Another possibility for P4P

Technically, I don't believe that we are at the point that we would want any outside source determining whether we have provided quality service or not.  And truthfully, I'm not sure if we ever truly want some outside party controlling the decision-making process.  Initially, if P4P becomes an actuality, we should have the greatest amount of control.

CMS has now required reporting measures and technically no strict requirements are in place.  This is actually a good thing.  It is advantageous to have professional control to determine the tool or functional assessment test to utilize.  The documentation of various measures is a start, but CMS isn't doing anything with the data because the data isn't being provided to them.  Technically the only time that CMS will see that outcome measurements were used is if an audit occurs.  An audit definitely isn't going to be performed from a quality perspective, but instead from a perspective of CMS fining and capturing money back secondary to lack of meeting documentation requirements.

I liked the idea that Dennis Hart presented in the work on P4P and outcomes.... the idea of a sliding scale of how a provider would be paid.  What I did not like was some computer generated target goal.  We aren't there yet... there isn't enough data yet... and frankly, how much of those generated goals were for the geriatric population alone?   To go the definite and difficult route of being evaluated based on actual outcomes and that being tied to reimbursement, we as providers need the control.  For example:  identify the tool to measure change; indicate the amount of change that is clinically relevant; then, determine the target goal at discharge and  determine the number of visits needed to reach the target goal.  Of course, we all aren't stupid so we'd be generous in the number of visits to make darn sure the goal could be met within the indicated number of visits (which means that on a sliding scale that had two parts, we could always be under in the number of visits but the rolling of the die would be in whether the target goal was met or not met).  The other area would be that the target goal would need to be outside of the amount of clinically relevant change.  Granted, the system could be beat in choosing a low target goal to ensure it occurred and play the system that way initially.  Initially, this would be reasonable, especially if therapists haven't used outcome data in goal setting combined with no available data set for comparison.  As years go by though and data become abundant, then the system could be tightened down for less wiggle room in playing the system.   For now though, lots of wiggle room is required. 

On another note:  Physicians haven't aligned themselves with P4P in a manner that measures anything except their behaviors.  "Quality" for physicians is only based upon the clinical actions taken - for example:  certain tests ordered, certain meds prescribed.... Physicians have full control of meeting "quality."   Do we as providers want to instead be measured based on our actions for items like:  home exercise program provided, educated on "blank," recommended "blank?" 

Just some ideas that were rumbling around in my head.  We should be held accountable for our services.