"I don't believe now, or in the future, that physicians will trust a
quality-measurement system that happens in Washington," said Health and
Human Services Secretary Mike Leavitt in an address to the AMA House of
Delegates during the AMA's interim meeting in Las Vegas (see article
Judging from discussions at the House of Delegates in the days following
Leavitt's address, the secretary was on to something.
Two resolutions that would have put the house on record in opposition to
the government's pay-for-performance (P4P) program were brought to reference
committee hearings for debate. (One was titled "Rejection of Pay for
Performance as Economic Credentialing That Will Decrease Patient Access to
"P4P is not about rewarding physicians for performance; it is about
allocating already existing insufficient funds in a punitive manner,"
said Peter Levine, M.D., of Del Mar, Calif., expressing a common
But P4P presents the AMA with a familiar dilemma: since value-based
purchasing appears to be inevitable, with private payers and the government
determined to pursue it in some fashion, an expression of blanket opposition
by the organization could be to disqualify itself from future negotiations
over the shape and scope of P4P.
Though the two resolutions were not approved, the house requested that the
AMA board report back on the items when delegates meet again for the AMA's
annual meeting next June.
At press time, John McIntyre, M.D., chair of the AMA Section Council on
Psychiatry, told Psychiatric News that on behalf of the section
council he would be asking the APA Board of Trustees at its meeting in
Arlington, Va., this month to convene a task force to develop a position on
He also noted that AMA delegates, with input from the psychiatry
delegation, approved "Pay-for-Performance Principles and
Guidelines" for the development of P4P programs during the House of
Delegates' 2005 annual meeting (Psychiatric News, July 15, 2005).
"This is clearly becoming a major issue for all of medicine,
including psychiatry," McIntyre said. "The challenge now is to
move from those principles to influencing the P4P projects that appear in the
form of pilot programs [by the government and private payers]. What we would
like to see is an attempt to assess these pilot programs in an evidence-based
manner to see if they are successful in improving the quality of care
"What delegates are concerned about is that the real focus isn't
quality at all but cost containment. As Secretary Leavitt said in his address
to the house, we aren't very good at measuring quality."
Mike Leavitt, secretary of Health and Human Services, tells the AMA's
House of Delegates that fixing America's health care system requires
value-based purchasing of medical services, use of electronic health records,
and a reorientation of physicians, payers, and patients to prevention and
wellness rather than illness. Ted Grudzinski, AMA