Pay-for-Performance
Several “pay-for-performance” programs, sponsored mainly by health insurance plans and large employers, have been developed to tie clinician performance on measures with reimbursement. Starting July 1, 2007, the Centers for Medicare and Medicaid Services (CMS) has been piloting a physician-level pay-for-reporting initiative, the Physician Quality Improvement Initiative (PQRI), widely seen as a precursor to physician-level pay-for-performance. There is a great deal of variability in how these programs are implemented, and in the measures that are used. There is little evidence on the impact of these programs on healthcare quality. While many programs are focused on primary care, there is increasing focus on expanding performance measures, and therefore pay-for-performance programs, into specialty areas including psychiatry. With the growing number of programs, there is a sense of inevitability about the pay-for-performance model. Physician specialty societies such as APA are participating in numerous performance measure development and endorsement initiatives to favor measures that are clinically meaningful, reliable, and evidence based. The materials below are provided for APA members to learn more about the pay-for-performance concept.
APA RESOURCES
Performance Measurement and Pay-for-Performance
March 2007
Fact Sheet on Pay-for-Performance
February 2007
Overview of Pay-for-Performance
October 2006
MATERIALS FROM OTHER SPECIALTY SOCIETIES
AAFP (American Academy of Family Physicians): Pay-For-Performance
AAN (American Academy of Neurology): Position on P4P
AAN (American Academy of Neurology): Pay-for-Performance
ACC: American College of Cardiology 2006 Principles to Guide Physician Pay-for-Performance Programs
ACP (American College of Physicians): Physicians should be able to review performance rates before release
AMA (American Medical Association): Principles for Pay-for-Performance Programs
AMA (American Medical Association): Guidelines for Pay-for-Performance Programs
Joint Commission: Principles for the Construct of Pay-for-Performance Programs
EXTERNAL RESOURCES
Gaming the System
Government HealthIT article (July 2007)
Physician Quality Reporting Initiative (PQRI)
Centers for Medicare and Medicaid Services (CMS) pay-for-reporting initiative
Rewarding Provider Performance: Aligning Incentives in Medicare
Institute of Medicine report (2007)
A Pay-for-Performance Program for Behavioral Health Care Practitioners
Psychiatric Services article (April 2007)
Physician-level P4P--DOA? Can quality-based payment be resuscitated?
American Journal of Managed Care article (May 2007)
P4P: rumors of its demise may be exaggerated.
American Journal of Managed Care article (May 2007)
Pay-for-Performance: Will the Latest Payment Trend Improve Care?
JAMA article (February 2007)
Pay for Performance at the Tipping Point
New England Journal of Medicine article (February 2007)
Pay-for-Performance and Accountability: Related Themes in Improving Health Care
Annals of Internal Medicine article (November 2006)
Pay for Performance in Commercial HMOs
New England Journal of Medicine article (November 2006)
What Family Physicians Need to Know About Pay for Performance
Family Practice Management article (July/August 2006)
Counselor Incentives to Improve Client Retention in an Outpatient Substance Abuse Aftercare Program.
Administration and Policy in Mental Health article (November 2006)
AMA Moves Cautiously on Pay for Performance
Psychiatric News article (July 2007)