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Ann Intern Med. 2007 Dec 4;147(11):792-4.

Pay-for-performance principles that promote patient-centered care: an ethics manifesto.

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  • 1American College of Physicians Center for Ethics and Professionalism, Philadelphia, Pennsylvania 19106, USA. lsnyder@acponline.org

Abstract

Pay-for-performance programs are growing, but little evidence exists on their effectiveness or on their potential unintended consequences and effects on the patient-physician relationship. Pay-for-performance has the potential to help improve the quality of care, if it can be aligned with the goals of medical professionalism. Initiatives that provide incentives for a few specific elements of a single disease or condition, however, may neglect the complexity of care for the whole patient, especially the elderly patient with multiple chronic conditions. Such programs could also result in the deselection of patients, "playing to the measures" rather than focusing on the patient as a whole, and misalignment of perceptions between physicians and patients. The primary focus of the quality movement in health care should not be on "pay for" or "performance" based on limited measures, but rather on the patient. The American College of Physicians hopes to move the pay-for-performance debate forward with a patient-centered focus--one that puts the needs and interests of the patient first--as these programs evolve.

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PMID:
18056664
[PubMed - indexed for MEDLINE]
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