The rush to adopt pay-for-performance programs has raised a number of concerns among physicians and policy analysts. In the November 2, 2006, issue of the New England Journal of Medicine (NEJM), Dartmouth Medical School professor Elliott Fisher, M.D., discusses the recent Institute of Medicine (IOM) report, “Rewarding Provider Performance: Aligning Incentives in Medicare.” The report, which was highlighted last month in CMA Alert’s “Quality Matters,” is the third in a series of quality improvement studies requested by Congress.

Dr. Fisher, a member of the IOM committee that produced the report, is critical of current work in performance measurement. “Unfortunately, much of the current work...seems to ignore one or more of the commonsense principles outlined by the IOM committee,” writes Dr. Fisher in the NEJM article. “The technical quality measures still reflect a tiny segment of clinical practice. The efficiency measures used or under discussion target discrete diagnoses and episodes (which can make fragmented care by multiple providers appear ‘efficient’), rather than the longitudinal costs and outcomes of care (which would reward comprehensive, coordinated care by single providers).”

In light of these shortcomings, Dr. Fisher says that it is critical that the “peformance” of any Medicare pay-for-performance program itself be measured so that officials and experts can identify and correct the inevitable mistakes that will be made.

Dr. Fisher also discusses the challenges of pay-for-performance participation for small office practices and the need for additional funding,

Click here to read the NEJM article.

Contact: Sandra Bressler, 415/882-5171 or sbressler@cmanet.org.