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Related Experiment Video

Updated: May 5, 2026

Movement Retraining using Real-time Feedback of Performance

Movement Retraining using Real-time Feedback of Performance

Published on: January 17, 2013

Early experience with pay-for-performance: from concept to practice.

Meredith B Rosenthal¹, Richard G Frank, Zhonghe Li

¹Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass 02115, USA. meredith_rosenthal@harvard.edu

|October 13, 2005

Summary

This summary is machine-generated.

Pay-for-performance programs show limited healthcare quality gains. Programs often reward higher-performing physicians, potentially offering little value for the investment in quality improvement.

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Area of Science:

Health Services Research
Healthcare Quality Improvement
Health Economics

Background:

Pay-for-performance (PFP) adoption is increasing, yet research on its effectiveness in healthcare is scarce.
Despite optimism, empirical evidence on PFP's impact on clinical quality remains limited.

Purpose of the Study:

To assess the effect of a physician PFP program on the quality of patient care.
Evaluate the impact of a PFP initiative on specific clinical process measures.

Main Methods:

A natural experiment design comparing California physician groups (intervention) with Pacific Northwest groups (comparison).
Analysis of administrative quality reports from October 2001 to April 2004 for approximately 300 physician organizations.
Focused on three key process measures: cervical cancer screening, mammography, and hemoglobin A1c testing.

Main Results:

California showed greater improvement in cervical cancer screening (5.3% vs 1.7%) compared to the Pacific Northwest, a statistically significant difference.
Mammography and hemoglobin A1c testing showed minimal quality improvement differences between the groups.
Physician groups already meeting performance thresholds received the largest share of bonus payments, despite showing the least improvement.

Conclusions:

A fixed PFP target may yield minimal quality improvements relative to program costs.
PFP programs predominantly reward clinicians with higher baseline performance, potentially limiting return on investment for quality enhancement.