Delegates set strict standards in pay-for-performance programs

Principles are affirmed as the Senate is poised to address such a pay program for Medicare.

By David Glendinning, AMNews staff. July 11, 2005.

Chicago -- Pay-for-performance is coming whether physicians like it or not, but doctors are ready to reject any program that they say will harm the delivery of quality care.

Delegates at the American Medical Association Annual Meeting in June officially adopted principles and guidelines developed earlier in the year by an AMA working group on pay-for-performance, the concept of reimbursing doctors based on how well they provide care. The Association said viable programs must be voluntary and must focus on enhancing the quality of care and providing positive financial incentives to doctors without interfering with the patient-physician relationship.

But delegates went one big step further than the AMA Board of Trustees recommended. Under the final policy the House of Delegates adopted, the AMA will "oppose private-payer, congressional or Centers for Medicare & Medicaid Services pay-for-performance initiatives if they do not meet the AMA's 'Principles and Guidelines for Pay-for-Performance.' "

Physician delegates said doctors must take a stand against future programs that purport to reward high-quality care but instead focus on cutting dollars. The time to take a stance is now, they said, because Medicare already has launched a pay-for-performance pilot program that includes an incentive to reduce utilization. Also, several insurance firms have started initiatives that are wholly focused on costs, doctors said.

"The reality of it is that pay-for-performance is an effort by insurers and businesses to save money under the guise of quality of care," said Leon Reinstein, MD, a physical medicine and rehabilitation physician from Baltimore. He said any payer would be unlikely to offer additional money to the performance incentives, one of the requirements laid out in the AMA principles.