Right response to wrong incentives

The AMA adopts a more aggressive stance concerning questionable pay-for-performance plans.

Editorial. Aug. 6, 2007.

Delegates at the AMA's June Annual Meeting approved a report that recommended giving the Association the authority to "actively oppose" any insurer's incentive program that fails to meet principles the Association developed to ensure that a program is fair to physicians and good for patients.

The AMA already had the authority from the House of Delegates to oppose misguided pay-for-performance, tiered network and physician rating programs, and has done so.

But the change in language signals a more aggressive stance when it comes to plans using cost of care, claims data, or other misleading or unreliable information as a basis for granting incentives to physicians, or publicly rebuking them with lower ratings on Web sites or higher co-pays for patients.

One immediate change in strategy from the delegates' approval is that the AMA will no longer act solely on a state medical society's invitation or permission to get involved in an insurer-physician dispute. For example, if an insurer's program is being introduced in multiple states, and it violates the Association's principles on incentive plans, the AMA can take on the insurer immediately about what the plan is doing in all locations.

These are the principles the AMA demands of any incentive plan: 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.

The principles are consistent with another report the delegates passed during the Annual Meeting that outlines strategies for health cost reduction. These strategies focus on achieving better value for health spending, rather than just a straight-out cost reduction.