Pay-for-Performance

In Brief 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. Pay-for-performance arrangements are intended to provide incentive for the implementation of evidence-based behavior in clinical practice. An effective pay-for-performance system applied to the management of spinal disorders will include a combination of measurable process variables and outcomes variables that reflect changes in health-related quality of life.