OPINION

Rewarding quality care: Physicians should set the standards

Incentives for providing quality care are the latest thing, but only physician involvement in standards will ensure that such programs are legitimate.

Editorial. Jan. 6, 2003.

You get what you pay for, the saying goes, so managed care plans and the federal government alike figure that if they want physicians to provide high-quality care, they should reward them for it with financial bonuses. Improved quality is expected to lower utilization rates and thereby reduce health care costs.

This well-intended proposition may very well live up to its potential -- it sure sounds good on paper -- yet physicians are right to view it with a somewhat skeptical eye.

Certainly, many physicians soon will have the chance to get a closer look. The Center for Medicare & Medicaid Services is now instituting a three-year demonstration project for groups of 200 or more physicians. It will pay groups a bonus for meeting certain quality benchmarks, as well as have them share in any savings resulting from better quality of care. The program got extra backing in October 2002, when the National Academy of Science's Institute of Medicine released a report saying the federal government should reward high-quality health care by giving financial rewards to the best doctors, hospitals, nursing homes and HMOs.

Blue Cross of California in 2003 is expanding to its PPO the pay-for-performance program it already has in its HMO. Blue Cross and five other large California plans have said they will adopt at least some of the quality criteria for rewarding physicians that have been developed by Integrated Healthcare Assn., a California-based health policy group. Other plans across the country are developing, or already have, some form of quality-based pay.

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