Wall Street Journal Examines Debate Over Payments to Physicians Who Adhere to Evidence-Based Guidelines

The Wall Street Journal on Thursday examined the increased number of employers, health plans and government programs that have begun to offer physicians financial incentives to adhere to "evidence-based" guidelines for care, a "controversial wrinkle in the pay-for-quality movement." A number of medical schools, specialty groups, government agencies and health care companies have developed more than 100 evidence-based guidelines -- based on "rigorous clinical studies and scientific research" -- that range from how to treat common conditions such as asthma and hypertension to how to perform surgeries and treat serious diseases such as cancer, the Journal reports. However, some health care experts have raised concerns that "going strictly by guidelines" to treat patients may "interfere with doctors' own intuition and experience," and others have questioned "why doctors should get paid extra to follow guidelines they should be adhering to already," according to the Journal. In addition, some health care experts criticize the practice as "thinly disguised cost-containment," the Journal reports. Charles Ingoglia, vice president of the National Mental Health Association, said, "A lot of states and other payers are exploring the idea of using evidence-based guidelines to deliver more cost-effective treatment, but that's just political cover" for the elimination of treatments and services for patients. However, according to Kenneth Fink, a program director at the Agency for Healthcare Research and Quality, "Evidence-based medicine is really a triangle that uses the best available scientific data within the context of the values of the patient and the experience and knowledge of the provider" (Landro, Wall Street Journal, 5/6).