Profession
Physicians uneasy about how plans will set rankings
■ Authors say the study shows physicians might rebel against pay-for-performance as they did against HMOs.
By Kevin B. O’Reilly — Posted April 16, 2007
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Most physicians like the idea of getting a bonus for scoring well on accurate quality measures, but they do not want the public to see how they rank. Also, physicians fear that quality measures could lead doctors to avoid high-risk patients and neglect unmeasured types of care. And, doctors have little confidence that payers will work hard to ensure the ratings' accuracy.
Conventional wisdom? Perhaps, but a March/April Health Affairs survey of 556 internists confirms it.
The rank-and-file doctors surveyed worry that the quality measures most health plans are using could have unintended consequences, with 82% saying physicians might avoid high-risk patients.
"I have 10 to 15 patients whom I would have to fire," one respondent said. "The poor, unmotivated, obese and noncompliant would all have to find new physicians."
Lawrence P. Casalino, MD, PhD, the study's lead author, favors pay-for-performance programs in principle but said the survey shows a potential for physician backlash against them akin to the doctor revolt against HMOs.
"There is a lot at stake here, so it's worth doing it right even if it takes longer and is more expensive," Dr. Casalino said.
To avoid hurting minorities and the poor, pay-for-performance programs should reward not only physicians who have the best scores but also those who show improvement over time, Dr. Casalino said. Also, quality measures should be risk-adjusted and stratified by income and race.
AMA policy says pay-for-performance programs should use scientifically sound data. The Association-convened Physician Consortium for Performance Improvement has developed 155 performance measures so far.
