The Obama administration prescribes pay-for-performance for doctors. What could possibly go wrong?

Do you ever feel as though reading one more word about our failed and failing public schools will cause your head to pop off of its very brain stem and spin wildly in the air before reattaching itself at an angle most askew? That is what is known as a medical condition, reader, which is why I am prescribing for you an immediate treatment course consisting of a winebox, bed rest and a change of scenery. Today’s topic: health care—specifically the Obama administration’s brilliant new policy of rewarding the excellence of doctors and hospitals through an innovative approach called *pay for performance.* What could possibly go wrong?

Code pink
As the consumer of a great many medical dramas, I know that the first step towards treating an improbably obscure ailment is to diagnose it. In short, our health care system is (f)ailing and all of its graduates will eventually pass on to the waiting room in the sky. Also, too many doctors have been just *showing up* to collect their McDreamy salaries, which they receive regardless of whether the limb they’ve just removed is the correct one. Thankfully, the Obama administration has a team of experts standing by to save the day—again. 

Pay 4 performance
But what remedy to prescribe??? Spying on the hospitals was one possible solution but those HIPAA privacy rules were such a bear. The other one-sized-fits-all prescriptions, drone attacks and deportation, didn’t seem to quite fit here either. Which left just one cure-all: pay for performance. While corporations were fleeing the practice in droves, it was working great in public education, except as evidenced on the government’s own What Works Clearinghouse™, which according to the government’s own metrics no one ever looked at anyway. In other words: whatevs.

Totally unexpected side effects 
Here’s where our story takes a completely unexpected and yet astonishingly familiar turn. Intended to reward *high quality health care,* the Obama administration’s introduction of pay for performance for doctors and hospitals has ended up punishing those that treat *large numbers of poor people.* Also, also the payment policies are *unintentionally worsening disparities* between rich and poor by shifting money away from doctors and hospitals that care for disadvantaged patients. Also, also, also providers with a disproportionate share of disadvantaged patients appear to *provide lower quality care* than they actually do. 

Rxpectations
The Rxperts at the National Quality Forum who found these findings also recommended apossible course of treatment. Why not adjust measures of health care quality and performance for various *sociodemographic factors*? Because as the group’s president explains: *Factors far outside the control of a doctor or hospital—patients’ income, housing, education, even race—can significantly affect patient health, health care and providers’ performance scores.* I don’t know about you, reader, but I think we can safely diagnose these doctors with an ailment with which you’ll be most familiar: low expectation-i-tis. Obama administration, take it away: *The administration has said adjusting the data for social or demographic factors would be equivalent to accepting a double standard, with lower expectations for the care provided to low-income patients.*

Double dose
If you feel like you’ve read these exact same words before, it may mean that you have double vision, which you might want to ask your doctor about. But there is a little something different about this particular tale. You see, unlike teachers who long ago lost any hope that either President Obama or Arne Duncan can be swayed from their prescription of *tough medicine* for the nation’s public schools, the doctors involved here still believe that Obama and his team of experts can be reasoned with. Like this National Quality Forum panel member who observed that while the administration was *inadvertently exacerbating disparities in access to medical care for poor people who live in isolated neighborhoods,* he was sure that that wasn’t what President Obama had intended. I believe that reaction is what’s known as denial on the Kübler-Ross scale. Don’t worry, young medical professional. Like a slight case of the monkey pox, this too shall pass. About the time that Team Obama announces plans to rate the nation’s medical schools by their graduates’ performance in the operating room.