To date, our customers have faired quite well under most of the P4P plans.  We have some clients adding (it appears) as much as 10% to their bottom lines.  We had one client pay for their new EHR with it.  And, for the most part, the reporting hasn't been horrible.

A new twist floated past my desk the other day (thanks, Lynn, you know who you are!).   Rather than cut checks to the practices on a monthly or quarterly basis to be recorded properly, a handful of these programs have decided to have the patients pay at least some portion of the P4P "bonuses!"

How does it work?  If a practice does the right thing, whatever it may be, the insco then adds some small extra allowable onto the charge in the EOB.  For example, if the HMO would normally pay $40 for a 99213, they might pay $43 for a specific encounter.  Actually, they have it come out of the patient deductible.  Nice trick.  They don't actually have to pay for the first few months of P4P bonuses, if at all.  Ignoring the enormous accounting challenge this creates (how can you possible even track what is due to you all the time, now?  Does everyone have the ability to track "P4P allowance" on a charge-by-charge basis?), the inscos know that they are off the hook for the the extent of any unused deductibles.