More On Pay-for-Performance

Saturday, June 30th 2007
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The AMA will now “actively oppose” some private P4P measures.

[A]fter five hours of debate — often over the addition or deletion of a single word — the AMA’s House of Delegates said that it will “actively oppose” any pay-for-performance programs that do not meet the AMA’s five pay-for-performance principles.

Adopted in 2005, those principles specify that programs should ensure quality of care, foster the patient/physician relationship, offer voluntary physician participation, use accurate data and fair reporting, and provide fair and equitable program incentives.

The number of pay-for-performance programs, which provide monetary bonuses to participating physicians who make progress in achieving specific quality or efficiency benchmarks, has increased significantly over the last four years — from 35 plans in 2003, to 130, for a growth rate of 271%, according to one report. By 2008, it’s estimated that there will be more than 160 pay-for-performance programs covering services provided to an estimated 85 million patients.

But this is minutiae.

The association was already on record as opposing plans that didn’t meet AMA criteria, but, said Dr. Rohack, by adding the word “actively” the delegates authorized the AMA to mount opposition against any plan, anywhere that did not meet the standards.

I’m about as involved in organized medicine as any student can be. And while I couldn’t stay for the big HOD meeting at Annual this year (which is where this resolution came from), I’ve been around the pay-for-performance debate.

And I’m not sure this adds anything to it. The battle really is between those who don’t want physicians to have anything to do with planning P4P and those who think P4P is coming no matter what physicians do, and so we better get to the bargaining table to make its implementation more…acceptable.

There was near disaster in Las Vegas at the AMA interim meeting last year when Secretary Mike Leavitt stumbled into the P4P bear trap during a speech to the physician HOD. In it he basically admitted that P4P was coming no matter what, and it was coming so that payers (Medicare) could save money.

Kind’ve a no duh, but even as his handlers used a sheep herding hook to drag him off the stage the outrage was blooming amongst the physicians. I think the argument on how to respond to those comments by the HHS Secretary was the best display of the schism in organized medicine (and amongst all physicians) over how to respond to pay-for-performance initiatives.

I’m not sure this new resolution does much to gap the divide.

I’m on the record for thinking that, if implemented properly, P4P can actually be a positive thing; not just something physician’s have to get used to. But even if I didn’t think that, it seems to me that P4P is coming no matter what.

It is. That is just reality.

And while there’s something valiant in being principled, the greater part of such is discretion. Choose your battles; go to the table on pay-for-performance in order to assure that at least it has physician input.

And, through all my meetings, that has been the consistent position of the AMA it seems. They’re willing to go to the table, but once there to only acquiesce to P4P plans under certain terms (such as guidelines being drawn up by physicians). Throwing in the word active changes this position, how? It opens up more options for the BOT? Small, small change. I’m not sure how many of the nay sayers such can bring over to the side of ‘compromise’.