by Karla Gale

Last Updated: 2007-12-06 16:29:23 -0400 (Reuters Health)

NEW YORK (Reuters Health) – The American College of Physicians (ACP) Ethics, Professionalism and Human Rights Committee has drafted an "ethics manifesto," warning against pay-for-performance programs that fail to protect patients.

"We hope to alert physicians, payers, and policy makers to the potential for ‘deselection’ and thereby avert problems for patients," Lois Snyder, JD, told Reuters Health. "Pay-for-performance programs can improve quality of care, but the ACP would like the views of patients to be part of the design of these programs."

Writing in the Annals of Internal Medicine for December 4, Snyder and Dr. Richard L. Neubauer assert, "Clinicians must ensure that the provision of a medically appropriate level of care takes precedence over personal considerations."

Although patient neglect or ethical problems have not yet been formally documented, Snyder pointed out that "some physicians are not participating in pay-for-performance programs because of ethical concerns."

The committee cautions against discrimination against patients with multiple comorbidities. They support programs that encourage physicians to care for the sickest and most vulnerable patients, while decreasing unnecessary care and medical costs.

"Another potential pitfall is ‘gaming of the system’ to achieve good scores on limited performance measures rather than focusing on comprehensive care," Snyder explained. "Medically appropriate care for the individual patient has priority over other considerations," she said, "and program incentives should encourage that."

Snyder, Director of the ACP Center for Ethics and Professionalism in Philadelphia, and Dr. Neubauer, at the Alaska Native Medical Center in Anchorage, say increased administrative oversight of physicians, to prevent deselection of challenging patients, is the price of better compensation for better care.

Ann Intern Med 2007;147:792-794.