Pay-for-Performance Principles That Promote Patient-Centered Care: An Ethics Manifesto

4 December 2007 | Volume 147 Issue 11 | Pages 792-794

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.

Author and Article Information

From the American College of Physicians Center for Ethics and Professionalism, Philadelphia, Pennsylvania, and the Alaska Native Medical Center, Anchorage, Alaska.

Acknowledgment: The ACP Ethics, Professionalism and Human Rights Committee thanks the following reviewers of drafts of this paper: Patricia P. Barry, MD; Peter Basch, MD; Donald E. Casey, MD, MPH, MBA; Sima S. Desai, MD; S.A. Dean Drooby, MD; Herbert I. DuPont, MD; Faith T. Fitzgerald, MD; Robert B. Gibbons, MD; Robert A. Gluckman, MD; Rodney Hornback, MD; Mark Liebow, MD; Kay M. Mitchell, MD; L. Gregory Pawlson, MD; Laura Petersen, MD, MPH; Eric C. Schneider, MD, MSc; Michael C. Sha, MD; Bruce Vladick, PhD; Kathleen Weaver, MD; F. David Winter, Jr., MD, MSc.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Lois Snyder, JD, American College of Physicians Center for Ethics and Professionalism, 190 N. Independence Mall West, Philadelphia, PA 19106; e-mail, lsnyder{at}acponline.org.

Current Author Addresses: Ms. Snyder: American College of Physicians Center for Ethics and Professionalism, 190 N. Independence Mall West, Philadelphia, PA 19106.

Dr. Neubauer: Alaska Native Medical Center, 4315 Diplomacy Drive, Anchorage, AK 99508.

* This paper, written by Lois Snyder, JD, and Richard L. Neubauer, MD, was developed by the American College of Physicians (ACP) Ethics, Professionalism and Human Rights Committee. Members of the Ethics, Professionalism and Human Rights Committee were Frederick E. Turton, MD (Chair); Richard A. Hranac, MD (Vice Chair); Neil J. Farber, MD; Virginia L. Hood, MD, MPH; Allen S. Keller, MD; Diane E. Meier, MD; Paul S. Mueller, MD, MPH; Richard L. Neubauer, MD; Mahmoud Sharaf, MD; and Peter A. Ubel, MD. This paper is based on a longer position paper approved by the ACP Board of Regents on 29 October 2006 and is available on the ACP Web site at http://www.acponline.org.

Read all Rapid Responses

Pay-for-performance and Professionalism

Howard Brody

Annals Online, 11 Dec 2007 [Full text]

In Response

Christopher M. Lowther

Annals Online, 17 Dec 2007 [Full text]

Comments on P4P

Paulette M. Metoyer

Annals Online, 10 Jan 2008 [Full text]

Pay-for-Performance Ethics Response from ACP

Richard Neubauer, et al.

Annals Online, 7 Feb 2008 [Full text]