Get access

Cherry Picking in ESRD: An Ethical Challenge in the Era of Pay for Performance

Authors

  • J. Clint Parker

    1. Brody School of Medicine, Department of Bioethics and Interdisciplinary Studies and Eastern Nephrology and Associates, Greenville, North Carolina
    Search for more papers by this author

Address correspondence to: J. Clint Parker, East Carolina University, The Brody School of Medicine, Department of Bioethics and Interdisciplinary Studies, 2S-17 Brody Medical Sciences Building, Greenville, NC 27834, e-mail: parkerjo@ecu.edu.

Abstract

In poorly designed pay-for-performance schemes in which case mix adjustments are not adequate, self-interest could lead nephrologists toward cherry picking dialysis patients. Cherry picking, however, is morally problematic. First, it may manifest itself as a subtle form of covert rationing which threatens to undermine patient trust. Second, it involves shifting the burden of caring for sicker (and less financially attractive) patients to other nephrologists and dialysis units that do not practice cherry picking, creating injustices in the health care system. Finally, it treats patients as mere means through which nephrologists achieve reimbursement instead of as persons possessing dignity and deserving of respect.

Ancillary