Opinion

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

LETTER — Posted Jan. 16, 2006

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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.

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