Pay-for-performance at odds with the idea of patient autonomy

LETTER — Posted Jan. 16, 2006

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

Regarding "IOM: New agency needed to simplify pay-for-performance measures" (Article, Dec. 19, 2005): I am growing more alarmed at the onward march toward pay-for-performance initiatives. Virtually every publication I read has an article in each edition about this looming inevitability. Hasn't anyone noticed that P4P is in conflict with a long-held medical ethical standard: the right of patient autonomy?

We've all been taught that patients have the right to choose which recommendations to follow, even if their choices lead to death or disability. If P4P stands as written, now doctors will have to choose between respecting patient autonomy and their paychecks. Of course organized medicine will say doctors should continue to act in their patients' best interests as they watch their practices continue to fall into bankruptcy.

A simple change of wording [from IOM examples] would solve this problem with P4P: Instead of "percentage of women who had a mammogram during the past year" the standard should be "percentage of women whose doctor ordered a mammogram during the past year." Instead of "percentage of adults diagnosed with a new episode of depression who remained on an antidepressant drug for at least six months," the standard should be "percentage of adults diagnosed with a new episode of depression whose doctor discussed drug therapy as one option for treatment and if chosen, told the patient that the recommended length of treatment is six months.

And since patients ages 50 to 64 are one of the lowest tiers on the flu shot recommendations, I don't know why in the world "percentage of patients age 50-64 who received an influenza vaccine during the year" is even a contender as a standard.

When is organized medicine going to do something real to stop the continued erosion of our profession?

Christine Eady, DO, Austin, Texas

Note: This item originally appeared at http://www.ama-assn.org/amednews/2006/01/16/edlt0116.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