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Journal of General Internal Medicine
Published in: Journal of General Internal Medicine 7/2009

Open Access 01-07-2009 | Health Policy

High Quality Care and Ethical Pay-for-Performance: A Society of General Internal Medicine Policy Analysis

Authors: J. Frank Wharam, MB, BCh, BAO, MPH, Michael K. Paasche-Orlow, MD, MPH, Neil J. Farber, MD, Christine Sinsky, MD, Lisa Rucker, MD, Kimberly J. Rask, MD, PhD, M. Kathleen Figaro, MD, MPH, Clarence Braddock III, MD, MPH, Michael J. Barry, MD, Daniel P. Sulmasy, OFM, MD, PhD

Published in: Journal of General Internal Medicine | Issue 7/2009

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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.
Literature
1.
Rosenthal MB, Landon BE, Normand SL, Frank RG, Epstein AM. Pay for performance in commercial HMOs. N Engl J Med. 2006; 35518: 1895–1902.PubMedCrossRef
2.
Rosenthal MB, Frank RG. What is the empirical basis for paying for quality in health care? Med Care Res Rev. 2006; 632: 135–157.PubMedCrossRef
3.
Petersen LA, Woodard LD, Urech T, Daw C, Sookanan S. Does pay-for-performance improve the quality of health care? Ann Intern Med. 2006; 1454: 265–272.PubMed
4.
Amundson G, Solberg LI, Reed M, Martini EM, Carlson R. Paying for quality improvement: compliance with tobacco cessation guidelines. Jt Comm J Qual Saf. 2003; 292: 59–65.PubMed
5.
Fairbrother G, Hanson KL, Friedman S, Butts GC. The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates. Am J Public Health. 1999; 892: 171–175.PubMedCrossRef
6.
Kouides RW, Bennett NM, Lewis B, Cappuccio JD, Barker WH, LaForce FM. Performance-based physician reimbursement and influenza immunization rates in the elderly. The Primary-Care Physicians of Monroe County. Am J Prev Med. 1998; 142: 89–95.PubMedCrossRef
7.
Roski J, Jeddeloh R, An L, et al. The impact of financial incentives and a patient registry on preventive care quality: increasing provider adherence to evidence-based smoking cessation practice guidelines. Prev Med. 2003; 363: 291–299.PubMedCrossRef
8.
9.
Epstein AM, Lee TH, Hamel MB. Paying physicians for high-quality care. N Engl J Med. 2004; 3504: 406–410.PubMedCrossRef
10.
Blumenthal D. The vital role of professionalism in health care reform. Health Aff (Millwood). 1994; 131: 252–256.CrossRef
11.
Swick HM. Toward a normative definition of medical professionalism. Acad Med. 2000; 756: 612–616.PubMedCrossRef
12.
Wynia MK, Latham SR, Kao AC, Berg JW, Emanuel LL. Medical professionalism in society. N Engl J Med. 1999; 34121: 1612–1616.PubMedCrossRef
13.
Beauchamp TL, Childress JF. Principles of biomedical ethics. 5th ed. New York, N.Y.: Oxford University Press; 2001.
14.
Davis K, Schoenbaum SC, Audet AM. A 2020 vision of patient-centered primary care. J Gen Intern Med. 2005; 2010: 953–957.PubMedCrossRef
15.
Povar GJ, Blumen H, Daniel J, et al. Ethics in practice: managed care and the changing health care environment: medicine as a profession managed care ethics working group statement. Ann Intern Med. 2004; 1412: 131–136.PubMed
16.
17.
Wharam JF, Daniels N. Toward evidence-based policy making and standardized assessment of health policy reform. Jama. 2007; 2986: 676–679.PubMedCrossRef
18.
19.
Lohr KN, Donaldson MS, Harris-Wehling J. Medicare: a strategy for quality assurance, V: Quality of care in a changing health care environment. QRB Qual Rev Bull. 1992; 184: 120–126.PubMed
20.
Brook RH, McGlynn EA, Shekelle PG. Defining and measuring quality of care: a perspective from US researchers. Int J Qual Health Care. 2000; 124: 281–295.PubMedCrossRef
21.
22.
Maxwell RJ. Dimensions of quality revisited: from thought to action. Qual Health Care. 1992; 13: 171–177.PubMedCrossRef
23.
Quality of care: 1. What is quality and how can it be measured? Health Services Research Group. Cmaj. Jun 15 1992;146(12):2153-2158.
24.
Donabedian A. The seven pillars of quality. Arch Pathol Lab Med. 1990; 11411: 1115–1118.PubMed
25.
O’Leary DS, O’Leary MR. From quality assurance to quality improvement. The Joint Commission on Accreditation of Healthcare Organizations and Emergency Care. Emerg Med Clin North Am. 1992; 103: 477–492.PubMed
26.
Harteloh PP. The meaning of quality in health care: a conceptual analysis. Health Care Anal. 2003; 113: 259–267.PubMedCrossRef
27.
28.
29.
Wharam JF, Paasche-Orlow M, Sinsky C, Farber N, Rask K, Rucker L, Sulmasy D, Barry M, Figaro K. Ethical Issues in Pay-for-Performance: Opinions of SGIM Members. Unpublished. 2008.
30.
Casalino LP. The unintended consequences of measuring quality on the quality of medical care. N Engl J Med. 1999; 34115: 1147–1150.PubMedCrossRef
31.
