A Quality-Driven Physician Compensation Model: Four-Year Follow-up Study

Abstract

This case report describes a qualitative and preliminary quantitative assessment of a quality-based physician compensation program. The Hawaii Medical Service Association's Physician Quality and Service Recognition program offers an innovative and effective approach for improving delivery of high-quality and cost-effective care to patients enrolled in preferred provider organizations. Support for the program is demonstrated through increasing numbers of voluntarily participating physicians. Preliminary assessment of population outcomes reveals sustained improvements in many clinical areas and mixed findings in others. This study contributes to the body of knowledge available to payers and policy makers considering alternative payment methods to reward improved performance.

Systematic review: Effects, design choices, and context of pay-for-performance in health care

“…With regard to quality goals and targets, process indicators [32,79-81] generally yielded higher improvement rates than outcome measures,[82-86] with intermediate outcome measures yielding in-between rates[35,87-90]. Whereas early programs generally addressed one patient group or focus (e.g.…”

“…Furthermore, studies reporting involvement of stakeholders in target selection and definition (see for example references [79,88,97,98]) seem to have found more positive P4P effects (above 10% effect size) than those that don't.…”

“…With regard to the target unit of the incentive, programs aimed at the individual provider level [99,100,102,103,108] and/or team level [79,91,98] generally reported positive results. The study of Young et al (2007)[95] is one exception.…”

“…With regard to different communication strategies, studies found positive P4P effects (5 to 20% effect size) with programs that fostered extensive and direct communication with involved providers[87,97,106,112]. Involving all stakeholders in P4P program development also had positive effects (effect size of >10%)[79,88,97,98]. However, findings for studies examining high stakeholder involvement remain mixed[83,98].…”

Are Physician Reimbursement Strategies Associated with Processes of Care and Patient Satisfaction for Patients with Diabetes in Managed Care?

“…Performance‐based financial incentives such as cash bonuses increased immunization rates among children and influenza immunization rates among the elderly (Hemenway 1995; Kouides et al 1998; Fairbrother et al 1999, 2001). In a broader study, performance‐based bonuses were associated with increases in the use of ACE inhibitors and HbA1c assessments, but not childhood immunizations (Chung et al 2003). In another study by Hanchak (1997), bonus payments based on “quality” of patient care led to improvements in certain performance measures, e.g., lower Cesarean section rates, but patient satisfaction did not increase, perhaps because the performance measures used were better proxies for cost containment than quality, as argued by Armour et al (2001).…”