Fair pay a sounder approach than "pay for quality"

AMA Leader Commentary. By William G. Plested III, MD, March 1, 2004.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all physicians from the chair of the AMA Board of Trustees, William G. Plested III, MD.

This is a continuation of a two-part article on the problems of physician reimbursement. The first part ran in Dr. Plested's previous column (See column, Feb. 2).

The buzzword in health care today is "quality," and everyone is getting on the bandwagon. Of course, there is no generally accepted definition of "quality medical care," so everyone adopts his or her own. For the entitlement crowd, "quality care" means free care -- the definition of free care being whatever care an individual may desire that is paid for by someone else! For insurers, "quality care" is that care that can be provided at somewhere below 80% of the premiums they have collected. For lawyers, "quality care" is that provided by physicians with unlimited medical liability insurance, provided that they tackle complex medical problems. For legislators, "quality care" means care whose true costs can be shifted to anyone else. It is only when we get to physicians that the actual well-being of patients comes into the definition of quality.

The newest scam dreamed up by the multimillionaire CEOs of health insurance companies and HMOs is to link the payment for physician services to the "quality of care" that they provide. And here again, what amazes me is how many physicians actually believe this claptrap. Every physician knows that he or she would not even consider practicing anything but the best or highest quality of medicine possible. Therefore, they feel that they certainly will receive whatever higher payment is available for "quality care." But just a minute. Do you really believe that these insurers who gleefully bludgeoned us with managed care abuses are just trying to find a way to increase the payments to all -- or at the very least, a great majority of -- physicians? I'd submit that just the opposite is true, and this is simply a way to reduce payments to the vast majority of physicians.

The "pay for quality" movement has several characteristics, the most glaring of which is that the insurers do not share the definition of quality for which they propose to pay. If their goal were truly quality, insurers would freely share their requirements for bonus payments and rejoice if all their insureds received such care and all physicians received bonus reimbursement. Clearly no one can hit an unknown target that can be changed by mere whim. But of course, that's the whole idea.