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September 20, 2019

Value-Based Purchasing and Physician Professionalism

Author Affiliations
  • 1Division of Health Policy and Economics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, New York
  • 2Departments of Healthcare Policy and Research and Medicine, Weill Cornell Medical College, New York, New York
JAMA. 2019;322(17):1647-1648. doi:10.1001/jama.2019.14990

There is broad consensus among US policy makers that payers should move toward value-based purchasing (VBP), but less agreement about how programs should be designed or about their effect on physician professionalism. Value-based purchasing can be defined as payment models in which clinicians and health care organizations are held accountable for the quality and cost of care instead of being paid based on the volume of services they deliver.

There are 3 fundamental requirements for VBP to succeed: supporting physician professionalism, providing financial rewards for medical groups and hospital systems to invest in systematically improving care, and explicitly designing each program for the context in which it occurs. These contexts can be categorized by 3 combinations of who provides the incentives and who receives them: (1) incentives provided by an external entity (typically a payer, such as Medicare or a health insurer) to a health care delivery organization such as a medical group or hospital; (2) incentives provided by an external entity to individual physicians; and (3) incentives provided internally from a health care delivery organization to its own physicians (eFigure in the Supplement).

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    1 Comment for this article
    Value-based Purchasing Erodes Physicians' Professionalism
    Edward Volpintesta, MD | 155 Greenwood Avenue Bethel CT
    Regardless of whatever method is used, one thing should be clear: value-based purchasing reduces physicians’ professionalism to a greater or lesser extent depending on the methods used and the benefits accruing to the physicians, in bonuses, increased pay, or penalties.

    Physicians’ professionalism already is under attack and has been for several years as physicians are forced to conform to insurers’ regulations, including electronic health records and pre-authorizations for medications, testing, and referrals.