In health care circles, "pay for performance" for doctors is a hot topic. But how about pay for performance for patients? Wouldn't that be the ultimate "skin in the game?" (Aside from our literal skin, that is.) Isn't it what many employer wellness programs are doing, or beginning to do, already? Why not use money as both carrot and stick to induce better health behaviors? And is that enough questions for one introduction?

Dr. Steward Segal, an Illinois family physician, has a provocative post on KevinMD.com about his plan to create "PP4P" — patient pay for performance. He writes:

Recently, I have reassessed my P4P stance and believe that a system that pays patients for performance could work.  Yes, “patient pay for performance (PP4P)” would be a good thing.  As I envision PP4P, patients would be given performance guidelines and be graded on adherence to treatment plans, consistency in taking medications, participation in timely follow up visits, weight loss, and appropriate exercise.  Of course, there are many other performance standards that could be set for patients depending on what ails them.

A diabetic could be graded on his/her blood sugar control.  A patient with hypertension could be graded on his average blood pressure.  An obese patient could be graded on continued weight loss.  Paying patients for performance makes a lot of sense.  All we need is a grading system.

Dr. Segal writes that he's developing that system, and "It’s time to grade patients so that those with low grades can realize the errors of their ways and have a chance to improve their performance."

Readers? Would you want to be one of Dr. Segal's patients?