High Quality Care and Ethical Pay-for-Performance: A Society of General Internal Medicine Policy Analysis
Date
2009-3-18
Authors
Wharam, J. Frank
Paasche-Orlow, Michael K.
Farber, Neil J.
Sinsky, Christine
Rucker, Lisa
Rask, Kimberly J.
Figaro, M. Kathleen
Braddock, Clarence
Barry, Michael J.
Sulmasy, Daniel P.
Version
OA Version
Citation
Wharam, J. Frank, Michael K. Paasche-Orlow, Neil J. Farber, Christine Sinsky, Lisa Rucker, Kimberly J. Rask, M. Kathleen Figaro, Clarence Braddock, Michael J. Barry, Daniel P. Sulmasy. "High Quality Care and Ethical Pay-for-Performance: A Society of General Internal Medicine Policy Analysis" Journal of General Internal Medicine 24(7): 854-859. (2009)
Abstract
BACKGROUND
Pay-for-performance is proliferating, yet its impact on key stakeholders remains uncertain.
OBJECTIVE
The Society of General Internal Medicine systematically evaluated ethical issues raised by performance-based physician compensation.
RESULTS
We conclude that current arrangements are based on fundamentally acceptable ethical principles, but are guided by an incomplete understanding of health-care quality. Furthermore, their implementation without evidence of safety and efficacy is ethically precarious because of potential risks to stakeholders, especially vulnerable patients.
CONCLUSION
We propose four major strategies to transition from risky pay-for-performance systems to ethical performance-based physician compensation and high quality care. These include implementing safeguards within current pay-for-performance systems, reaching consensus regarding the obligations of key stakeholders in improving health-care quality, developing valid and comprehensive measures of health-care quality, and utilizing a cautious evaluative approach in creating the next generation of compensation systems that reward genuine quality.
Description
License
Copyright Society of General Internal Medicine 2009