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September 20, 2016

Increasing the Value of Social Comparisons of Physician Performance Using Norms

Author Affiliations
  • 1Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 2Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 3Department of Medical Ethics & Health Policy, University of Pennsylvania, Philadelphia
  • 4Corporal Michael J. Cresencz VA Medical Center, Philadelphia, Pennsylvania
  • 5The Leonard Davis Institute of Health Economics, Wharton School, University of Pennsylvania, Philadelphia
JAMA. 2016;316(11):1151-1152. doi:10.1001/jama.2016.10094

National policies, including the Medicare Access and CHIP [Children’s Health Insurance Program] Reauthorization Act of 2015, attempt to improve US health care by paying health systems and clinicians for value rather than volume of care. All payment systems, however, are susceptible to unintended consequences, and reimbursing physicians based on cost and quality outcomes may harm patients if financial and nonfinancial motivations are in conflict with each other.

Physicians are ideally motivated by factors beyond personal compensation, including providing care that aligns with patient well-being and professional standards. In turn, strategies that encourage physicians to practice high-value care need not always consist of monetary payments as done in pay-for-performance. One promising approach is to use social comparisons to influence physician behavior. Social comparisons provide individuals with comparative feedback on their own performance relative to that of their peers.