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Pay-for-Performance Shouldn't Affect Medical Professionalism

Researchers suggest conflicts between the two are possible but not inevitable

THURSDAY, March 18 (HealthDay News) -- Although there are potential conflicts between the attributes of medical professionalism and pay-for-performance, a clash between the two is by no means inevitable, according to an article in the March 16 issue of the Annals of Internal Medicine.

Amir Qaseem, M.D., of the American College of Physicians in Philadelphia, and colleagues describe how the main themes of medical professionalism -- application of scientific evidence, ethical patient-physician interaction, achieving equity, and a commitment to professionalism -- can be subject to both threats and opportunities in a pay-for-performance model, depending on how it is structured.

Physicians must play a key role in how pay-for-performance programs are defined and evaluated to ensure that they are compatible with, rather than in conflict with, the tenets of medical professionalism, the researchers say. One example of compatibility is rewarding cooperation between specialists and primary care physicians as a way to improve coordination of care, the authors suggest.

"Our analysis suggests that pay-for-performance programs should emphasize the collection of better scientific evidence about their effect on the quality of care, attend carefully to the ethical implications for the physician-patient relationship, ensure disclosure and transparency of payment incentives to patients, monitor whether pay-for-performance incentives produce greater equity in the care of patients, and support the development of professionals engaged in collective learning and improvement," Qaseem and colleagues conclude.

One author reported serving in an advisory capacity for Blue Cross Blue Shield of Massachusetts. Another author reported financial relationships with several pharmaceutical companies, including Novo Nordisk, which provided grant support for the study.

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