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Pay-for-performance: considerations in application to the management of spinal disorders
Sigurd Berven1, Amanda Smith, Kevin Bozic
1Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA 94143-0728, USA. Bervens@orthosurg.ucsf.edu
Study Design:
Descriptive review.
Objectives:
To describe the role of pay-for-performance as a health care policy that has a significant influence on the management of spinal disorders, and to consider parameters of quality measure that are likely to optimize the efficacy of a pay-for-performance system as applied to spine care.
Summary Of Background Data:
Pay-for-performance arrangements have been adopted in many areas of medicine with limited evidence for improvement in quality of care. There is an important role for a system that will improve quality of care in the management of spinal disorders. The absence of accepted evidence-based approaches to the management of spinal disorders makes the choice of parameters to measure for quality difficult.
Results:
Performance parameters to consider include a continuum of measures from process variables that focus on a discrete component of the health care experience, to outcome variables that encompass the end result of care. There are advantages and limitations to each parameter discussed.
Conclusion:
A pay-for-performance system in the management of spinal disorders should include both process variables that measure safety and outcome variables that reflect the end result of care.
