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 hottest 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.