An Iowa doctor describes the latest trend in how insurance companies deal with certain patients as a “medical quagmire.” Doctor Joe Molnar, of Charles City, says the new policy is called P-for-P, or Pay for Performance, which is used in determining what medical treatments will be covered. He says only certain treatments for certain conditions are being authorized.
Dr. Molnar says P-for-P is a formula that government and private health insurers are starting to coin that would link reimbursement with pay for performance. It’ll be dictated by “best practices” which he says, in many cases, will -not- be the best practice for the individual patient. Molnar says P-for-P can place limits on the care patients can receive, and that can impact how well the patient responds to treatment.
He says the best P-for-P, which isn’t very good, is based on a collection of data for a particular disease. Molnar says “If you have all of the little T’s crossed and the I’s dotted, they consider that to be excellent medicine,” but he says that’s not the case. He says P-for-P also bases the compensation doctors receive on how well the patients respond to treatment. The better the patients do, the more quickly the doctor is compensated and the amount the doctor receives in payments is higher.
Molnar says in cases where coverage is not provided for more effective treatments for certain conditions, doctors are penalized when patients don’t recover as quickly as they should. Also, he says doctors are penalized if patients fail to follow treatment guidelines and fail to recover as quickly as normal from conditions, even when the doctor has followed all of the guidelines. Molnar says more flexibility is needed in P-for-P programs to make sure patients receive the care they need based on their individual conditions and situations, and so doctors aren’t unfairly penalized because of restricted treatment or the failure of patients to follow instructions.