Physicians have a professional obligation and, in many states, a legal duty to report drivers whose functional or cognitive impairments may pose a safety hazard.
To be a useful tool for assessing quality of physician care, pay-for-performance must be designed to include process measures and to not penalize physicians for treating patients with difficult-to-manage conditions.
State laws often require physicians to report suspected abuse and assault, creating a dilemma for physicians who must not only treat the injured patient but act as an informant to police.
Appropriate use of the pay-for-performance system may improve quality of care by counteracting physician incentives to overtreat in fee-for-service situations or undertreat in capitation plans.