Letters Section Editor: Robert M. Golub, MD, Senior Editor.
To the Editor: In their Special Communication, Dr Boyd and colleagues1 argue that strict adherence to CPGs for populations with multiple comorbid diseases could have detrimental effects, a problem that could be exacerbated by linking pay to CPG adherence. However, CPGs could be used to establish a clinically relevant payment system. The current fee-for-service system does not reflect the evidence-based resource requirements to appropriately manage diseases. A payment system shaped by CPGs could base payments on evidence-based, clinically appropriate resources, thus creating an immediate incentive to reduce both overuse and underuse.
de Brantes F, Gosfield AG, McGlynn E, Rosenthal M, Levin-Scherz J. Clinical Practice Guidelines for Older Patients With Comorbid Diseases. JAMA. 2006;295(1):33-35. doi:10.1001/jama.295.1.34-a