Would pay for performance result in better care?(PRO & CON)

YES Health care in the United States is currently fragmented and uncoordinated across different practice settings. Performance measurement systems present an opportunity to establish evidence-based norms of care. In addition, valid and accepted indicators can be used as proxies to reflect the general state of health care. By pointing to disparities in care, indicators have the potential to raise the overall floor of acceptable practice standards.

Evaluating physician performance to improve quality of care is not a new subject. What has changed is the government's and market's demand for better information on which to make health care choices. The impact has been a heightened demand for comparative provider performance data, helping to raise the bar on quality by bringing professional accountability to the marketplace.

The ultimate goal of performance measures is to create a system that ensures the highest quality of care through transparency, accountability, and credibility. The goal is not to punish, but to incentivize improvements in care. To ensure that any performance measurement systems established meet this goal, the American College of Physicians feels the following positions must be kept in mind:

* The goal of performance measurement should be to foster continuous quality improvement of clinical care to meet or exceed evidence-based national standards of such care.

* Physician performance measures should be evidence based, broadly accepted, and clinically relevant. These measures should assess and focus on those elements of clinical care over which physicians have direct control. They should be built on statistical methods that provide valid and reliable comparative assessment across populations.

* Any data collection required to support performance measurement should be feasible, reliable, affordable, and practical. Data collection should not violate patient privacy or add to the paperwork burden for physicians. Information technology tools are crucial to this data collection and incentives need to be added to make sure physicians are able acquire these tools.

* The ACP supports demonstration projects to evaluate the use of incentives to reward physicians who meet or exceed standards. Financial incentives related to performance measurement should be directed at positive, not negative, reward.