Pay-for-performance: considerations in application to the management of spinal disorders.
METHODS
Descriptive review.


OBJECTIVE
To describe the role of pay-for-performance as a health care policy that has a significant influence on the management of spinal disorders, and to consider parameters of quality measure that are likely to optimize the efficacy of a pay-for-performance system as applied to spine care.


BACKGROUND
Pay-for-performance arrangements have been adopted in many areas of medicine with limited evidence for improvement in quality of care. There is an important role for a system that will improve quality of care in the management of spinal disorders. The absence of accepted evidence-based approaches to the management of spinal disorders makes the choice of parameters to measure for quality difficult.


RESULTS
Performance parameters to consider include a continuum of measures from process variables that focus on a discrete component of the health care experience, to outcome variables that encompass the end result of care. There are advantages and limitations to each parameter discussed.


CONCLUSIONS
A pay-for-performance system in the management of spinal disorders should include both process variables that measure safety and outcome variables that reflect the end result of care.
Berven
Sigurd
S
Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA 94143-0728, USA. Bervens@orthosurg.ucsf.edu
Smith
Amanda
A
Bozic
Kevin
K
Bradford
David S
DS
D019468:Disease Management; D006801:Humans; D010816:Physician Incentive Plans / Q000191:economics*; D011785:Quality Assurance, Health Care / Q000191:economics; D013122:Spinal Diseases / Q000191:economics* / Q000628:therapy*