William L. Rich, III, MD (Falls Church, VA)

Currently U.S. physicians under commercial fee for service, Medicaid and Medicare are paid for each transaction. Public policy opinion leaders, Congress, employers, MedPac, andpayers are demanding a shift to a value based delivery of care. This “Pay for Performance”
initiative will dramatically change the way we practice. Physicians who document validated quality measure in the outcomes and processes of care will be paid more than those who don’t. Those who provide these quality measures with the lowest cost or expenditure of resources (tests, drugs, level of office visit) will be paid more than those with greater expenditures. The AAO and ophthalmic subspecialties are working cooperatively to develop evidence based quality measures, which can be billed in 2007. By 2010 there will be public reporting of individual physician’s “score card.” The ability to risk adjust these measures to avoid adverse selection of sick patients is imperative.