title: High quality care and ethical pay-for-performance: a Society of General Internal Medicine policy analysis.
abstract: BACKGROUND
  Pay-for-performance is proliferating, yet its impact on key stakeholders remains uncertain.
  
  
  OBJECTIVE
  The Society of General Internal Medicine systematically evaluated ethical issues raised by performance-based physician compensation.
  
  
  RESULTS
  We conclude that current arrangements are based on fundamentally acceptable ethical principles, but are guided by an incomplete understanding of health-care quality. Furthermore, their implementation without evidence of safety and efficacy is ethically precarious because of potential risks to stakeholders, especially vulnerable patients.
  
  
  CONCLUSIONS
  We propose four major strategies to transition from risky pay-for-performance systems to ethical performance-based physician compensation and high quality care. These include implementing safeguards within current pay-for-performance systems, reaching consensus regarding the obligations of key stakeholders in improving health-care quality, developing valid and comprehensive measures of health-care quality, and utilizing a cautious evaluative approach in creating the next generation of compensation systems that reward genuine quality.
authors.affiliation: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 133 Brookline Avenue, 6th Floor, Boston, MA 02114, USA. jwharam@partners.org
authors.forename: J Frank
authors.initials: JF
authors.lastname: Wharam
authors.forename: Michael K
authors.initials: MK
authors.lastname: Paasche-Orlow
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Farber
authors.forename: Christine
authors.initials: C
authors.lastname: Sinsky
authors.forename: Lisa
authors.initials: L
authors.lastname: Rucker
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Rask
authors.forename: M Kathleen
authors.initials: MK
authors.lastname: Figaro
authors.forename: Clarence
authors.initials: C
authors.lastname: Braddock
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Barry
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Sulmasy
mesh_terms: D004992:Ethics, Medical; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics; D007388:Internal Medicine / Q000191:economics*; D016134:Organizational Policy; D010816:Physician Incentive Plans / Q000191:economics*; D016730:Program Development; D011787:Quality of Health Care; D012955:Societies, Medical; D014481:United States