Assume the Position!: Major Medical Society Statements on Pay for Performance

Published: Thursday, Feb 21, 2008
As healthcare costs continue to soar out of control, the push to contain costs by tying physician reimbursement to patient outcomes that conform with pre-determined quality indicators is gaining momentum, with the Centers for Medicare and Medicaid Services and other federal programs leading the way. Many professional medical societies are at least nominally supportive of the concept of pay-fo-rperformance (P4P), with many crafting official position statements in the past year or two that outline goals for programs that measure physician quality. Many of these documents also express concerns over the validity of some measurements, the need to provide incentives for physicians to invest in the information technology and other tools that will be necessary for participation, and other necessary components and provisions of these programs. This feature provides a snapshot of the current dialog about P4P, with links to reports, articles, and other online resources that present a variety of perspectives and opinions.


Document online. Although supportive of the general concept, the Society’s statement notes that  "A pay-for-performance infrastructure is contingent upon the development of evidence-based performance measures--a task that has proven challenging. To date, several groups are working to develop and test measures for implementation. However, it is difficult to develop standardized measures across medical specialties. In addition, developed measures must be tested, which can be tedious, time-consuming, and expensive. A proper infrastructure is critical to ensure appropriate and systematic collection of data from practices, as well as protect patient privacy." Like many groups, the Society is leery of ceding too much decision-making authority to the dictates of "best practices," noting that "variations must be allowed to meet the unique needs of an individual patient based on the physician's clinical judgment." The Society also has specific concerns related to linking P4P to changes in the physician payment system, especially where Medicare is concerned--the Society comes right out and claims that "any P4P program will not work under the current sustainable growth rate (SGR) payment formula. The two are inconsistent methodologies, and the Society believes that the SGR must be repealed if P4P is to be successfully implemented." The Society is also concerned that "data collection requirements intrinsic to P4P programs should not place financial or administrative burdens on providers." The ability of small practices to comply with P4P reporting requirements, as well as the ability of practices that care for underserved patient populations and practices that do not possess sufficient hardware and other technology resources, must also be taken into consideration.

For Your Consideration

The Endocrine Society P4P position statement raises the issue of how to account for treatment outcomes in the current health-team approach to care. Given the overlap in care provided across specialties, how can P4P programs incorporate outcomes that rely on multidisciplinary approaches while holding each individual provider accountable for his or her performance?

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Document online. "However." That word inevitably comes up before too long in just about everything we read about P4P. And the ACC's position statement is no exception. The American College of Cardiology Foundation, we are told, "recognizes the importance of, and supports the concept of, paying for performance to inspire greater focus on improving care delivery systems. However, physician pay-for-performance programs should be designed to support and facilitate the quality improvement process and strengthen the patient - physician relationship, not just reporting performance and outcomes." The ACC goes on to outline 12 important principles that should guide P4P program development, including the usual suspects of providing "adequate incentives for investments in structure, best practices and tools," determining performance targets through a "national consensus processes" that addresses a variety of factors, ensuring programs "emphasize success and reward achievement," and that provider rating methods should be transparent.

One interesting note: the ACC makes it a point to express its support for programs that "favor the use of clinical data over claims-based data," in contrast to the contention made by some CMS officials that risk-adjusted claims and billing data tracks closely with clinical data. More on this subject.

For Your Consideration

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