Well-Designed P4P Programs Can Improve Patient Relations, Says Physician Panel

An expert panel convened by the American College of Physicians says that properly designed pay-for-performance programs can strengthen physician-patient relations and improve care.

"Concerns about the conflicts between medical professionalism and pay-for-performance have been based primarily on theories about the tension between external motivation and self-interest and the internal motivation and self-restraint that characterize professional expectations," said panel member Amir Qaseem, MD, a senior medical associate with ACP, in a media release. "We believe that physicians should play a key role in defining and evaluating P4P programs that are compatible with professionalism."

The ACP-led panel's analysis appears in the March 16 issue of Annals of Internal Medicine. The panel, which included experts in clinical medicine, law, management, and health policy, met six times to examine the relationship between medical professionalism and various P4P financial incentive programs.

The panel concluded that:

• A P4P incentive should be linked to specified, evidence-based measures because they can drive the delivery of care to conform to scientific evidence. Inadequately risk-adjusted measures that do not recognize the severity or complexity of a patient's condition may lead physicians to cherry pick. The evidence must be protected from inappropriate influence by nonprofessionals or others who have a direct financial interest in a particular definition or performance measure.
• Transparency of quality measures and disclosure of payment incentives may enhance patient trust.
• P4P programs are unlikely to foster the equitable distribution of care unless they include measures of access to care and adequate case-mix and risk-adjustment strategies. Measuring the allocation of patients among providers enables adjustment of performance rewards based on the complexity of patient socioeconomic and clinical case-mix of a provider group.
• P4P programs that pay only on the basis of the top tier of performance put physicians in competition with each other. P4P programs could be designed to encourage the sharing of knowledge, scientific evidence, and information—a principle of professionalism.