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November 20, 2001
Performance-based Pay for Doctors?
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what could be a first in the U.S., a coalition of several major employers in central Florida is seeking to launch a health-care system that pays doctors based on performance.

The Central Florida Health Care Coalition wants to hold doctors more accountable for the care they give their patients, according to the Orlando Sentinel.

The coalition includes Walt Disney World, Lockheed Martin, Universal Orlando and Darden Restaurants.

Last week, the Sentinel reported, the coalition released the results of a local patient-satisfaction survey that shows people are frustrated with long waits for appointments and with doctors who are quick to prescribe medications but don't counsel them on healthy-living habits or problems such as stress.

The coalition hopes to implement its reimbursement plan within three years.

It would pay good doctors more than their poorly performing peers for the same services, based on consumer, financial and clinical ratings for each physician.

"How can you expect people to have incentive to do better if everyone gets paid the same?" Becky Cherney, the coalition's president, asked an audience of 65 doctors, insurance executives, corporate health-plan administrators and drug-company representatives at a meeting Friday in downtown Orlando.

The coalition, whose members help insure more than 1 million workers and family members in Central Florida, faces several obstacles:

  • The plan needs the cooperation of health insurers.

  • Cherney herself acknowledges that the plan likely faces legal and regulatory hurdles.

  • Any extra costs associated with a pay-for-performance system would probably be shouldered by the coalition's members.

Still, the coalition expects to ultimately lower its health-care costs as doctors work harder to control their costs and maintain their patients' health, Cherney said.

Some local doctors told the Sentinel that they like the idea of performance-based pay but worry about developing fair methods to evaluate doctors. For instance, they said, if a patient refuses to comply with a doctor's orders and becomes ill or dies, it could hurt that physician's clinical evaluation.

Still, most doctors would accept the idea of pay based on performance as long as they were confident they would be judged fairly, said Robert Westergan, medical director of Jewett Orthopaedic Clinic.

"We are a very competitive group, and we don't like to be at the bottom of the pile, so we'll always try to succeed," Westergan said. "It's a good motivator."

To view the Orlando Sentinel story, click here.

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