While I was away Retired Doc linked to this article in the Annals of Internal Medicine, fueling more skepticism about pay for performance (P4P). The results of P4P programs, according to this systematic review, may be more cosmetic than real. Providers seem to be gaming the system and treating the chart rather than the patient.
This isn’t new. We’ve been playing chart games ever since reimbursement was tied to E and M coding, leading to the popularity of template generated progress notes. As a hospitalist who cares for a large number of “unassigned” patients I depend a great deal on outside records. From the vantage point of patient care the template generated notes (of which I’m seeing more and more) are the least helpful. Templates force all the “right” questions to make the coders happy, but produce little meaningful clinical information. P4P will fuel even more cosmetic charting and make the problem worse.