AMA's pay-for-performance stand will benefit patients

Regarding "Delegates set strict standards in pay-for-performance programs" (Article, July 11): It was with great joy that I learned that our AMA House of Delegates has taken a strong position in favor of a patient's right to receive medical care in their best interest.

By strengthening the AMA's Pay-for-Performance Principles and Guidelines and demanding adherence to them by government and private payers, the AMA has staked out its position as an advocate for the patient.

Patients and medicine face two clearly different pathways over the next 10 years. One path would have patients continuing to receive the highest quality medical care in the world with special attention to potential areas of quality improvement led by physicians in the interests of their patients. The alternate, the PFP pathway advocated by the so-called "patient safety" movement and large corporations, will lead to a vast socialization of medical practice. No longer will the patient's best interests be paramount. The first considerations will be cost savings for others and the political and social agendas of government bureaucrats and special interests. The AMA must never submit to carte blanche support of such PFP programs.

Some worry that such a "line-in-the-sand" approach will hurt the negotiating position of organized medicine and physicians. Those worries are not valid as long as our AMA always represents the best interests of the patient first. If Medicare won't fix the pay formula without PFP, then let it lapse, and patients will demand a fix.

The PFP pathway would have physicians providing their practice data to bureaucrats in the government and at private payers. That data would be reviewed for its consistency with cookbook medical protocols. Payment would be based on physician compliance with such protocols and some, if not many, physicians will be "deselected" from participation as providers. The cookbook protocols and algorithms will give lip-service to evidence-based medicine, but in the end will not meet the scientific rigor truly required by EBM. Patients will lose as our medical system is transformed from one based on the interests of individual patients to one based on the interests of government, insurers, special interest groups.

Thank you AMA House of Delegates for standing up for my patients and my practice!

David McKalip, MD, St. Petersburg, Fla.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2005/08/08/edlt0808.htm.