Lois Snyder, JD; Richard L. Neubauer, MD; for the American College of Physicians Ethics, Professionalism and Human Rights Committee *
Acknowledgment: The ACP Ethics, Professionalism and Human Rights Committee thanks the following reviewers of drafts of this paper: Patricia P. Barry, MD; Peter Basch, MD; Donald E. Casey, MD, MPH, MBA; Sima S. Desai, MD; S.A. Dean Drooby, MD; Herbert I. DuPont, MD; Faith T. Fitzgerald, MD; Robert B. Gibbons, MD; Robert A. Gluckman, MD; Rodney Hornback, MD; Mark Liebow, MD; Kay M. Mitchell, MD; L. Gregory Pawlson, MD; Laura Petersen, MD, MPH; Eric C. Schneider, MD, MSc; Michael C. Sha, MD; Bruce Vladick, PhD; Kathleen Weaver, MD; F. David Winter, Jr., MD, MSc.
Potential Financial Conflicts of Interest: None disclosed.
Requests for Single Reprints: Lois Snyder, JD, American College of Physicians Center for Ethics and Professionalism, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, email@example.com.
Current Author Addresses: Ms. Snyder: American College of Physicians Center for Ethics and Professionalism, 190 N. Independence Mall West, Philadelphia, PA 19106.
Dr. Neubauer: Alaska Native Medical Center, 4315 Diplomacy Drive, Anchorage, AK 99508.
Pay-for-performance programs are growing, but little evidence exists on their effectiveness or on their potential unintended consequences and effects on the patient–physician relationship. Pay-for-performance has the potential to help improve the quality of care, if it can be aligned with the goals of medical professionalism. Initiatives that provide incentives for a few specific elements of a single disease or condition, however, may neglect the complexity of care for the whole patient, especially the elderly patient with multiple chronic conditions. Such programs could also result in the deselection of patients, “playing to the measures” rather than focusing on the patient as a whole, and misalignment of perceptions between physicians and patients. The primary focus of the quality movement in health care should not be on “pay for” or “performance” based on limited measures, but rather on the patient. The American College of Physicians hopes to move the pay-for-performance debate forward with a patient-centered focus—one that puts the needs and interests of the patient first—as these programs evolve.
Snyder L, Neubauer RL, for the American College of Physicians Ethics, Professionalism and Human Rights Committee. Pay-for-Performance Principles That Promote Patient-Centered Care: An Ethics Manifesto. Ann Intern Med. ;147:792–794. doi: 10.7326/0003-4819-147-11-200712040-00011
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Published: Ann Intern Med. 2007;147(11):792-794.
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