Pay-for-performance draws doctors' ire

Two proposals called for changes in AMA policy, but neither was adopted by delegates.

By Damon Adams and Tanya Albert Henry, AMNews staff. Dec. 4, 2006.

Las Vegas -- Physicians attending the AMA's Interim Meeting vented their doubts, frustrations and concerns about pay-for-performance. But when the Association's meeting wrapped up, they decided not to make a policy change.

The issue was in the air from the start. During the opening session, AMA President William G. Plested III, MD, expressed his views to the Association's House of Delegates in an impassioned speech.

"Most of you know what I think of this whole idea, so I won't dwell on that," he said. "I will point out that -- reminiscent of the managed care debacle -- P4P will allow insurers to dictate the treatment that we give our patients and will publicly label any physician foolish enough to contract with them and not follow their dictates as nonpreferred, substandard or some such label."

Dr. Plested said AMA guidelines can be used to identify which programs are quality-based, fair and ethical. But he said he did not know of a pay-for-performance program that had been subjected to a thorough review and was found to be in compliance with all of the guidelines.

AMA policy says pay-for-performance programs must ensure quality of care, foster the patient-physician relationship, offer voluntary physician participation, use accurate data and fair reporting, and provide fair and equitable program incentives.

Health and Human Services Secretary Michael Leavitt, the keynote speaker at the AMA's opening session, told physicians there is still a lot to learn about measuring quality.