This is our third installment on pay-for-performance (P4P), following a general overview and then a response to common criticisms.

Amercian College of Physicians (ACP) released a position paper outlining a productive approach to implementing P4P, which was further discussed in Modern Healthcare and California Healthline.

ACP shows some refreshing intellectual honesty. They do not pretend P4P has nothing to do with health care quality or stretch the facts to fit an agenda. Instead ACP comes out with strong support of "The Use of Incentives to Promote Physician Quality Care" and states "The Need to Fundamentally Redesign the Physician Payment System".

But DO NOT confuse ACP with starry-eyed dreamers.

You can get all details from the report, but in essence ACP outlines the list of reasonable recommendations for implementing workable P4P programs. Here is the list of all report sections / ACP positions:

• The Use of Incentives to Promote Physician Quality Care
• The Need to Fundamentally Redesign the Physician Payment System
• Minimizing Physician Burdens
• Transparency and Oversight
• Selection of Measures
• Data Collection
• Data Accuracy, Data Aggregation, and Scoring
• Public Reporting and Other Appropriate Uses of Analyzed Data

• Program Implementation

What do we think is the most important point?

ACP views P4P and EMR adoption as inseparable, just as we wrote before: "Can Doctors Learn to Love EMRs? YES, IF". This means factoring EMR costs (fixed and variable) into P4P program design. This further means that a radically new EMR design is needed to implement this vision.

There is a long road to getting all this work, but ACP is clearly going in the right direction, focusing on the right priorities.