Pay-for-Performance Doesn't Shortchange Patients

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That finding should also "be reassuring to doctors who are concerned that their efforts to manage patients who have a lot of complex conditions would be at a handicap under pay-for-performance," she said.

But the finding does not necessarily apply to all people treated in all medical centers, Petersen cautioned. "The Veterans Administration has a lot of special systems in place to improve the quality of medical care," she said. "It has excellent electronic medical records and systems to report on the quality of care."

Many medical centers don't have such systems, she said, but "the VA could serve as a model for them."

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The study does speak to the value of electronic medical records, said Dr. Vincent J. Bufalino, president and chief executive officer of Midwest Heart Specialists, a 50-physician cardiology group in suburban Chicago that has such a system.

"It makes you better because you don't have to read anyone's handwriting, including my own," Bufalino said. "It does streamline your ability to take care of these folks."

And the study has meaning for blood pressure treatment strategies, he added. "It says that knowing someone is sick doesn't mean you can't control his blood pressure," Bufalino said. "You can do it with good follow-up in an electronic setting."

The message for physicians is the importance of meeting guidelines for good medical practice, said Bufalino, who sits on the physicians advisory council for Medicare. "We're not going to pay you as much if you don't meet the guidelines," he said.

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Recommendations on blood pressure control are made by the American Heart Association.

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