Readers know how I would vote on this debate.  Should Physician Pay Be Tied to Performance?

The con side is well done, however, it does miss a major point.  Performance is too complex to summarize in measures.  We have a responsibility to individualize therapy – be patient centric. Some patients deserve different goals than others.  Trying to assume that we should always treat each disease in the same way ignores the co-morbidities, the social situation, the patient’s age and many other issues.  Performance measurement does not apply to every patient, because we will never have performance measures for every disease and every manifestation of the disease.  Performance measurement does not value diagnosis.  It does not value bedside manner – patient satisfaction is NOT a proxy for bedside manner.

P4P is a horrible idea for many reasons.  But the wonks will not give up this idea.