outcomes. This would include indications, preoperative evaluation, operative parameters, and long-term outcomes. Recent discussions have revolved around “efficiency measures”; although, during discussions about the “efficiency of care” the cost of care is always linked to quality to produce efficiency measures, it is of concern that the cost of providing care becomes a goal in and of itself. Furthermore, CMS and various private healthcare purchasers and insurance companies are pushing hard for expediency in the development of P4P measures and initiatives; it is concerning that the process is moving ahead of the infrastructure needed to support it. In addition, many other questions remain: How should we set performance targets? How many data should be required, and who should collect them? How about risk adjustment, and should we accept non–risk-adjusted data as a basis for P4P? Should providers be rewarded if they meet a target or if they improve from their baseline? Should incentives be directed to physicians, hospitals, or a combination of those?

As this process is rapidly moving forward, Vascular Surgery can take the position that the actual implementation of a comprehensive program is few years away, pay no attention to it now, and play catch up later or, preferably, be involved in the process. As we examine our options, please consider the following: It is incumbent upon us, as vascular surgeons, to be fully engaged in all aspects of this process, populating various national and local committees, subcommittees, and workgroups to maximize our impact. To do so, we need volunteers who are willing to dedicate their time and effort to this process. We need especially the involvement
of those in private practice. These colleagues are going to deal with these issues in their offices and practices; their challenges can be very different from those in full-time practice. Their input will be highly valuable.

Our influence will help make P4P medically and surgically pertinent and, thus, more acceptable. We should encourage our institutions to participate in ACS-NSQIP. The process is ongoing, and the sooner we get involved in it, the better. Vascular surgeons have always submitted themselves to self-critique. We have never shied away from discussing our complications; we should not be apprehensive or worried now about numerically representing our overall performance.

Finally, P4P is here to stay. The tide is too strong to reverse. No type of practice will be immune since both the public and private sectors are highly interested in seeing P4P programs expand and mature; they see it as an opportunity to improve quality and curtail cost. Most importantly, P4P has the full support of consumer  groups, the most prominent of which is the American Association of Retired Persons (AARP). This common interest in this one issue by Congress, insurance companies, health care purchasers, and the AARP is very powerful. The last time these groups got together, the unimaginable happened; Congress enacted the Medicare Drug Prescription Bill!

Article References

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Reprinted from Journal of Vascular Surgery, Volume 44, Number 4, October 2006, Anton M. Sidawy, MD, MPH, Washington, D.C., Pay for Performance: The process and its evolution, 892-902, Copyright 2006, with permission from The Society for Vascular Surgery.

Journal of Vascular Surgery (http://www.jvascurg.org)