Ignoring Evidence Basis in Health Policy Is Unhealthy

One year ago today we had all the evidence that we needed to move away from payment policies that punished practices and delivery team members with meaningless use and other abuse. A year ago today, a landmark comprehensive review indicated that outcomes were not improved by financial incentives.

 

“In summary, we found low-strength, contradictory evidence that P4P programs could improve processes of care, but we found no clear evidence to suggest that they improve patient outcomes.” from

The Effects of Pay-for-Performance Programs on Health,Health Care Use, and Processes of Care: A Systematic Review, Annals of Internal Medicine 1/10/17.  

 

Happy Anniversary to Aaron Mendelson, BA; Karli Kondo, PhD; Cheryl Damberg, PhD; Allison Low, BA; Makalapua Motúapuaka, BA; Michele Freeman, MPH; Maya O'Neil, PhD; Rose Relevo, MLIS, MS; Devan Kansagara, MD, MCR for a fine study - substantially ignored 

 

Not even primary care associations have moved away from financial incentives. In fact AAFP continues to promote its own confusing version rather than supporting the evidence basis - and working to stop policies that hurt family practice most of all.

 

The preoccupation with meaningless use has actually delayed progress on meaningful health reforms such as 

• Better payment for cognitive, office, basic services
• Payment equity for practices serving where needed - not 15% less.
• An end to higher costs of digitalization, innovation, regulation, and certification instead of 50 - 100% more for each as measured per primary care physician 
• An end to costly and cumbersome financial designs

Meaningful Health Reform Is Not Even on the Radar Scope

 

A year ago this blog called for an end to the disruption of financial incentives.

 

The financial design in areas such as primary care is so broken where most Americans most need care that recovery will take decades and no training design can overcome the power of the financial design to punish practices where needed. 

Health reform is constantly in the news - but sadly the health care news includes far too much fake news inserted by those doing well or hoping to do well by the new opportunities set up by a focus on pay for performance, financial incentives, value based, and other meaningless, costly abuses.

False health reform includes 

• Micromanagement of cost that cost as much as saved (CBO) and 
• Micromanagement of quality that is costly, adds to meaningless complexity, and does not significantly change outcomes (Annals IM comprehensive evidence based review exactly one year ago)

False claims include the promotion of new schools, programs, or other training interventions as solution for health access. They are incapable of overcoming the limitations of dollars specific to each of 

• Primary Care
• Women's Health
• Mental Health
• Small Practices
• Small Hospitals
• 75% of the rural population with lowest concentrations of health workforce
• 32% of the population most behind in urban settings with lowest concentrations

Happy Anniversary to the study that should have halted meaningless use. 

 

Sullivan, Soumerai, Jha, and others have also called for the end of this crabgrass They have exposed the discrimination, the false attribution, the inability to assess risk, the costly complexity, and more. The financial incentives continue to spread like crabgrass despite the evidence basis, despite logical thinking, and despite common sense.

When health reform and the evidence basis from the literature both line up against the major direction of payment policy (financial incentives) and the nation does not pay attention - we have a failure to communicate or worse. We have the designers that have belief in false assumptions. At a time when science appears under attack, we need those who claim to be scientific and evidence based to comply.

 

With any reflection it is clear that too much health care news is fake news. And as such, this also defeats the value of journals, articles, the media, and social media