An incentive approach to physician implementation of medical practice guidelines

Abstract

We propose a probabilistically based incentive payment system for guideline implementation that provides rewards for physicians who follow practice guidelines and additional remuneration for physician leaders who engage in information sharing. All payments are based on observed outcomes of patient treatment. A fixed base payment forms the core of the system with probabilistic offsets calculated from the chance that a 'good' outcome occurs without optimal treatment or information. The system pays different physician types for different task sets.

Planning and Studying Improvement in Patient Care: The Use of Theoretical Perspectives

“…Changes in the reimbursement of health care providers and in cost sharing by patients can be used to influence professional or organizational performance, and they may influence whether a specific innovation is implemented (Barnum, Kutzin, and Saxenian 1995). For example, health care systems have different reimbursement methods (Barnum, Kutzin, and Saxenian 1995), and more variations have been proposed (Shaughnessy and Kurowski 1982; Sonnad and Foreman 1997). Prospective reimbursement systems (salary, budget, capitation, subscription) differ from retrospective systems (fee‐for‐service).…”

Effects of a behaviour independent financial incentive on prescribing behaviour of general practitioners

“…Findings in the literature show that financial incentives or bonus systems might be effective as an implementation strategy and are therefore worth considering as alternatives for the more complex implementation strategies [14–17]. Although we already know a certain amount from implementation research regarding the effects of financial incentives aimed at the individual professional, little is known about the effects of group‐focused financial incentives.…”

“…Financial incentives or bonus systems could also function as an implementation strategy. They are less difficult to execute, and are therefore worth considering as alternatives for the more complex implementation strategies [14–17].…”

Organizational Interventions To Encourage Guideline Implementation

“…19 Perhaps one of the most potent strategies for enhancing guideline adherence is incorporating guideline-related outcomes as performance accountabilities for physician evaluation and compensation. 20 This could be easily integrated by health-care organizations that track outcomes as part of their overall quality assurance strategy and that participate in reporting systems such as HEDIS.…”