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Experts: Tie Doctors' Pay to Quality

Medicare Urged to Establish Pay-for-Performance Program to Encourage Good Care

'Long March' to Incentives continued...

Researchers have only begun to settle on how to accurately measure the performance of doctors, who often work on highly complex and varied types of cases.

Experts also say they have not figured out how much more money -- 10%, 20%, or more -- would be necessary to shift the behavior of poorly performing physicians.

Not surprisingly, the idea of tying payments to job performance is eyed with suspicion by doctors, who worry that measures could wind up dictating to them how to practice their craft, or worse, fail to take into account sicker and harder-to-treat patients.

"This is a change in culture," says Robert Glavin, MD, a member of the IOM panel and director of global health for General Electric Co.

The American Medical Association (AMA), which looks after doctors' interests in Washington, has said any new payment incentive system should be voluntary for doctors. The organization is coming up with its own set of quality measures for Medicare to consider.

"In addition, pay-for-performance programs should ensure quality of care, foster the patient-physician relationship, and use accurate data and fair reporting," Cecil Wilson, MD, the AMA's board chairman, said in a statement Thursday.

Medicare has already launched demonstration projects designed to test whether pay-for-performance incentives can improve care. Outgoing Medicare chief Mark McClellan, MD, a physician and economist, has said the agency plans to expand those programs.

Donald McCleod, a Medicare spokesman, said hospitals participating in a voluntary demonstration received $8.85 million in bonuses for improvements on quality measures this year. He called the IOM's report "right on target."

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