Effects of Paying Physicians Based on their Relative Performance for Quality
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Studies examining the effectiveness of pay-for-performance programs to improve quality of care primarily have been confined to bonus-type arrangements that reward providers for performance above a predetermined threshold. No studies to date have evaluated programs placing providers at financial risk for performance relative to other participants in the program.
The objective of the study is to evaluate the impact of an incentive program conferring limited financial risk to primary care physicians.
There were 334 participating primary care physicians in Rochester, New York.
The design of the study is a retrospective cohort study using pre/post analysis.
The measurements adhere to 4 diabetes performance measures between 1999 and 2004.
While absolute performance levels increased across all measures immediately following implementation, there was no difference between the post- and pre-intervention trends indicating that the overall increase in performance was largely a result of secular trends. However, there was evidence of a modest 1-time improvement in physician adherence for eye examination that appeared attributable to the incentive program. For this measure, physicians improved their adherence rate on average by 7 percentage points in the year after implementation of the program.
This study demonstrates a modest effect in improving provider adherence to quality standards for a single measure of diabetes care during the early phase of a pay-for-performance program that placed physicians under limited financial risk. Further research is needed to determine the most effective incentive structures for achieving substantial gains in quality of care.
- Baker G, Carter B. Provider pay-for-performance incentive programs: 2004 national study results. San Francisco: Med-Vantage, Inc; 2005.
- Medicare Value-Based Purchasing for Physicians’ Services Act of 2005, H.R. 3617, 109th Cong., 1st Sess. (2005).
- Medicare Value Purchasing Act of 2005, S. 1356, 109th Cong., 1st Sess. (2005).
- Rosenthal MB, Frank RG, Li Z, Epstein AM. Early experience with pay-for-performance: from concept to practice. JAMA. 2005;294:1788–93. CrossRef
- Amundson G, Solberg LI, Reed M, Martini EM, Carlson R. Paying for quality improvement: compliance with tobacco cessation guidelines. Jt Comm J Qual Saf. 2003;29:59–65.
- Roski J, Gregory R. Performance measurement for ambulatory care: moving towards a new agenda. Int J Qual Health Care. 2001;13:447–53. CrossRef
- Kouides RW, Bennett NM, Lewis B, Cappuccio JD, Barker WH, LaForce FM. Performance-based physician reimbursement and influenza immunization rates in the elderly: the primary-care physicians of Monroe County. Am J Prev Med. 1998;14:89–95. CrossRef
- Hillman AL, Pauly MV, Kerstein JJ. How do financial incentives affect physicians’ clinical decisions and the financial performance of health maintenance organizations? N Engl J Med. 1989;321:86–92. CrossRef
- The state of health care quality. Washington, D.C.: National Committee for Quality Assurance, 2005 and 2003. (Accessed November 4, 2005 at http://www.ncqa.org/Docs/SOHCQ_2005.pdf and http://www.ncqa.org/Communications/Publications/03annual.pdf.)
- Cabana MD, Rand CS, Powe NR, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282:1458–65. CrossRef
- Bokhour BG, Burgess JF, Hook JM, et al. Incentive implementation in physician practices: a qualitative study of practice executive perspectives on pay for performance. Med Care Res Rev. 2006;63:73S–95S. CrossRef
- Dudley RA. Pay-for-performance research: how to learn what clinicians and policy makers need to know. JAMA. 2005;294:1821–3. CrossRef
- Chassin MR. Does paying for performance improve the quality of healthcare? Med Care Res Rev. 2006;63:122S–5S. CrossRef
- Effects of Paying Physicians Based on their Relative Performance for Quality
Journal of General Internal Medicine
Volume 22, Issue 6 , pp 872-876
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- financial incentives
- quality of care
- Industry Sectors
- Author Affiliations
- 1. Department of Health Policy and Management, Boston University School of Public Health, Talbot Building, 715 Albany Street, Boston, MA, 02118-2526, USA
- 2. Department of Veterans Affairs, Center for Organization, Leadership and Management Research, Boston, MA, USA
- 3. Rochester Individual Practice Association, Rochester, NY, USA
- 4. Excellus Health Plans, Rochester, NY, USA
- 5. MedVantage, Inc., San Francisco, CA, USA
- 6. Center for Health Quality, Outcomes and Economic Research, Department of Veterans Affairs, Bedford, MA, USA