AMA meeting: AMA toughens P4P policy, vows to oppose problematic programs

The delegates' vote means the Association can aggressively act against deficient initiatives without waiting for state medical societies to weigh in.

By David Glendinning, AMNews staff. July 16, 2007.

Chicago -- The American Medical Association House of Delegates last month beefed up the AMA's policy on pay-for-performance programs by giving the Association freer rein to go after initiatives harmful to patients.

After intense debate, delegates at the Annual Meeting largely reaffirmed existing AMA policy on pay-for-performance but added language stating it would "actively oppose" any program that does not meet all of the Association's principles on the issue. First adopted two years ago, the principles maintain that programs must be voluntary, ensure quality of care, foster the patient-physician relationship, establish fair and accurate performance measures, and offer positive incentives -- not penalties.

During its 2005 Annual Meeting, the house voted to oppose programs that did not meet the principles. But by reaffirming this opposition and adding the word "actively," delegates this year agreed that the gloves should come off if the Association determines that a given public or private pay-for-performance initiative is in violation, said AMA Trustee J. James Rohack, MD.

"We interpret this to say that if we find a plan is being problematic, we can work with entities to try to correct that and don't need state societies' permission to come in," he said. "Sometimes, especially when we look at insurers that cross state boundaries, we will have to take action because of the implications that may affect all physicians."

The AMA already is claiming victory in heading off at least one public program that did not make the grade. Medicare's first attempt at a voluntary reporting program -- considered by many to be a precursor to pay-for-performance -- has been abandoned. It was replaced by a six-month pilot that uses new money for bonuses and uses measures developed by physicians. Dr. Rohack said that strong physician opposition to the initial plan was instrumental in that switch.