Working under a clinic-level quality incentive: primary care clinicians' perceptions.

Area of Science:

• Health Services Research
• Healthcare Management
• Medical Economics

Background:

• Designing effective pay-for-performance (P4P) programs requires deciding whether to incentivize individual clinicians or clinical teams.
• Team-based incentives reward all team members based on collective performance, while individual incentives focus on personal achievements.
• This study investigates primary care clinicians' views on clinic-level quality incentives within a P4P framework.

Purpose of the Study:

• To explore primary care clinicians' perceptions of a team-based, clinic-level quality incentive program.
• To identify the perceived benefits and drawbacks of clinic-level incentives in a P4P model.
• To determine clinicians' preferences for incentive targets (individual vs. team) in primary care.

Main Methods:

• The study was conducted at Fairview Health Services, where 40% of primary care compensation was tied to clinic-level quality performance.
• Forty-eight in-depth interviews were conducted with clinicians to gather qualitative insights.
• An online survey of 150 clinicians (56% response rate) assessed preferences for incentive targets.

Main Results:

• Strengths of clinic-level incentives included improved team quality and reduced patient dumping.
• Weaknesses involved a lack of clinician control and 'coattail riding' by lower performers.
• Survey results indicated 73% of clinicians favored a hybrid model combining clinic and individual incentives.

Conclusions:

• Clinic-level performance incentives offer significant advantages and disadvantages that must be carefully considered.
• Hybrid incentive models may balance the benefits of team collaboration and individual recognition.
• Further research is needed to evaluate the effectiveness of hybrid group and individual incentive designs.