Opinion

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

LETTER — Posted April 26, 2004

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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.

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