The recently announced expansion of the Bridges to Excellence pay-for-performance program shows how quickly the concept is gaining steam after just two years, supporters say.

"Now it seems everybody is on board," said Brian Schilling, director of communications for the National Committee for Quality Assurance, one of the program's participants.

The initiative pays bonuses to physicians who meet certain standards of care. Incentives range from $50 to $160 per patient per year. Even with the bonuses, participating health plans say they save money through reduced hospital visits and unnecessary testing.

Supporters say measures are the way to go to improve quality of care, while at the same time getting a handle on costs. Critics say it might seem like a good idea, but there are some dangers. For instance, some doctors might refuse to take on seriously ill patients for fear they might hurt their scores.

Manuel Lowenhaupt, MD, vice president with Capgemini Health, has observed a growing interest and growing sophistication in the programs. He expects the trend to continue, as more physicians seem to be recognizing the value and the potential.

Large employers, such as Procter & Gamble and GE, eager to drive down the cost of healthcare, gave the program its initial push. A coalition of employers, payers and providers launched the non-profit Bridges to Excellence in 2003 and started the program in Ohio, Kentucky and Massachusetts. The effort offered measures in three areas: diabetes care, cardiovascular care and patient care management systems.

CareFirst BlueCross BlueShield joined the pay-for-performance effort last month and announced it would pay doctors as much as $20,000 to install electronic patient record systems as part of the health plan's bonus plan. The new initiative involves 10 states and more than 2 million people.

Cigna HealthCare also recently licensed the Bridges to Excellence program and will work with employers in Phoenix and North Carolina.

The Centers for Medicare and Medicaid Services launched its own pay-for-performance initiative earlier this year, engaging 10 physician practices across the country in the effort.

Some physicians have expressed skepticism over pay-for-performance, suggesting that an "apples-to-apples" measurement is nearly impossible to achieve.

However, pay-for-performance programs have won the support of several physician organizations, including the American Academy of Family Physicians and the Medical Group Management Association, which has published a position paper on the topic.

William Jessee, MD, president and CEO of MGMA, believes the programs will grow and gain in staying power. It's important, he said, for payers to adopt the same type of programs across the board and resist the urge to be unique. Most critical of all, Jessee added, all participants must keep in mind the MGMA's first principle: "The primary goal of pay-for-performance programs must be improving health quality and safety."

Lowenhaupt agrees, and believes the programs will boost quality of care.

"This is the right thing for American medicine," he said. Given limited resources, you align the resources with the best clinical outcome."