It turns out the the Oklahoma Highway Patrol, in spite of years denying this, are paid on commission.  In a crisis of conscience, a trooper, worried about the public’s perception of him and his fellow “officers” has anonymously revealed that “pay-for-performance” is at work within this group, a policy handed down from management who refused to be interviewed for the “Tulsa World” newspaper article revealing this.  In some areas of the state, 30 arrests for driving under the influence must be made by each officer to reach the “bonus” level.  In addition, 40% of traffic stops or more should result in fines or tickets, not warnings, in order to reach the next level of pay.  

Local attorney, John Hunsucker is quoted:  ”When their paycheck depends on and their raises depend on the numbers of stops they do, then at that point are they really enforcing the law or are they seeing stuff?  You  see some exaggeration.”  

Quoting from the article: “Hunsucker said the patrol has other motives besides safety to enact such policies.  He noted that court costs and fees generated by arrests and citations add money to the agency’s coffers in tight budget times.”  

“You are going to see more situations where you are going to be pulled over for doing nothing more than driving at 2 o’clock in the morning,” Hunsucker said. 

I would maintain that it is just as crazy to pay physicians for performance as to give incentives to the police to write us tickets or arrest us.  ”Pay for performance”, just as it will result in bizarre results in law enforcement will do the same or worse in medical practice.  First, surgeons will more likely operate on normal people.  What?  If nothing is wrong with someone to begin with, they will more likely have a great outcome.  On the flip side, people who are sick and high risk will have more trouble getting care as the increased likelihood that they will end up with a bad result, will “foul” the doctor’s performance statistics and lower his reimbursement.  ”Pay for performance” will ultimately act as a rationing tool for the sicker more complicated patients, as taking these folks on will expose the physician to the risk of a lowered paycheck should the patient not do well.

“Pay for performance.”  A bad idea for the police and a bad idea for physicians and their patients.  What sort of arrogant lunatics come up with this stuff?

G. Keith Smith, M.D.