Simplify doc payment system

By Stephen Kemble, M.D.
Modern Healthcare, Letters, June 6, 2015

Regarding the recent feature “Physician quality pay not paying off” (, June 1, p. 20), several reviews have shown no improvement in population health measures or cost savings from pay-for-performance or pay-for-quality. It is time to face the fact that this is not a case of performance measurement of individual physicians being in a “fledgling state.” The reality is that healthcare, by its nature, is too complex and requires too much individualization to be amenable to management through standardized quality metrics for individual physicians. The metrics that anyone can come up with generally lack validity or are too narrow to have much meaning or value.

Instead of ever greater and more expensive efforts to measure individual physicians' performance, let's move to physician payment that is commensurate with the training and expertise necessary to do what physicians do, but is as simplified and incentive-neutral as possible. Then rely on professionalism and intrinsic motivation for quality improvement, which worked well for years without any financial incentives at all. The road to achieving the triple aim goals is not through pay-for-performance targeting individual physicians, but through administrative simplification leading to reduced healthcare prices and improved access to care for everyone who needs it in the most cost-effective (usually outpatient) settings.

Dr. Stephen Kemble is assistant clinical professor of medicine at John A. Burns School of Medicine University of Hawaii, Honolulu.