American Medicine: P4 What You Will
The payment system in the US is complex. There are multiple payers, uninsured patients, concierge care, CMS, e/m coding, CPT, ICD-9 (soon to be 10), EMR, CPOE, and a multitude of other nuances that make the alphabet soup of American medicine. Confused by it all? You are not alone. It seems that solutions to the current mess just make the situation more of a mess.
Perhaps the hottets topic in medicine is Pay for performance (P4P). While P4P has gotten lots of attention, as well as taking much fire from critics, it is not the only way to pay physicians. To help you through the quagmire I have set up a table of some of the more common forms of payment:
| Acronym | What it stands For | What it looks like in Real Life | Pay |
| P4P | Pay for Performance | Paying money to doctors for meeting certain “performance” criteria (such as preventive care or diabetes care | ?? |
| P4SLOP | Pay for Seeing Lots of Patients | The current form of medical reimbursement for primary care. The more people you see in less time, the better paid you are. (AKA PM4L- Pay More For Less) |
$$ |
| P4PREP | Pay for Performing Really Expensive Procedures | Another means of making money in the current system. This accounts for the high pay of may subspecialists | $$$$$ |
| P4SCOOP | Pay for Steering Clear of Objectionable Procedures | How to deal with managed care. If you stay away from unauthorized procedures, your staff can do more important things than sit on the phone talking to an elf in front of a computer | $ |
| P4TOPTAR | Pay for Treating Only Patients That Are Rich | Concierge medicine. Charging a large fee for patients to get “access” to care. Then offer these “select” patients a level of care that the general population cannot get. | $$$ |
| P4PIE | Pay for Placating Insecure Egos | Cosmetic Surgery | $$$$$$$$ |
| P4ALH | Pay for Avoiding Living Humans | Pathology | $ |
| P4SCP | Pay for Solving Crossword Puzzles | Anesthesia | $$$$ |
| P4SPA | Pay for Soothing Parental Anxiety | Pediatrics | $ |
| P4KBH | Pay for Keeping Banker’s Hours | Radiology | $$$$ |
| P4POOP | Pay for POOP | Gastroenterology | $$$$ |
| P4PEA | Pay for PEA | Urology/Neprhology | $$$$/$$ |
| NP | No Pay | Psychiatry | NA |
Do you have more? I would like to hear other payment criteria I have missed.
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