Impact of a Pay-for-Performance Program on Low Performing Physicians

Abstract

Studies have shown that the lowest performing physicians in pay-for-performance (P4P) programs improved the most; however, it is unclear whether this would occur without the P4P program or be sustained. The objective of this study is to investigate the impact of P4P in a Preferred Provider Organization (PPO) on low performing physicians over a 4-year period. We used administrative claims data from a PPO health plan in Hawaii, which implemented a P4P program, and a PPO plan in the South, which did not implement a P4P program. The difference-indifference model was used to compare the quality scores between the two physician groups in preventive measures, a heart failure measure, and an HbA1c testing measure. We found that P4P programs may be effective in incentivizing low performing physicians to improvement quality of care and sustain improvement, and the positive benefit of the P4P program may not be realized until the 3rd or 4th year of the program.

Medical Claim Cost Impact of Improved Diabetes Control for Medicare and Commercially Insured Patients with Type 2 Diabetes

“…Several studies have reported improved quality and clinical metrics in individuals with diabetes when cared for by physicians in a P4P arrangement, compared with those cared for by physicians without a P4P arrangement. [32][33][34] Another initiative aimed at improving physician care coordination for individuals with diabetes and other chronically ill patients is the medical home movement, which often incorporates a P4P arrangement. Several patient-centered medical home demonstrations have reported improvements in quality and clinical outcomes in diabetes patients cared for under this model.…”

When financial incentives do more good than harm: a checklist

“…Perhaps the best returns on investment come from targeting people with the poorest performance and rewarding the extent to which they narrow the gap between desired and current performance. 22 Finally, some incentives may lead to long term structural changes that persist, such as the setting up of computer systems, but many behavioural changes seem to revert when incentives are withdrawn. 23 9.…”

Innovation in Hospital Quality Improvement Activities—Acute Postoperative Pain Management (APOP) Self-Help Toolkit Audits as an Example

“…The nexus between research and translation of new knowledge into practice can be problematic. It is often difficult to maintain change in a health system, public or private, around aspects of quality improvement in care (Beckett & Kipnis, 2009;Chen et al, 2010;Glasgow, Scott-Caziewell, & Kaboli, 2010). Many behavioral strategies have been used to try to improve the uptake of new practices and knowledge (Baker et al, 2010;Farmer et al, 2008;Flodgren et al, 2007;Jamtvedt, Young, Kristoffersen, O'Brien, & Oxman, 2006;O'Brien et al, 2007) with reports of different activities (Binhas et al, 2011;Nease et al, 2010;Oyler, Vinci, Johnson, & Arora, 2011).…”