AccessMyLibrary provides FREE access to over 30 million articles from top publications available through your library.
Create a link to this page
Copy and paste this link tag into your Web page or blog:
The perils of pay for performance.(GUEST EDITORIAL)
The concept of quality improvement in medical practice is laudable, but the "pay-for-performance" method--in which physicians are financially rewarded for reaching certain goals set by panels of "experts"--is particularly offensive to our professional identity.
Are we, like cabbies or waiters, to be tipped for the very service that we are bound by our doctor-patient covenant to achieve? Are we, like car salesmen, to be put on commission?
The collaboration in setting such goals as evidence of quality by our collective societies in medicine--the American Medical Association, the American College of Physicians, the American Board of Internal Medicine, and others--is an act of desperation born of the steadily decreasing value given by third-party payers to doctors who craft their care by applying time-consuming assessment and judgment to individual patients.
Will we not, if we accept this, again generate a rush of laboratory studies, medication prescriptions, and screening protocols for all patients within a given diagnostic cohort ("the diabetic," "the hypertensive," "the person over 50"), rather than decide what is appropriate for the single patient who sits before us? Experience says we will, if only to eke out enough money to continue caring for people in the face of diminishing recompense that barely covers overhead in many practices. This is iniquitous, and is yet another capitulation to the fallacy that the art and science of medicine is a business like any other.
There are, I think, two major dangers inherent in pay-for-performance schemes. The first is evident to those old enough in the profession to have witnessed the multiple cataclysmic reversals of "expert" judgments in medicine and science. Hormone therapy for all menopausal women, prostate-specific antigen screening for all men of a certain age and family background, calcium supplements for osteoporosis, CA 125 screening, the latest diet, and--coming soon, I'm fairly sure--revisions of the now astonishingly broad category of people who should be on statins all flash upon the stage of medicine as initially wonderful, then useless or, worse, detrimental.
When we fall in with these epileptiform ...
- St. Louis-based Bryan Cave works on $16.8 billion UC Rusal loan restructuring
- Newspaper article from: Missouri Lawyers Media December 7, 2009 700+ words
...about 50 credit agreements with more than 70 lenders. The restructuring includes "pay-if-you-can" principal repayments based on the business's performance; the conversion of part of shareholder ONEXIM Group's $2.7 billion debt into...
- Missouri Supreme Court Case Summaries: December 7, 2009
- Newspaper article from: Missouri Lawyers Media December 7, 2009 700+ words
...the state's characterization of the victim as a "saint" or to persuade the state not to use character evidence, so the performance of counsel was deficient and the defendant suffered prejudice as a result as shown by the fact that victim character evidence...
- Federal City builders use 'tilt-up' technique to meet deadline in Algiers
- Newspaper article from: New Orleans CityBusiness Ben Myers December 7, 2009 700+ words
...industry, which Sauter said is one of the "slowest to adopt new ideas." "If you have problems you haven't foreseen, who will pay for your learning experience?" Sauter said. But Federal City, along with similar projects, is helping to advance tilt...
- Offensive woes = kicker's success UCLA FOOTBALL: Forbath is 17 for 18 on field...
- Newspaper article from: Los Angeles Daily News October 22, 2009 700+ words
...I also spent a lot of time alone on my technique trying to get stronger and more consistent. I think it's starting to pay off." The biggest improvement in Forbath's game, he said, is the consistency of his swing. A kicker's leg swing is like...
- Gov't Pay For Abortion? No!
- Newspaper article from: Intelligencer Journal Lancaster New Era Saturday ed December 7, 2009 700+ words
...belongs to insist the government should pay for abortion. That's extreme.The Supreme...abortion. That doesn't mean I should have to pay for it. The Constitution also guarantees...course not. The government shouldn't pay for abortion either. Kathy Martin Manheim...
- Claremont board member believes art museum can be revived
- Newspaper article from: Inland Valley Daily Bulletin Wes Woods II December 6, 2009 700+ words
...quality type of museum we wanted to be," Chabre said. "That's the fundamental management policy we had. Whether it's pay or any expense." When asked if the drive to make the museum a "regional museum of international significance" negatively...
- Part-time Legislature initiative generating buzz
- Newspaper article from: Inland Valley Daily Bulletin Sandra Emerson December 6, 2009 700+ words
...be shown you don't get $115,000 a year for working 130 days a year. We reintroduced (the initiative) with the cut in pay and put it at a minimum of 50 percent, but the people who set those salaries at the state level can drop it even further...
- A fantastic resource
- Newspaper article from: Inland Valley Daily Bulletin Anonymous December 6, 2009 700+ words
...investigated and, if found derelict, be made to pay back the taxpayers or face charges themselves...program. We have paid high Medicare taxes and pay a monthly fee. Second, it will cost working...gives the "poor" more services than we who pay for our own. Also in reality many doctors...
Source: HighBeam Research, The perils of pay for performance.(GUEST EDITORIAL)