Pay-for-quality concept deserves to be judged on its merits

LETTER — Posted April 26, 2004

Print  |   Email  |   Respond  |   Reprints  |   Like Facebook  |   Share Twitter  |   Tweet Linkedin

Regarding "Fair pay a sounder approach than 'pay for quality' " (Column, March 1): AMA Board Chair William G. Plested III, MD, suggests in his column that there is little to be gained by linking compensation and performance in medicine. We would suggest that much has been lost by not doing so.

Research by the IOM, Rand Corp., Dartmouth, the National Committee for Quality Assurance and others supports the concept of pay for quality and rejects the status quo, which actually punishes quality by failing to reimburse for quality improvement efforts such as keeping a registry of patients with chronic conditions or reaching out to patients who need follow up. As sponsors and supporters of one of the largest pay-for-quality efforts -- the Bridges to Excellence initiative -- we believe that fair pay and pay for quality are not mutually exclusive. They can and must be the same thing.

We propose physicians ask the following questions to evaluate any such effort:

Were physicians involved in designing the program? Any successful effort will have physician input from the start.

How will performance and quality be measured? Any such effort should use adapted HEDIS or other such measures that are well tested, relevant and feasible. Performance thresholds must be readily available.

Will participating in the initiative help physicians improve their practices? Participating physicians should receive feedback on their performance on a regular basis. Physicians can and do use such feedback. It helps ensure better performance, and larger rewards, in the future.

What are the potential rewards? Available rewards should be sufficient to make the effort of participating worthwhile. Physicians participating in BTE can earn up to $20,000 per year in rewards and are recognized in selected network directories.

Is consideration given to risk-adjustment issues? BTE allows physicians to have their patient data risk-adjusted before it is scored by NCQA.

Are there any mechanisms in place to help physicians improve their practice and achieve the required performance levels? In particular, are county medical societies and quality improvement organizations involved in the effort and available to offer assistance?

But for space restrictions, this list could go on; we believe, however, that physicians are well-equipped to ask these questions and judge pay for quality on its merits. The alternative is simply to defend the status quo, in which good doctors get paid the same as those who don't measure up.

Margaret E. O'Kane*, president, National Committee for Quality Assurance

Thomas R. Reardon, MD*, former AMA president

Joseph Newhouse, PhD*, John D. MacArthur professor, Harvard University

Debra Ness*, executive vice president, National Partnership for Women and Families

Jeff Hanson, treasurer, Bridges to Excellence

Thomas H. Lee, MD, network president, Partners Healthcare System

Francois De Brantes, program leader, health care initiatives, GE

Helen Darling, president, National Business Group on Health

Dale Whitney, corporate health care manager, United Parcel Service

Russell Hoffman, MD, Louisville, Ky.

* Member of National Committee for Quality Assurance Board of Directors

Note: This item originally appeared at http://www.ama-assn.org/amednews/2004/04/26/edlt0426.htm.

Back to top



Read story

Confronting bias against obese patients

Medical educators are starting to raise awareness about how weight-related stigma can impair patient-physician communication and the treatment of obesity. Read story

Read story


American Medical News is ceasing publication after 55 years of serving physicians by keeping them informed of their rapidly changing profession. Read story

Read story

Policing medical practice employees after work

Doctors can try to regulate staff actions outside the office, but they must watch what they try to stamp out and how they do it. Read story

Read story

Diabetes prevention: Set on a course for lifestyle change

The YMCA's evidence-based program is helping prediabetic patients eat right, get active and lose weight. Read story

Read story

Medicaid's muddled preventive care picture

The health system reform law promises no-cost coverage of a lengthy list of screenings and other prevention services, but some beneficiaries still might miss out. Read story

Read story

How to get tax breaks for your medical practice

Federal, state and local governments offer doctors incentives because practices are recognized as economic engines. But physicians must know how and where to find them. Read story

Read story

Advance pay ACOs: A down payment on Medicare's future

Accountable care organizations that pay doctors up-front bring practice improvements, but it's unclear yet if program actuaries will see a return on investment. Read story

Read story

Physician liability: Your team, your legal risk

When health care team members drop the ball, it's often doctors who end up in court. How can physicians improve such care and avoid risks? Read story

  • Stay informed
  • Twitter
  • Facebook
  • RSS
  • LinkedIn