Not by money alone

Physi­cians will re­spond bet­ter to in­trin­sic in­cen­tives to im­prove than to P4P

Modern Healthcare - - OPINIONS COMMENTARY - Dr. Kevin Weiss

For more than a decade, con­sumers and pur­chasers have been con­vinced that fi­nan­cial in­cen­tives, such as pay­for-per­for­mance, are a key to im­prov­ing our health­care sys­tem. Re­sults of this con­cept—a form of ex­trin­sic mo­ti­va­tion—have been mixed. For ex­am­ple, a study pub­lished this year by BMJ (the online Bri­tish Med­i­cal Jour­nal) de­ter­mined that a highly in­cen­tivized physi­cian pay-for-per­for­mance pro­gram in the United King­dom ul­ti­mately did not im­prove out­comes in pa­tients with high blood pres­sure.

We are con­fi­dent that a pow­er­ful and com­pli­men­tary path­way to health­care qual­ity lies in tap­ping into the physi­cian’s in­trin­sic mo­ti­va­tion for im­prove­ment and pro­fes­sional growth. It is this in­ter­nally di­rected mo­ti­va­tion that forms the foun­da­tion of pro­fes­sion­al­ism and serves as the foun­da­tion for the Amer­i­can Board of Med­i­cal Spe­cial­ties Main­te­nance of Cer­ti­fi­ca­tion pro­gram.

Board cer­ti­fi­ca­tion, un­like li­cen­sure, is a vol­un­tary process and demon­strates to the pub­lic a physi­cian’s ex­per­tise in a par­tic­u­lar spe­cialty or sub­spe­cialty of medicine. Ap­prox­i­mately 85% of U.S. physi­cians are board cer­ti­fied by one or more of the 24 ABMS mem­ber boards. Stud­ies have shown that, com­pared to those who are not board cer­ti­fied, physi­cians who are board cer­ti­fied by an ABMS mem­ber board de­liver higher qual­ity care and their pa­tients have bet­ter out­comes. Fur­ther, sur­veys show the pub­lic val­ues the as­sur­ance that board cer­ti­fi­ca­tion pro­vides.

But re­search also tells us that physi­cians’ skills can de­cline over time. This in­formed the de­vel­op­ment and im­ple­men­ta­tion of the ABMS cer­ti­fi­ca­tion main­te­nance pro­gram. It is a sys­tem of pro­fes­sional life­long ed­u­ca­tion and as­sess­ment tools that sup­port con­tin­ued pro­fes­sional de­vel­op­ment and pub­lic ac­count­abil­ity to keep pace with rapidly ac­cel­er­at­ing sci­en­tific knowl­edge, med­i­cal tech­nol­ogy and pro­fes­sional stan­dards as they ap­ply to their spe­cial­ties. We be­lieve qual­ity physi­cians in­her­ently un­der­stand this to be true and are mo­ti­vated to strive to­ward this qual­ity of pa­tient care.

The main­te­nance pro­gram is de­signed to pro­mote life­long learn­ing by con­tin­u­ally mea­sur­ing physi­cians on six core com­pe­ten­cies: pro­fes­sion­al­ism; pa­tient care and pro­ce­dural tifi­ca­tion main­te­nance pro­gram.

It is clear that the ex­trin­sic mo­ti­va­tion path­way will con­tinue to be a ma­jor force in the ef­fort of health­care pay­ers to im­prove the qual­ity of care. To be ef­fec­tive, how­ever, health­care qual­ity im­prove­ment ef­forts will most likely re­quire ap­proaches de­signed to ap­peal to in­trin­sic mo­ti­va­tion, such as those em­ployed through the cer­ti­fi­ca­tion main­te­nance pro­gram.

To this end, ABMS and its mem­ber boards are com­mit­ted to ed­u­cat­ing ex­ter­nal au­di­ences re­gard­ing the ben­e­fits of the pro­gram, as well as rais­ing aware­ness among physi­cians of the im­por­tance of par­tic­i­pa­tion in the pro­gram. Ex­trin­sic and in­trin­sic ac­count­abil­ity ac­tiv­i­ties can and should align in or­der to achieve re­sults that will ben­e­fit all of us. We, there­fore, are en­gag­ing in di­a­logue with health­care pur­chasers, health or­ga­ni­za­tions, con­sumers and pa­tients to ex­plore a new, shared ac­count­abil­ity frame­work that takes ad­van­tage of po­ten­tial syn­er­gies.

As an ex­am­ple, in 2010, ABMS reached out to Congress as it worked on health­care re­form to in­form them of the value of board cer­ti­fi­ca­tion. This re­sulted in the Pa­tient Pro­tec­tion and Af­ford­able Care Act link­ing the ABMS cer­ti­fi­ca­tion main­te­nance pro­gram with the CMS’ Physi­cian Qual­ity Reporting pro­gram.

Physi­cians have an in­trin­sic de­sire to de­liver qual­ity care, and that in­trin­sic mo­ti­va­tion is at the heart of the pro­fes­sional and helps build a crit­i­cal con­nec­tion be­tween physi­cians and pa­tients. As the ABMS board cer­ti­fi­ca­tion and cer­ti­fi­ca­tion main­te­nance pro­grams evolve, we in­vite you to visit Cer­ti­fi­ca­tionMat­ters.org to learn more about the process and our quest to im­prove our na­tion’s health­care. We are con­fi­dent that the cer­ti­fi­ca­tion main­te­nance pro­gram, which speaks to doc­tors’ pride and pro­fes­sion­al­ism, will be a ma­jor driv­ing force as we work to­gether to build a qual­ity health­care en­ter­prise.

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