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Implementing P4P in a Family Medicine Residency Program: From the Residents’ Point of View

Implementing P4P in a Family Medicine Residency Program: From the Residents’ Point of View. Laura Pattison MD Outgoing Chief and P4P Advocate Maya Miley MD Incoming Chief and P4P Skeptic. The Survey. 1 strongly disagree 2 disagree 3 neutral 4 agree 5 strongly agree

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Implementing P4P in a Family Medicine Residency Program: From the Residents’ Point of View

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  1. Implementing P4P in a Family Medicine Residency Program: From the Residents’ Point of View Laura Pattison MD Outgoing Chief and P4P Advocate Maya Miley MD Incoming Chief and P4P Skeptic

  2. The Survey 1 strongly disagree 2 disagree 3 neutral 4 agree 5 strongly agree 1. I feel I have a very good understanding of what “pay-for-performance” means. 2. I feel I have a very good understanding of P4P practice guidelines that our clinic is following at this time. 3. I believe P4P practice guidelines have improved my medical knowledge. 4. I believe P4P practice guidelines improve my efficiency in clinic. 5. In particular cases I have a conflict between doing the right thing clinically and following P4P guidelines. 6. I am insulted by the idea that I should follow practice guidelines for financial incentives. 7. I believe P4P will result in better patient outcomes. 8. I like the idea that physicians should be paid for quality of care as well as quantity of patients seen. 9. I like having clear goals and expectations for diabetes care (e.g. “grand slam”) 10. I believe P4P implementation at my clinic has improved my understanding of clinic operations/ finances. 11. I believe P4P practice guidelines are being smoothly integrated into practice at my residency program. 12. I find P4P practice guidelines to be distracting. 13. My overall impression of P4P is negative. 14. I believe I can fly. 15. I believe I can touch the sky. Comments:

  3. I feel I have a very good understanding of what “pay for performance” means

  4. I believe P4P practice guidelines have improved my medical knowledge

  5. I believe that P4P practice guidelines improve my efficiency in clinic

  6. In particular cases I have conflict between doing the right thing clinically and following P4P guidelines

  7. I believe P4P will result in better patient outcomes

  8. I like having clear goals and expectations for diabetes care

  9. My overall impression of P4P is negative

  10. I believe I can fly

  11. I believe I can touch the sky

  12. P4P and Medical Knowledge

  13. Cons Less critical thinking “tunnel vision” inability to see or manage well exceptions to the rules Pros: Clear goals early on Faster learning Easy data collection for objective feed back P4P and Medical Knowledge

  14. Physician-Patient relationship

  15. Pros: Patient more engaged knowing the goals of their care Enhances relationship appreciates aggressive and equal management Cons Patient becoming a set of numbers v.s. humanistic vision Resentment towards patients not following our advice? Competing agendas P4P and Physician-Patient relationship

  16. P4P and Patient Care

  17. P4P and Patient Care • Pros: • More aggressive management to obtain excellent results • Improves consistency • Less errors or incomplete care? • “Equality of care” • Cons: • Guidelines not patient-population specific: medically complex, socially disadvantaged, elderly… • Clinics serving these pts may be financially disadvantaged

  18. P4P and Clinic Efficiency

  19. Pros: Clarity of guidelines allows consistent systematic approach to complicated diseases EMR templates can simplify a visit Con: Increased documentation and bureaucracy P4P and Clinic Efficiency

  20. Conclusions • Overall response to P4P positive • Residents need more repeated exposure to general principals and specific guidelines of P4P • We need greater understanding of how this might impact medically and psychosocially complex patients

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