Wharam, JamesPaasche-Orlow, Michael K.Farber, Neil J.Sinsky, ChristineRucker, LisaRask, Kimberly J.Figaro, M. KathleenBraddock, ClarenceBarry, MichaelSulmasy, Daniel P.2011-11-162009Wharam, J. Frank, Michael K. Paasche-Orlow, Neil J. Farber, Christine Sinsky, Lisa Rucker, Kimberly J. Rask, M. Kathleen Figaro, Clarence Braddock, Michael J. Barry, and Daniel P. Sulmasy. 2009. High quality care and ethical pay-for-performance: a society of general internal medicine policy analysis. Journal of General Internal Medicine 24(7): 854-859.0884-8734http://nrs.harvard.edu/urn-3:HUL.InstRepos:5346784BACKGROUND: Pay-for-performance is proliferating, yet its impact on key stakeholders remains uncertain. OBJECTIVE: The Society of General Internal Medicine systematically evaluated ethical issues raised by performance-based physician compensation. RESULTS: We conclude that current arrangements are based on fundamentally acceptable ethical principles, but are guided by an incomplete understanding of health-care quality. Furthermore, their implementation without evidence of safety and efficacy is ethically precarious because of potential risks to stakeholders, especially vulnerable patients. CONCLUSION: We propose four major strategies to transition from risky pay-for-performance systems to ethical performance-based physician compensation and high quality care. These include implementing safeguards within current pay-for-performance systems, reaching consensus regarding the obligations of key stakeholders in improving health-care quality, developing valid and comprehensive measures of health-care quality, and utilizing a cautious evaluative approach in creating the next generation of compensation systems that reward genuine quality.en-USethicshealth policypay-for-performancequality improvementphysician reimbursementJournal Article2011-11-1610.1007/s11606-009-0947-3