By NextBestFitReport measures publicly without tying pay to them
Publish data for transparency but don't attach bonuses, removing the incentive to game.
Draft decision:RejectedConfidence: medium · not yet reviewed
Some pay-for-performance kept (wait guarantees, risk adjustment).
Review ledgerHow this path connects
This path
Report measures publicly without tying pay to them
Concrete changes if chosen
What would actually have to change in law, agencies, payment rules, or systems.
- Publish measures without tying pay
Effects
Each effect has its own page: the evidence, the case that it is or isn't a real cost, and whom it affects.
What it fixes
- Targets and quality metrics invite gaming
Publishing performance data without bonuses removes the financial incentive to game and reduces administration.
- About $1 trillion a year in administrative cost
Publishing data without attaching bonuses requires less administration.
What it creates or worsens
- Weakens incentives for desired behavior
Removing performance bonuses weakens the incentive associated with the measures.
- Leaves less complete or useful data
Publishing data without bonuses may reduce data quality.
Who's affected
Who gains
- People with ongoing or specialist care needs
- Targets and quality metrics invite gaming: Gaming wait-time and quality measures undermines their intended protection.
- Doctors, nurses, and other clinicians
- About $1 trillion a year in administrative cost: Time goes to billing and insurer rules instead of patients.
- People with employer coverage
- About $1 trillion a year in administrative cost: Premiums pay for the administration.
- Taxpayers and public budgets
- About $1 trillion a year in administrative cost: Public programs pay for it too.
Who loses
- Hospitals, clinics, and care organizations
- Targets and quality metrics invite gaming: They can benefit by changing referral dates, avoiding sick patients, or upcoding.
- Health insurers, brokers, and their shareholders
- About $1 trillion a year in administrative cost: Insurers, billing firms, and clearinghouses earn from the complexity.
- Insurance and billing workers
- About $1 trillion a year in administrative cost: Their jobs exist because of the complexity.
Where it has been tried
- U.S. MIPS critique: MedPAC recommended ending MIPS.