Pierce Read G, Bozic Kevin J, Bradford David S
University of California, San Francisco, CA, USA.
Clin Orthop Relat Res. 2007 Apr;457:87-95. doi: 10.1097/BLO.0b013e3180399418.
In recent decades American medicine has undergone tremendous changes. Numerous reimbursement and systems approaches to controlling medical inflation and improving quality have failed to provide cost-effective, high-quality health care in most circumstances. Public and private payers are currently implementing pay for performance, a new reimbursement method linking physician pay to evidence of adherence to performance measures, to constrain costs, encourage efficiency, and maximize value for health care dollars. High-quality research regarding pay for performance and its impact is scarce, particularly in orthopaedic surgery. Although supporters argue pay for performance will remedy the fragmented, costly delivery of health services in the United States, skeptics raise concerns about disagreement over quality guidelines, financial implications for providers and hospitals, inadequate infrastructure, public reporting, system gaming, and physician support. Our survey of orthopaedic surgeons reveals limited understanding of pay for performance, marked skepticism of nonphysician stakeholders' intentions, and a strong desire for greater clinician involvement in shaping the pay for performance movement. As pay for performance will likely be a long-term change that will have an impact on every orthopaedic surgeon, clinician awareness and participation will be fundamental in creating successful pay for performance programs.
近几十年来，美国医学经历了巨大的变革。在大多数情况下，众多控制医疗通胀和提高质量的报销及系统方法未能提供具有成本效益的高质量医疗服务。公共和私人支付方目前正在实施按绩效付费，这是一种将医生薪酬与遵守绩效指标的证据相挂钩的新报销方法，以控制成本、鼓励效率并使医疗保健资金的价值最大化。关于按绩效付费及其影响的高质量研究稀缺，尤其是在骨科手术领域。尽管支持者认为按绩效付费将纠正美国医疗服务分散且成本高昂的问题，但怀疑者对质量指南的分歧、对提供者和医院的财务影响、基础设施不足、公开报告、系统博弈以及医生支持等问题表示担忧。我们对骨科医生的调查显示，他们对按绩效付费的理解有限，对非医生利益相关者的意图持明显怀疑态度，并且强烈希望临床医生更多地参与塑造按绩效付费运动。由于按绩效付费可能是一项长期变革，将对每位骨科医生产生影响，临床医生的意识和参与对于创建成功的按绩效付费计划至关重要。
