Could Pay-For-Performance Lead To Overuse Of Antibiotics?
Not long ago, the Joint Commission (a healthcare quality organization) established that patients with pneumonia should receive antibiotics within four hours of diagnosis. Timely diagnosis and treatment can be the difference between life and death in patients with this illness. In fact, some people believe this kind of quality measure should play a large role in how we pay for medical care. After all, doctors should not be paid solely on the basis of how much care they provide, but also based on the quality of that care. All else equal, a physician who treats pneumonia efficiently should be rewarded more handsomely than one who takes a fortnight to make a diagnosis.
Only one problem with this seemingly sensible view. Experts believe this four-hours-to-treat requirement leads to an over diagnosis of pneumonia and, consequently, to an overuse of antibiotics. How we measure healthcare quality, and how we factor such measures into physician reimbursement, can have surprising effects on how physicians diagnose and treat patients.
Consider another life-threatening illness – sepsis, a syndrome of widespread inflammation and, at its most extreme, multi-organ failure caused by infection. Sepsis typically requires not only high power antibiotics but also intensive care from multiple specialists. A recent article in the New England Journal of Medicine suggests we may be experiencing an over diagnosis of this syndrome, because hospitals often receive higher reimbursement for patients with sepsis than for ones with milder infections. In other words, it pays not to miss sepsis diagnoses. (Visit Forbes to read more and leave comments.)
