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Does Pay-for-Performance Improve the Quality of Health Care?

Laura A. Petersen, MD, MPH
[+] Article and Author Information

From Michael E. DeBakey Veteran Affairs Medical Center, Houston, Texas.


Potential Financial Conflicts of Interest: None disclosed.


Ann Intern Med. 2007;146(7):538-539. doi:10.7326/0003-4819-146-7-200704030-00016
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Pay for Performance: A Wolf in
Posted on April 2, 2007
Edward J Volpintesta
No Affiliation
Conflict of Interest: None Declared

The author is correct to emphasize the importance of examining the "unintended negative outcomes" of pay for performance programs. Clearly, they have the potential to completely change the focus of medicine from concern for the individual patient to concern over accumulating the "right" data. Increasingly, the "right" data will be determined by managed care and other health care organizations as doctors' ability to shape their destinies continues to be slowly taken away from them. Doctors will be under pressure to make sure their data is "right" even if in their hearts they know that the quality of their care was not good.

Although HMOs and other organizations will use these quality indicators to demonstrate their excellence and concern for patients, their real motivation will be to promote their expansion and attract new business. And doctors will be be forced to embrace pay for performance in order to keep their positions on HMO panels, hospital staffs, and possibly even their own medical groups.

Pay for performance works well when making toasters and radios and televisions. But it has little use in the way doctors treat patients; and its potential to undermine physicians' integrity cries out for attention. When compared to the other difficulties that concern physicians about pay for performance, the danger it poses by changing focus from patient to data collection is much much greater.

Also it is easy to imagine how opportunistic malpractice lawyers will use pay for performance as the basis for alleging malpractice. When a jury hears that a test or consultation was not because of financial considerations that were linked to a physician's year-end bonus, regardless of any evidence-based guidelines that exist, that physician will be under intense pressure to prove the contrary. Who needs that kind of worry?

Conflict of Interest:

None declared

Pay for Performance: A Wolf in
Posted on April 2, 2007
Edward J Volpintesta
No Affiliation
Conflict of Interest: None Declared

The author is correct to emphasize the importance of examining the "unintended negative outcomes" of pay for performance programs. Clearly, they have the potential to completely change the focus of medicine from concern for the individual patient to concern over accumulating the "right" data. Increasingly, the "right" data will be determined by managed care and other health care organizations as doctors' ability to shape their destinies continues to be slowly taken away from them. Doctors will be under pressure to make sure their data is "right" even if in their hearts they know that the quality of their care was not good.

Although HMOs and other organizations will use these quality indicators to demonstrate their excellence and concern for patients, their real motivation will be to promote their expansion and attract new business. And doctors will be be forced to embrace pay for performance in order to keep their positions on HMO panels, hospital staffs, and possibly even their own medical groups.

Pay for performance works well when making toasters and radios and televisions. But it has little use in the way doctors treat patients; and its potential to undermine physicians' integrity cries out for attention. When compared to the other difficulties that concern physicians about pay for performance, the danger it poses by changing focus from patient to data collection is much much greater.

Also it is easy to imagine how opportunistic malpractice lawyers will use pay for performance as the basis for alleging malpractice. When a jury hears that a test or consultation was not because of financial considerations that were linked to a physician's year-end bonus, regardless of any evidence-based guidelines that exist, that physician will be under intense pressure to prove the contrary. Who needs that kind of worry?

Conflict of Interest:

None declared

Submit a Comment

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