Hugs, Tweets, and Physician Reimbursement — A Problem for Pay-For-Performance

According to recent research, a hug a day could keep the doctor away. According to another study, twitter can predict the chance that people will experience heart attacks. A normal blogger would look at these two findings and tell a story about the relationship between stress and health. I’m not normal. I looked at these two studies and came to a different conclusion – that we need to change the way we reimburse physicians.

Want to know how I arrived at that view? Let’s start with a quick look at the two studies.

A research team headed by Sheldon Cohen from the University of Pittsburgh exposed volunteers to Rhinovirus particles and monitored them for signs and symptoms of illness, going as far as weighing their nasal mucus. (Isn’t research fun!) Consistent with previous research, they found that people under psychological stress were more likely to become sick, unless they reported having strong social support in their lives. You see, stress creates a neurohumoral cascade, a series of physiologic reactions in the body that impair the immune system. But social support can buffer the immune system.

Even more interestingly, Cohen discovered that hugs – the likelihood that a volunteer was hugged each day – further buffered people’s immune systems, reducing colds even after accounting for the other kinds of social support people received. Hugs are good medicine!

What does this hugging study have to do with physician pay?

In the old days, health care reimbursement was based primarily on the volume of services medical providers provided. Perform one procedure and receive payment; ten procedures and receive ten payments. Perform one annual exam and you’ll be paid for one annual exam, well… you get it. More recently, payers have tried to shift from such fee-for-service payments to pay-for-performance methods. Two doctors might charge Medicare for conducting annual exams on their patients, but if measures show that one does a better job of making sure her patients receive appropriate preventive measures, she will receive higher payments than the other physician. In this case, Medicare would be relying on process measures of care to adjust payments. In other cases, pay-for-performance is based upon outcome measures. For example, cardiac surgeons might receive different levels of pay at the end of the year depending on the survival rates of their patients who undergo specific procedures, after accounting for the severity of patients’ underlying illnesses before the procedure. It’s these outcome-based pay-for-performance measures that are threatened by hugs and tweets.

(To read the rest of this article, please visit Forbes.)

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