One major issue with pay-for-performance is that it is compensating physicians for something they should be doing anyway—taking care of their patients. Some pay-for-performance plans reward physicians for administering flu shots and some reward physicians for screening patients for diseases like colon cancer. So physicians receive compensation for the office visits as well as the outcomes—double dipping.
Most physicians reject pay-for-performance for introducing accountability into the practice of medicine—another dent in the armor of the physician-as-god complex. They claim that it is only being implemented to control costs, and some in the AMA support this view. Perhaps so.
Quietly, however, many physicians have realized that pay-for-performance can be their ticket to extra profits. Weekend conferences at ski resorts teach physicians how to milk the new pay-for-performance environment. Even the AMA has gotten into the game and published several papers to help physicians navigate the maze of pay-for-performance programs and maximize their participation in “incentive plans.” (Unfortunately, access to many of these papers is restricted to only AMA members.)
Everyone, including physicians, should favor improved patient care. Ultimately, aligning physician behavior with the actual clinical outcomes of their patients will improve care. As more studies are done, these results will become even more transparent. Years from now, we will look back on this time and wonder why so many physicians resisted this move. Perhaps, one day, we’ll see the end of those traditional compensation plans and physicians will only be compensated for the results they can achieve.
