Pay-for-Performance

In the News

• ADA Military Legislative Achievements in 2006 (PDF)

At Issue

Pay-for-Performance (P4P) is built upon the premise that providers who perform well should be paid more than those who do not as an incentive to improve quality. This concept has gained a great deal of interest from third party payers and, especially, the federal government. While initially targeting medical care, it is highly likely that the concept will be considered for dental care as well.

ADA Priorities

The 2006 ADA House of Delegates adopted the following 10 principles for Pay for Performance or Other Third-Party Financial Incentive Programs:

1. The primary objective of pay for performance (P4P) or other third-party financial incentive programs must be improvement in the quality of oral health care, so performance measures in those plans shall be quality-related.
2. The provisions of P4P or other third-party financial incentive programs must not interfere with the patient-doctor relationship by injecting factors unrelated to the patient’s needs into treatment decisions.
3. The incentives in P4P or other third-party financial incentive programs must reward both the achievement of desired quality levels and significant improvement in quality directed toward meeting the desired levels.
4. P4P or other third-party financial incentives programs must not limit access to care for patients requiring extraordinary levels or types of care.
5. The incentives in a P4P or other third-party financial incentive program must be positive and of a type and magnitude that will drive improvement in quality of care or support consistently high quality care.
6. The measures upon which incentive payments are based:
   • must be exact, clear, measurable and based on valid science;
   • must be standard and have broad acceptance within the dental community;
   • must be risk-adjusted to account for patient differences;
   • must factor in patient compliance;
   • must require a minimum of measurements.
7. Reporting of quality to the public must be fair and provide an opportunity for dentists to comment on ratings. Payers must discuss quality problems they identify with dentists before any public action is taken.
8. Participation by dentists must be voluntary, with no financial penalties for not participating.
9. Savings in cost must not accrue to plans but must be returned to patients in reduced co-payments or expansion of benefits.
10. Regular reassessment of P4P or other third-party financial incentive programs must be done with input from participating dentists.

The ADA will continue to monitor congressional P4P legislative proposals as they are developed.

Letters & Testimonies

• H.R. 1932 (Rep. Candice Miller) (PDF)
• ADA Thanks Rep. Candice Miller for support of H.R. 1932 (PDF)

Contact Us

For additional information, please contact:

• Michael Graham, Senior Congressional Lobbyist, Congressional Affairs
• Frank Kyle, D.D.S., Manager, Legislative & Regulatory Policy, Federal Affairs
• Paul O'Connor, Legislative Liaison, State Government Affairs

Federal Affairs
1111 14th Street NW, Suite 1100
Washington, DC 20005
202.898.2400
Fax: 202.898.2437
E-mail: govtpol@ada.org

State Government Affairs
ADA Chicago Headquarters
211 East Chicago Avenue
Chicago, IL 60611
312.440.2525
Fax: 312.440.3539
E-mail: govtpol@ada.org