Medicare and other third-party payers are moving toward a pay-for-performance system

Medicare and other third-party payers are moving toward a pay-for-performance system, also known as a value-based purchasing system. This means that clinical social workers and other providers may be paid for the quality of the service rendered rather than a fee for service. The quality of service may be determined by the use of specific measures in practice.

What’s your opinion about pay for performance, and how do you think it may affect clinical practice?

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4 Responses to “Medicare and other third-party payers are moving toward a pay-for-performance system”

  1. Leslie Krom Selden Says:
    November 22nd, 2009 at 12:33 am

    This is a damaging, inappropriate model for human services of all kinds, i.e. school teachers as well as social workers. It is most appropriate for factories, where performance is easy to measure. Yet even in manufacturing settings, workers formed unions and therfore are paid by an hourly wage, not their productivity. Performance can only be measured when accurate pre and post tests are given. In our profession, meaningful pre-tests would need to be so comprehensive as to be cost-ineffective. To judge the “performance” of a social worker with a particular client, considerations would need to be factored in including estimates of an individual client’s internal and external resources and supports that impact on their likely capacity to make positive changes, as well as data re: typical prognoses for various diagnoses. Furthermore, meaningful “results” occur over time, not always in a specific time period. Social work involves processes over time between the helper and the helped (often plural), sometimes with immediate and countable benefits, but often with many levels of benefits, rather like ripple effects that fan out over time.
    It is noteworthy the extent to which the wealthy and powerful in our society maintain therir postions and pay regardless of their performance. However,
    those of us in human service professions, already overworked and underpaid, are at risk of being subjected to this bizarre experiment of “pay for performance”, which could jeopardize our already meager incomes and tenous job security. Especially given the current constraints from insurance companies and decreasing community funding, which can present significant obstacles to giving our best to clients. On some level this seems like the latest brainchild of some idealogues to cut costs, with no conception and/or concern for the human costs to clients and workers alike.

  2. marybrenneman Says:
    January 25th, 2010 at 2:27 pm

    i think that this model takes away our rites as providers to :be where the client is,and provide what is best for them.we as providers need to fight thid model as it gives the ins. companies even more power over what they will pay us.Also, who makes the decision on my performance? The client and the provider can do this.I as a provider should have ultimate on what and does not work for my clientand refer as needed. Please send me where to write about this issue.

  3. Don Horsley Says:
    January 27th, 2010 at 11:01 am

    I second what Leslie Krom Selden has to say about pay-for-performance, perhaps even more so than most since I’m a couples counselor. I cannot/will not promise “success” in therapy, only the guarantee that they’ll never view themelves in relationship in the same way again. “Pay-for-performance” when a couple comes to me in crisis, both partners dysfunctional in the partnership, often one of them dysfunctional in another critical realm of their life……Please: where’s the hazardous duty premium in this scheme?

  4. CaroleTrickett Says:
    March 18th, 2010 at 1:09 pm

    This is so ridiculous it is hard to comment on - It is in the same league as the unversity’s attempt to view students as customers. The value to be found in a casework relationship is often intangible and no less important than a tangible result as in motivating individuals to become a successful student and so. This is so entirely naive I cannot believe that it is being considered. I agree with comment # 1. Here we are in a skewed society.

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