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Physician Pay for Performance Reimbursement Incentives Could Backfire

Kathleen Blanchard's picture

Experts from Johns Hopkins suggest new government incentives associated with healthcare reform that pay for performance could backfire. Obese patients often have poor health outcomes, and one third of the population is obese. An unintended consequence of pay for performance incentives could lead to financial punishment for physicians, hospitals, as well as discrimination toward obese individuals seeking medical care.

The hardest hit population according to lead study author Martin A. Makary, M.D., M.P.H., an associate professor of surgery and health policy at the Johns Hopkins University School of Medicine will be minorities. Dr. Makary says pay for performance incentives could lead doctors to “pass on, stall or delay treatment of obese patients, many of whom are minorities." African Americans and treating physicians would be hurt the most says Dr. Makary.

There is no disagreement about the need for taking good care of patients to prevent complications, cut healthcare costs, and provide the best patient care. Makary suggests better metrics are needed so doctors and patients aren’t punished with pay for performance healthcare reimbursement. There are known risks and increased cost associated with patients with obesity.

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"Rewarding providers based on outcomes is good when the outcomes are adjusted for case complexity or co-morbidities, but it can be discriminatory and create perverse incentives when metrics aren't adjusted. And what is the most prevalent and leading co-morbidity in America that skews outcome? Hands down, it's obesity."

Makary and his colleagues looked at insurance claims among obese and non-obese patients who underwent gallbladder surgery and appendectomy from 2002 to 2008. The group examined 30 day complication rates, finding that treating obese patients costs more. The total costs for an inpatient stay for basic gallbladder removal was $2,978 higher for obese patients and $1,621 higher for obese patients who had appendectomy, compared to non-obese patients.

Obese patients had higher rates of infection and hemorrhage and required second surgeries. Treating obese patients, especially those that need abdominal surgery, is complex. Pay for performance incentives could backfire, resulting in financial punishment to physicians and discrimination against obese patients, many of whom are minorities.

Johns Hopkins Medical Institutions