And you thought pay for performance was tough medicine

Pay for performance (P4P) programs typically reward providers with a few percent bonus for meeting or exceeding guidelines. Some even threaten to withhold a couple percent for bad performance. As they gain confidence in the guidelines and P4P mechanics, health plans are getting ready to take the next logical step: not paying hospitals that don't follow the guidelines.From today's Boston Globe (Guideline is skirted on obesity surgeries)

At least five Massachusetts hospitals continue to perform obesity surgery although they don't do enough of the operations to meet voluntary patient-safety guidelines issued more than a year ago. But now the state's largest health insurer, Blue Cross and Blue Shield of Massachusetts, plans to add teeth to the recommendations: Starting in 2007, it will no longer pay for the procedure at hospitals that fall significantly short of these and other standards.

If this is the start of a trend the implications for hospitals and physicians will be profound.