Value-Based Purchasing and Physician Professionalism

Discusses value-based purchasing related to professionalism. Professionalism may be decreased whenphysicians perceive that VBP programs focus on relatively unimportant measures, are unnecessarily complex, increase administrative burden, lack the statistical power to reliably measure performance, rely on checking of boxes, penalize physicians who care for socioeconomically disadvantaged or complex patients, or incentivize inappropriate care. Given the complexity, heterogeneity, and entrenched financial interests of the US health care system, the shift toward meaningful VBP remains challenging. But current VBP efforts also are hampered by lack of clarity about the context in which a program is being deployed and lack of attention to the intrinsic motivation of physicians. The goal of VBP should not be to incentivize physicians to work harder. The vast majority of physicians already work hard. Failure to recognize this may result in physician resistance, decreased professionalism, and unsuccessful VBP programs. A VBP program is more likely to succeed if it supports physician professionalism.