Richard L. Neubauer, MD; Lois Snyder, JD
Potential Financial Conflicts of Interest: None disclosed.
Neubauer RL, Snyder L. Are Pay-for-Performance Programs a Threat to Medical Professionalism?. Ann Intern Med. 2008;148:630-631. doi: 10.7326/0003-4819-148-8-200804150-00022
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Published: Ann Intern Med. 2008;148(8):630-631.
We appreciate Dr. Metoyer's thoughtful comments, many of which the American College of Physicians Ethics, Professionalism, and Human Rights Committee agree with in the College's pay-for-performance position paper. We do not agree, however, with her conclusion that, in some regards, pay-for-performance programs are inherently unethical. Every payment system creates incentives and potential conflicts of interest, such as the incentives in fee-for-service payment to increase care or the incentives under capitation to do less rather than more. The College believes pay-for-performance programs have promise if they can be focused on patient perspectives on care and professionalism, including the duty to ensure medically appropriate care before financial and other considerations. As pointed out in the ACP Ethics Manual (1), “medical practice” does not stand still. Clinicians must be prepared to deal with changes and reaffirm what is most important. The pay-for-performance ethics paper attempts to lay out principles that may guide clinicians in dealing with pay-for-performance programs, as well as provide ethical guidance to those who would design such systems. The problem of current payment systems rewarding substandard care and then paying again to improve that care goes beyond pay-for-performance programs.
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