Medicare Compliance & Reimbursement

P4P must be voluntary, docs contend.

The pay-for-performance movement seems well on its way in health care, but it still needs to win more buy-in from the people who receive the pay.

The American Medical Association March 2 issued principles and guidelines that it says should guide all P4P programs. Most problematic for health plans could be this principle: "Physician participation in any [pay-for-performance] program must be completely voluntary."

An increasing number of health plans have instituted P4P programs, and even those who have voluntary programs are hoping to eventually expand them to cover all physicians.

In addition, Medicare will soon launch a P4P demo aimed at determining the viability of a systemwide program. But the AMA guidelines show that physicians would oppose any efforts to institute mandatory P4P.

The AMA also wants health plans to design their P4P programs based on evidence-based guidelines, use "accurate data and fair reporting," provide equitable incentives and continue to foster a strong relationship between patient and provider. AMA Unhappy With P4P Tag? Although AMA didn't mention this in its guidelines, the phrase "pay for performance" apparently ticks off many providers, according to a Democratic congressional aide. Physicians and other providers have told Hill aides that they don't like the word "performance," because performing is what monkeys and circus animals do, said the staffer.

"I think we need to find another name for it, perhaps 'value purchasing' or 'pay for quality'," said the aide.