High Quality Care and Ethical Pay-for-performance: a Society of General Internal Medicine Policy Analysis

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 2009 Mar 19

PMID 19294471

Citations 11

Authors

J Frank Wharam

Michael K Paasche-Orlow

Neil J Farber

Christine Sinsky

Lisa Rucker

Kimberly J Rask

M Kathleen Figaro

Clarence Braddock 3rd

Michael J Barry

Daniel P Sulmasy

Affiliations

Soon will be listed here.

Abstract

Background: Pay-for-performance is proliferating, yet its impact on key stakeholders remains uncertain.

Objective: The Society of General Internal Medicine systematically evaluated ethical issues raised by performance-based physician compensation.

Results: We conclude that current arrangements are based on fundamentally acceptable ethical principles, but are guided by an incomplete understanding of health-care quality. Furthermore, their implementation without evidence of safety and efficacy is ethically precarious because of potential risks to stakeholders, especially vulnerable patients.

Conclusion: We propose four major strategies to transition from risky pay-for-performance systems to ethical performance-based physician compensation and high quality care. These include implementing safeguards within current pay-for-performance systems, reaching consensus regarding the obligations of key stakeholders in improving health-care quality, developing valid and comprehensive measures of health-care quality, and utilizing a cautious evaluative approach in creating the next generation of compensation systems that reward genuine quality.

Citing Articles

A mixed-method study on physicians' perceptions of pay for performance: impact on professionalism, morality and work-life balance.

Kavas M, Tut H, Senyurek G, Elhan A BMC Health Serv Res. 2025; 25(1):78.

PMID: 39810168 PMC: 11734429. DOI: 10.1186/s12913-024-12148-9.

Unintended consequences and challenges of quality measurements in dentistry.

Obadan-Udoh E, Calvo J, Panwar S, Simmons K, White J, Walji M BMC Oral Health. 2019; 19(1):38.

PMID: 30823894 PMC: 6397478. DOI: 10.1186/s12903-019-0726-4.

Provider Perspectives on Quality Payment Programs Targeting Diabetes in Primary Care Settings.

Garabedian L, Ross-Degnan D, Wharam J Popul Health Manag. 2018; 22(3):248-254.

PMID: 30204544 PMC: 6555171. DOI: 10.1089/pop.2018.0093.

Ethical Issues in the Design and Implementation of Population Health Programs.

DeCamp M, Pomerantz D, Cotts K, Dzeng E, Farber N, Lehmann L J Gen Intern Med. 2017; 33(3):370-375.

PMID: 29256088 PMC: 5834965. DOI: 10.1007/s11606-017-4234-4.

Supporting Patient Behavior Change: Approaches Used by Primary Care Clinicians Whose Patients Have an Increase in Activation Levels.

Greene J, Hibbard J, Alvarez C, Overton V Ann Fam Med. 2016; 14(2):148-54.

PMID: 26951590 PMC: 4781518. DOI: 10.1370/afm.1904.

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