Real-time Feedback in Pay-for-Performance: Does More Information Lead to Improvement?

Area of Science:

• Health Services Research
• Medical Informatics
• Physician Quality Improvement

Background:

• Pay-for-performance (P4P) programs aim to enhance healthcare quality through physician incentives.
• The relative impact of information provision versus financial incentives within P4P remains unclear.

Purpose of the Study:

• To evaluate if enhanced information feedback, without altering financial incentives, improves physician performance within an established P4P program.
• To assess the effect of a new registry providing real-time quality measure feedback.

Main Methods:

• An observational, predictive piecewise model analyzed physician-level quality data from 2010-2015.
• Data included physician demographics, registry usage (click rates), and patient characteristics.
• Performance on ten quality metrics was assessed before and after registry implementation.

Main Results:

• No consistent performance improvement was observed across the ten quality measures with real-time information feedback.
• Performance increased for two measures (rotavirus immunization, diabetic nephropathy screening) but decreased for three (influenza immunization, HbA1c testing, poor HbA1c control).
• Physicians in groups with higher registry access showed greater improvement.

Conclusions:

• Real-time information feedback via electronic registries alone is insufficient to improve physician performance in high-performing P4P programs.
• Future research should explore combining information feedback with financial incentives.
• Electronic registries may require complementary strategies to drive significant performance gains.