Statement on the AMA Agreement with Congress to Develop “Performance Measures”
February 21, 2006
By Jane M. Orient, M.D., F.A.C.P., Executive Director
AAPS, a nationwide organization of physicians in all specialties, founded in 1943 to promote private medicine and the sanctity of the patient-physician, strongly objects to attempts by Congress to delegate the regulation of the practice of medicine to a private organization, such as the American Medical Association or any other such group.
Congress does not itself have the constitutional authority to dictate the practice of medicine, and specifically promised not to attempt to do so in the Act that established Medicare:
1801. Nothing in this title shall be construed to authorize any Federal officer or employee to exercise any supervision or control over the practice of medicine or the manner in which Medical services are provided, or over the selection, tenure, or compensation of any officer or employee of any institution, agency, or person providing health services; or to exercise any supervision or control over the administration or operation of any such institution, agency, or person.
There are many reasons why attempts to pay physicians on the basis of AMA-dictated performance measures will serve to harm patients. These include:
- The most appropriate treatment for a given patient depends on the characteristics of the individual patient, not the idealized abstraction that committees of “experts” use to develop the guidelines.
- The appropriateness of any guideline depends on the accuracy of the diagnosis; thus, slavish adherence to guidelines may reward doctors who have made the wrong diagnosis.
- Guidelines have not been scientifically validated as either safe or effective; nor have they even been shown to save money in most cases.
- Guidelines serve to hinder innovation; many previously novel and disfavored treatments are now considered the “standard of care.”
- The process of developing guidelines is likely to be unduly influenced by special interest groups, including pharmaceutical companies, insurers, and governmental or nongovernmental agencies or organizations.
- The process of reporting the required information imposes an unfunded mandate on physicians and will serve to divert resources from the activities that best serve patients’ real needs to those that satisfy the data collectors.
- The “pay for performance” (P4P) campaign is apparently part of a cost-containment program that will cut physicians’ pay. This will further reduce expenditures by restricting access to care.
- P4P will further delay the urgent need for fundamental reform in the entitlement system.