Journal of General Internal Medicine

, Volume 22, Issue 6, pp 872–876 | Cite as

Effects of Paying Physicians Based on their Relative Performance for Quality

  • Gary J. Young
  • Mark Meterko
  • Howard Beckman
  • Errol Baker
  • Bert White
  • Karen M. Sautter
  • Robert Greene
  • Kathy Curtin
  • Barbara G. Bokhour
  • Dan Berlowitz
  • James F. BurgessJr.
Health Policy

Abstract

Background

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.

Objective

The objective of the study is to evaluate the impact of an incentive program conferring limited financial risk to primary care physicians.

Participants

There were 334 participating primary care physicians in Rochester, New York.

Design

The design of the study is a retrospective cohort study using pre/post analysis.

Measurements

The measurements adhere to 4 diabetes performance measures between 1999 and 2004.

Results

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.

Conclusions

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.

KEY WORDS

pay-for-performance financial incentives quality of care diabetes 

References

  1. 1.
    Baker G, Carter B. Provider pay-for-performance incentive programs: 2004 national study results. San Francisco: Med-Vantage, Inc; 2005.Google Scholar
  2. 2.
    Medicare Value-Based Purchasing for Physicians’ Services Act of 2005, H.R. 3617, 109th Cong., 1st Sess. (2005).Google Scholar
  3. 3.
    Medicare Value Purchasing Act of 2005, S. 1356, 109th Cong., 1st Sess. (2005).Google Scholar
  4. 4.
    Rosenthal MB, Frank RG, Li Z, Epstein AM. Early experience with pay-for-performance: from concept to practice. JAMA. 2005;294:1788–93.PubMedCrossRefGoogle Scholar
  5. 5.
    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.PubMedGoogle Scholar
  6. 6.
    Roski J, Gregory R. Performance measurement for ambulatory care: moving towards a new agenda. Int J Qual Health Care. 2001;13:447–53.PubMedCrossRefGoogle Scholar
  7. 7.
    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.PubMedCrossRefGoogle Scholar
  8. 8.
    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.PubMedCrossRefGoogle Scholar
  9. 9.
    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.)
  10. 10.
    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.PubMedCrossRefGoogle Scholar
  11. 11.
    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.PubMedCrossRefGoogle Scholar
  12. 12.
    Dudley RA. Pay-for-performance research: how to learn what clinicians and policy makers need to know. JAMA. 2005;294:1821–3.PubMedCrossRefGoogle Scholar
  13. 13.
    Chassin MR. Does paying for performance improve the quality of healthcare? Med Care Res Rev. 2006;63:122S–5S.PubMedCrossRefGoogle Scholar

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Gary J. Young
    • 1
    • 2
  • Mark Meterko
    • 1
    • 2
  • Howard Beckman
    • 3
  • Errol Baker
    • 2
  • Bert White
    • 1
  • Karen M. Sautter
    • 1
  • Robert Greene
    • 3
  • Kathy Curtin
    • 4
    • 5
  • Barbara G. Bokhour
    • 1
    • 6
  • Dan Berlowitz
    • 1
    • 6
  • James F. BurgessJr.
    • 1
    • 2
  1. 1.Department of Health Policy and ManagementBoston University School of Public HealthBostonUSA
  2. 2.Department of Veterans AffairsCenter for Organization, Leadership and Management ResearchBostonUSA
  3. 3.Rochester Individual Practice AssociationRochesterUSA
  4. 4.Excellus Health PlansRochesterUSA
  5. 5.MedVantage, Inc.San FranciscoUSA
  6. 6.Center for Health Quality, Outcomes and Economic ResearchDepartment of Veterans AffairsBedfordUSA

Personalised recommendations