The Sustainable Growth Rate was replaced in 2015 by the Medicare Access and CHIP Reauthorization Act, which introduced fixed annual physician fee updates and a merit-based incentive payment system.

Although measures of patient satisfaction are being used to improve patients’ hospital experience, implementing incentives based on these measures may be premature and have unintended consequences for care delivery.

AMA Journal of Ethics theme editor Amanda Xi, MD, a transitional year resident at Henry Ford Hospital, interviewed Donald M. Berwick, MD, shortly before the Supreme Court’s decision in King versus Burwell.

Many treatments are given to patients who have little to gain from them.

The belief persists that patient satisfaction surveys are more responsive to friendliness and expensive facilities than clinician interaction, but there is evidence to the contrary.

Outcome-based payment more closely aligns payments with what patients want, which is better health rather than more health care. But these approaches remain challenging to implement.

Measuring outcomes alone is not the answer. There should be a way to reward the doctor for educating a patient about lifestyle modifications and then documenting that the care provided followed patient preferences.

Four opinions from the AMA Code of Medical Ethics' on physician responsibility under various models of payment of care.

Similar key outcomes in patients from hospitals where financial incentives were offered and patients from hospitals where financial incentives were not offered suggest that financial incentives may not be the answer to improving quality of care.

The use of coded patient data for reimbursement purposes can tempt clinicians to exaggerate the severity of the patient's condition, skewing the accuracy of the data and interfering with clinical decision support and research.