TABLE C-1 Comparison Among Nonspecialist Groups’ Pay-for-Performance Position Statements

Design Issue

American Medical Association

American College of Physicians

American Academy of Family Physicians

Participation (Voluntary/Mandatory)

Voluntary only; nonparticipation should not threaten economic viability of physician practices; must not favor participation of particular specialties, or groups of particular sizes or information technology (IT) capabilities; not linked to participation in other programs.

Not applicable.

Rewards for voluntary measurement and reporting; minimum number of encounters per patient per year; minimum number of patients/physician per year before data are considered valid.

Unit of Accountability

Physician practice groups and/or across health care systems (rather than individually) when feasible; no financial penalties based on factors outside of the physicians’ control.

Physician office.

Develop methodology to allow physicians to receive payments for achieving systemwide Medicare savings attributable to individual physicians, physician group practices, or physician-guided chronic care coordination.

Improvement/ Excellence


Primary goal of pay for performance must be to promote continuously improving quality of care across the health care delivery system.

Reward both improving performance and meeting performance targets.


Quality focused.

Data should be fully adjusted for case-mix composition.

Start with strongest weight for structural measures, followed by process measures and finally clinical outcome measures in a phased implementation.


Rewards only.

Should be directed at positive rather than negative rewards.

Reward-based (positive incentives instead of withholds and penalties).

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