Pay-for-performance: It's about cost control, not quality

AMA Leader Commentary. By William G. Plested III, MD, Feb. 19, 2007.

AMA LEADER COMMENTARY

A few words about current events in medical practice

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A message to all physicians from AMA President William G. Plested III, MD.

I am always entranced when intelligent people become mesmerized by an idea that is patently stupid. Nowhere has this phenomenon been more in evidence than in the pay-for-performance (P4P) mania that is absolutely sweeping the nation.

There is so much energy being expended in efforts to rush out these programs that there seems to be none left over for a calm, rational assessment of the whole idea. This is the incarnation of the wonderful children's story, "The Emperor's New Clothes." A delightful charlatan convinced the emperor that the "clothes" that he sold him were invisible to anyone who was unfit for his office or unforgivably stupid. The inevitable result was that nobody wanted to appear stupid or unfit, so they all complimented the naked emperor on his beautiful clothing.

It would appear that this whole thing was enabled by some papers written about the care that patients received from visits to their physicians. These papers were long on sensationalism and short on scientific rigor; however, that's what is tailor-made for today's popular press. The qualifications of the reviewers can be questioned. What is not in question is their underlying bias.

The bottom line of the studies was the widely touted result that in only 50% of cases did the treatment meet the standards that had been preselected by the reviewers. It was then widely reported that the chance of obtaining proper treatment from American physicians was essentially random.

This, of course, is patently ridiculous, and even the most naive can poke innumerable holes in this argument. But this pronouncement was manna from heaven to employers, insurers and government agencies continually looking for any excuse to reduce physician reimbursement.