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January 4, 2006

Clinical Practice Guidelines for Older Patients With Comorbid Diseases

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2006;295(1):33-35. doi:10.1001/jama.295.1.34-a

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.

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