Clinical Practice ManagementPay-for-Performance in Pulmonary Medicine Opportunity or Threat?Reineck, Lora A. MD*; Kahn, Jeremy M. MD, MS†Author Information *Division of Pulmonary, Allergy, and Critical Care Medicine †Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA Funded by NIH 5T32HL7563 (L.A.R.). The authors declare that they have nothing to disclose. Address correspondence to: Jeremy M. Kahn, MD, MS, Department of Critical Care, Medicine and Health Policy & Management, University of Pittsburgh School of Medicine and Graduate School of Public Health, Scaife Hall Room 602-B, 3550 Terrace Street, Pittsburgh, PA 15221. E-mail: [email protected]. Clinical Pulmonary Medicine: September 2012 - Volume 19 - Issue 5 - p 206-214 doi: 10.1097/CPM.0b013e318267097a Buy Metrics Abstract Pay-for-performance (P4P) is a quality improvement strategy that links a portion of reimbursement to provider health care performance measures with the goal of better and more efficient health care. P4P programs are increasingly common at both the hospital and physician level, including the introduction of Medicare’s Hospital Inpatient Value-Based Purchasing program later this year and a physician value-based purchasing program in development. Although many clinicians view P4P as a threat to autonomy and income, an alternative view is that P4P presents an important opportunity for clinicians to partner with payers to improve health care outcomes for our patients. Indeed, financial incentives are powerful tools for behavior change, and an ideal health care system should not reward the volume of care in the absence of quality. In this review, we provide practicing pulmonary clinicians with an overview of P4P in health care, discuss the potential adverse consequences inherent in P4P, and provide concrete strategies to help clinicians engage policy makers and health care payers in these initiatives. Among these strategies are participating in existing P4P programs such as Medicare’s Physician Quality Reporting System, working through professional medical associations to create quality metrics that are important to both physicians and patients, and educating the next generation of physicians about the importance of linking reimbursement to quality. Only through active engagement can the pulmonary community ensure that P4P programs best serve our patients and the health care system at large. © 2012 Lippincott Williams & Wilkins, Inc.