Cognetti David M, Reiter David
Otolaryngol Head Neck Surg. 2006 Jun;134(6):1036-42. doi: 10.1016/j.otohns.2005.11.036.
To introduce otolaryngologists to outcomes-linked reimbursement ("pay-for-performance"), identify clinical practice implications, and recommend changes for successful transition from the traditional "pay-for-effort" reimbursement model.
Policy review.
Payers are actively linking reimbursement to quality. Since the Institute of Medicine issued its report on medical errors in 1999, there has been much public and private concern over patient safety. In an effort to base health care payment on quality, "pay-for-performance" programs reward or penalize hospitals and physicians for their ability to maintain standards of care established by payers and regulatory groups. More than 100 such programs are operational in the United States today. This reimbursement model relies on detailed documentation in specific patient care areas to facilitate evaluation of outcomes for purposes of determining reimbursement. Because performance criteria for reimbursement have not yet been proposed within otolaryngology-head and neck surgery, otolaryngologists must be involved to ensure the adoption of reasonable goals and development of reasonable systems for documentation.
"Pay-for-performance" reimbursement is increasingly common in the current era of outcomes-based medicine. It will assume an even greater role over the next 3 years and will directly affect most otolaryngologists.
向耳鼻喉科医生介绍与结果挂钩的报销制度（“按绩效付费”），确定其对临床实践的影响，并就如何从传统的“按工作量付费”报销模式成功过渡提出建议。
政策审查。
支付方正在积极将报销与医疗质量挂钩。自1999年医学研究所发布关于医疗差错的报告以来，公众和私人部门都对患者安全高度关注。为了使医疗保健支付基于质量，“按绩效付费”计划会根据医院和医生维持支付方及监管机构所制定的医疗标准的能力给予奖励或惩罚。如今美国有100多个这样的计划在实施。这种报销模式依赖于特定患者护理领域的详细记录，以便于为确定报销目的而对结果进行评估。由于耳鼻喉头颈外科领域尚未提出报销的绩效标准，耳鼻喉科医生必须参与进来，以确保采用合理的目标并制定合理的记录系统。
在当前基于结果的医学时代，“按绩效付费”报销越来越普遍。在未来3年它将发挥更大作用，并将直接影响大多数耳鼻喉科医生。