Casalino LP, Alexander GC, Jin L, Konetzka RT. General internists’ views on pay-for-performance and public reporting of quality scores: a national survey. Health Aff (Millwood). 2007; 262: 492–499.CrossRef
32.
Casalino LP, Elster A, Eisenberg A, Lewis E, Montgomery J, Ramos D. Will pay-for-performance and quality reporting affect health care disparities? Health Aff (Millwood). 2007; 263: w405–414.CrossRef
33.
Fisher ES. Paying for performance–risks and recommendations. N Engl J Med. 2006; 35518: 1845–1847.PubMedCrossRef
34.
Hayward RA. All-or-nothing treatment targets make bad performance measures. Am J Manag Care. 2007; 133: 126–128.PubMed
35.
36.
37.
Wachter RM, Shojania KG. The unintended consequences of measuring quality on the quality of medical care. N Engl J Med. 2000; 3427: 520.PubMedCrossRef
38.
Volandes AE, Paasche-Orlow MK. Health literacy, health inequality and a just healthcare system. Am J Bioeth. 2007; 711: 5–10.PubMed
39.
Lo B, Groman M. Oversight of quality improvement: focusing on benefits and risks. Arch Intern Med. 2003; 16312: 1481–1486.PubMedCrossRef
40.
Bellin E, Dubler NN. The quality improvement-research divide and the need for external oversight. Am J Public Health. 2001; 919: 1512–1517.PubMedCrossRef
41.
Casarett D, Karlawish JH, Sugarman J. Determining when quality improvement initiatives should be considered research: proposed criteria and potential implications. Jama. 2000; 28317: 2275–2280.PubMedCrossRef
42.
Kofke WA, Rie MA. Research ethics and law of healthcare system quality improvement: the conflict of cost containment and quality. Crit Care Med. 2003; 313 Suppl: S143–152.PubMedCrossRef
43.
Perneger TV. Why we need ethical oversight of quality improvement projects. Int J Qual Health Care. 2004; 165: 343–344.PubMedCrossRef
44.
Nerenz DR, Stoltz PK, Jordan J. Quality improvement and the need for IRB review. Qual Manag Health Care. 2003; 123: 159–170.PubMed
45.
Lynn J, Baily MA, Bottrell M, et al. The ethics of using quality improvement methods in health care. Ann Intern Med. 2007; 1469: 666–673.PubMed
46.
Strasberg SM, Ludbrook PA. Who oversees innovative practice? Is there a structure that meets the monitoring needs of new techniques? J Am Coll Surg. 2003; 1966: 938–948.PubMedCrossRef
47.
Marron JM, Siegler M. Ethical issues in innovative colorectal surgery. Dis Colon Rectum. 2005; 486: 1109–1113.PubMedCrossRef
48.
Bunker JP, Hinkley D, McDermott WV. Surgical innovation and its evaluation. Science. 1978; 2004344: 937–941.PubMedCrossRef
49.
Cronin DC 2nd, Millis JM, Siegler M. Transplantation of liver grafts from living donors into adults–too much, too soon. N Engl J Med. 2001; 34421: 1633–1637.PubMedCrossRef
50.
Reitsma AM, Moreno JD. Ethical regulations for innovative surgery: the last frontier? J Am Coll Surg. 2002; 1946: 792–801.PubMedCrossRef
51.
Reitsma AM, Moreno JD. Ethics of innovative surgery: US surgeons’ definitions, knowledge, and attitudes. J Am Coll Surg. 2005; 2001: 103–110.PubMedCrossRef
52.
Margo CE. When is surgery research? Towards an operational definition of human research. J Med Ethics. 2001; 271: 40–43.PubMedCrossRef
53.
Amoroso PJ, Middaugh JP. Research vs. public health practice: when does a study require IRB review? Prev Med. 2003; 362: 250–253.PubMedCrossRef
54.
55.
Cheraghi-Sohi S, Hole AR, Mead N, et al. What Patients Want From Primary Care Consultations: A Discrete Choice Experiment to Identify Patients’ Priorities. Ann Fam Med. 2008; 6: 107–115.PubMedCrossRef
56.
Rao M, Clarke A, Sanderson C, Hammersley R. Patients’ own assessments of quality of primary care compared with objective records based measures of technical quality of care: cross sectional study. Bmj. 2006; 3337557: 19.PubMedCrossRef
57.
58.
59.
Kent DM, Hayward RA. Limitations of applying summary results of clinical trials to individual patients: the need for risk stratification. Jama. 2007; 29810: 1209–1212.PubMedCrossRef
60.
Daniels N, Sabin JE. Setting limits fairly : can we learn to share medical resources? Oxford, New York: Oxford University Press; 2002.
Metadata
Title
High Quality Care and Ethical Pay-for-Performance: A Society of General Internal Medicine Policy Analysis
Authors
J. Frank Wharam, MB, BCh, BAO, MPH
Michael K. Paasche-Orlow, MD, MPH
Neil J. Farber, MD
Christine Sinsky, MD
Lisa Rucker, MD
Kimberly J. Rask, MD, PhD
M. Kathleen Figaro, MD, MPH
Clarence Braddock III, MD, MPH
Michael J. Barry, MD
Daniel P. Sulmasy, OFM, MD, PhD
Publication date
01-07-2009
Publisher
Springer-Verlag
Published in
Journal of General Internal Medicine / Issue 7/2009
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI
https://doi.org/10.1007/s11606-009-0947-3

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