Pay-for-Performance Programs Show Positive Impact on Low-Performing Physicians

Abstract

Pay-for-performance (P4P) programs are payment models that reward workers for meeting certain performance measures for quality and efficiency. In the health care setting, P4P programs use a variety of methods to reward physicians financially for achieving targets, including fee differentials and bonuses. A new study in the Journal for Healthcare Quality reveals that P4P programs seem to be effective in incentivizing low-performing physicians. These programs are increasingly being adopted by health plans and purchasers in the United States, the authors note. Over half of physicians practicing in commercial health maintenance organizations and about one quarter of all physicians in other settings participate in some form of P4P contracts, studies show. Still, as the new report points out, “only a few studies have assessed the ability of P4P programs to significantly improve alter physician behavior and the results are mixed.” Moreover, it remains unclear whether improvements would occur without the P4P program or whether they would be sustained. The new study supported by the Hawaii Medical Service Association in Honolulu investigated the impact of P4P in a Preferred Provider Organization (PPO) on low-performing physicians over a 4-year period. The study group consisted of providers in Hawaii who participated in a P4P program for ≥2 years from 1999 through 2007 and who qualified for awards on ≥1 of 7 clinical indicators: Angiotensin-converting enzyme inhibitor use among heart failure patients, mammography, cervical cancer screening, colorectal cancer screening, hemoglobin A1C testing for diabetes, the varicella vaccine, and the mumps, measles, and rubella vaccine. A comparison group of physicians consisted of providers enrolled in a large, commercial, PPO health plan for ≥2 years over the same time period as the Hawaii sample but not located in Hawaii and in a PPO without any performance-based incentive program. The groups were matched by specialty and patient quality indicator eligibility criteria. The P4P program financially incentivizes physicians in Hawaii (additional 1.5%–7.5% of their base professional fees) to perform quality care processes. Results showed that a P4P program in a PPO setting can improve quality of care. This was particularly the case for quality measures such as mammography, cervical cancer screening, A1C testing, and childhood immunization measures. Overall, the majority of quality scores were good, because more than three quarters of the eligible population received the recommended care in both groups. However, low-performing physicians using P4P improved significantly more than the comparison group. Further, although colorectal cancer screening had the lowest quality score, it showed the greatest improvement with time. In addition, the study found that the positive benefit of the P4P program may not be realized until the third or fourth year, highlighting the importance of sustaining P4P over longer periods of time. See: Journal for Healthcare Quality 2010;32:13–22.