Beyond Measurement and Reward: Methods of Motivating Quality Improvement and Accountability

Abstract

ObjectiveThe article examines public policies designed to improve quality and accountability that do not rely on financial incentives and public reporting of provider performance.Principal FindingsPayment policy should help temper the current “more is better” attitude of physicians and provider organizations. Incentive neutrality would better support health professionals’ intrinsic motivation to act in their patients’ best interests to improve overall quality than would pay‐for‐performance plans targeted to specific areas of clinical care. Public policy can support clinicians’ intrinsic motivation through approaches that support systematic feedback to clinicians and provide concrete opportunities to collaborate to improve care. Some programs administered by the Centers for Medicare & Medicaid Services, including Partnership for Patients and Conditions of Participation, deserve more attention; they represent available, but largely ignored, approaches to support providers to improve quality and protect beneficiaries against substandard care.ConclusionsPublic policies related to quality improvement should focus more on methods of enhancing professional intrinsic motivation, while recognizing the potential role of organizations to actively promote and facilitate that motivation. Actually achieving improvement, however, will require a reexamination of the role played by financial incentives embedded in payments and the unrealistic expectations placed on marginal incentives in pay‐for‐performance schemes.

Impact of Provider Incentives on Quality and Value of Health Care

“…Many commentators see this abandonment as inevitable, believing incentive programs to be fundamentally flawed. Some concerns are technical in nature and relate to the difficulty of accurately defining and measuring the most important aspects of quality with the greatest impacts on patient outcomes (7). Incentive schemes, as a consequence of their one-size-fits-all nature, also promote a guideline-driven approach that discourages physicians from considering individual patient preferences (67).…”

Policy‐Oriented Research on Improved Physician Incentives for Higher Value Health Care

“…As pointed out in the other papers in this series, there are several key problems with FFS incentives for physicians (see Conrad 2015;Berenson and Rice 2015). Patients do not fit the theoretical model of independent economic actors deciding whether the cost of a service is worth the expected incremental health benefits.…”

Physician Engagement Strategies in Care Coordination: Findings from the Centers for Medicare & Medicaid Services’ Health Care Innovation Awards Program

“…; Punke ). In addition, financial incentives can distort providers' motivations; thus, there may be better, nonfinancial means that build physicians' desire to engage in innovations (Berenson and Rice ).…”

“…This may be because physicians' concerns usually relate to increased time and responsibility needed to generate the same compensation, rather than inadequate base salaries (Shanafelt et al 2012;Punke 2013). In addition, financial incentives can distort providers' motivations; thus, there may be better, nonfinancial means that build physicians' desire to engage in innovations (Berenson and Rice 2015).…”