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To the Editor: In their Special Communication, Dr Boyd and colleagues¹ argue that strict adherence to CPGs for populations with multiple comorbid diseases could have detrimental effects, a problem that could be exacerbated by linking pay to CPG adherence. However, CPGs could be used to establish a clinically relevant payment system. The current fee-for-service system does not reflect the evidence-based resource requirements to appropriately manage diseases. A payment system shaped by CPGs could base payments on evidence-based, clinically appropriate resources, thus creating an immediate incentive to reduce both overuse and underuse.

Such a payment model is being designed by Bridges to Excellence,² a multistakeholder group. In this model, physicians and payers would agree on the selection of specific CPGs; initially, patients with multiple complex conditions would be excluded. The payment amount would be based on resources required to deliver the services recommended in the chosen CPG. Physicians who are contracted . . . [Full Text of this Article]

Francois de Brantes, MBA
francois.debrantes@ge.com
General Electric Company
Fairfield, Conn

Alice G. Gosfield, JD
Alice G. Gosfield & Associates
Philadelphia, Pa

Elizabeth McGlynn, PhD
RAND Corp
Santa Monica, Calif

Meredith Rosenthal, PhD
Harvard School of Public Health
Boston, Mass

Jeffrey Levin-Scherz, MD
Partners Community Health Care Inc
Boston, Mass

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