Pay for performance in rheumatology: will we get the carrot or the stick?

Introduction A number of developments suggest that large payers are placing increasing emphasis on value-based purchasing or pay-for-performance (P4P) programs for many medical services (see Table 1 for a glossary of terms used). This drive to tie provider compensation to objective measures of care processes and outcomes is fueled by the perception that payments are insufficiently related to value provided (1– 3). No one can dispute that the US health care system is underperforming, especially with regard to chronic conditions such as the rheumatic diseases, or that fundamental changes in health care delivery processes will be required for improvement. A basic question is whether P4P programs will be designed to provide benefits to patients and reward providers for improving efficiency and outcomes, or will they be aimed exclusively at controlling payer costs—in other words, will we get the carrot or the stick?

[1]  Jeffrey R Curtis,et al.  American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. , 2008, Arthritis and rheumatism.

[2]  J. Harrington,et al.  Osteoporosis disease management for fragility fracture patients: new understandings based on three years' experience with an osteoporosis care service. , 2007, Arthritis and rheumatism.

[3]  Harrington Jt,et al.  Redesigning the care of rheumatic diseases at the practice and system levels. Part 1: practice level process improvement (Redesign 101). , 2007 .

[4]  L. Casalino,et al.  General internists' views on pay-for-performance and public reporting of quality scores: a national survey. , 2007, Health affairs.

[5]  R. Hooker,et al.  The United States rheumatology workforce: supply and demand, 2005-2025. , 2007, Arthritis and rheumatism.

[6]  David A Asch,et al.  Clinical Concerns About Clinical Performance Measurement , 2007, The Annals of Family Medicine.

[7]  L. Sandy,et al.  Pay for performance in commercial HMOs. , 2007, The New England journal of medicine.

[8]  E. Newman,et al.  Redesigning the care of rheumatic diseases at the practice and system levels. Part 2: system level process improvement (Redesign 201). , 2007, Clinical and experimental rheumatology.

[9]  Robert A. Greene,et al.  Return on Investment in Pay for Performance: A Diabetes Case Study , 2006, Journal of healthcare management / American College of Healthcare Executives.

[10]  Dan Berlowitz,et al.  Provider attitudes toward pay-for-performance programs: development and validation of a measurement instrument. , 2006, Health services research.

[11]  J. Christianson,et al.  Health plan pay-for-performance strategies. , 2006, The American journal of managed care.

[12]  M. Porter,et al.  Redefining Health Care: Creating Value-based Competition on Results , 2006 .

[13]  A. McMahon,et al.  Effect of a treatment strategy of tight control for rheumatoid arthritis (the TICORA study): a single-blind randomised controlled trial , 2004, The Lancet.

[14]  E. Newman,et al.  "The rheumatologist can see you now": Successful implementation of an advanced access model in a rheumatology practice. , 2004, Arthritis and rheumatism.

[15]  A. Gibofsky.  American College of Rheumatology. , 2002, Journal of the Medical Association of Georgia.

[16]  J. Harrington,et al.  Pre-appointment management of new patient referrals in rheumatology: a key strategy for improving health care delivery. , 2001, Arthritis and rheumatism.

[17]  W. Edwards Deming,et al.  Out of the Crisis , 1982 .