Pay-For-Performance, Setting Patients up for Higher Bills?

The letters to the editor, in response to the Times article I wrote about previously, viciously point out the inherent problems with a PFP reimbursement approach. You can read some of them HERE. A good point: "If hospitals are forced to provide free corrective treatment to victim patients, those costs will become part of hospital overhead, which we will all pay for anyway." Is that all that PFP does, skips the bill so that both providers and patients are left with the difference?

Another question we have to ask when debating PFP is whether this system demands no errors in an industry that cannot exist without some errors. Although we would love to avoid every preventable accident in medicine, it may be dangerous to punish an industry that relies on risk/benefit ratios, experimental treatments, and other efforts to treat diesease. From one of the letters:

"It is important to understand the context in which medical events like catheter-related urinary tract infections and pressure ulcers occur in hospitalized patients.

These patients have multiple chronic medical problems and are often immobile and institutionalized, having lost the ability to care for themselves because of diseases like Alzheimer’s or severe stroke. Others are in intensive care units suffering from multisystem organ failure and on the verge of death.

Therefore the analogy to use should not be one of an auto mechanic accidentally breaking the windshield while repairing the engine. Rather, it should be of the mechanic who is required to perfectly repair a vehicle that arrived at the shop totaled."