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Effects of paying physicians based on their relative performance for quality
Gary J Young1, Mark Meterko, Howard Beckman
1Department of Health Policy and Management, Boston University School of Public Health, Talbot Building, 715 Albany Street, Boston, MA 02118-2526, USA. health@bu.edu
Journal of General Internal Medicine
|April 20, 2007
Summary
This study found that pay-for-performance programs with financial risk for physicians showed a small improvement in diabetes care adherence, specifically for eye exams. Further research is needed to optimize incentive structures for better quality of care.
Area of Science:
- Health Services Research
- Medical Economics
- Quality Improvement
Background:
- Pay-for-performance (PFP) programs typically use bonuses, not financial risk, to improve care quality.
- Few studies have assessed PFP models that incorporate financial risk for providers.
Purpose of the Study:
- To evaluate the impact of a PFP incentive program on primary care physicians, incorporating limited financial risk.
- To assess changes in adherence to diabetes performance measures.
Main Methods:
- Retrospective cohort study with pre/post analysis.
- 334 primary care physicians in Rochester, New York participated.
- Four diabetes performance measures were tracked from 1999 to 2004.
Main Results:
- Overall performance increased across measures post-implementation, but this was attributed to secular trends.
- A modest, one-time improvement in physician adherence for eye examinations was observed.
- Physician adherence for eye exams increased by an average of 7 percentage points after program implementation.
Conclusions:
- PFP programs with limited financial risk demonstrated a modest effect on improving adherence to a single diabetes care quality measure.
- Further investigation is required to identify optimal incentive structures for significant quality improvements in healthcare.
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