Pay for Performance Alone Cannot Drive Quality

Abstract

Objective: To determine whether aligning design characteristics of a pay-for-performance program with objectives of an asthma improvement collaborative builds improvement capability and accelerates improvement. Design:Interrupted time series analysis of the impact of pay for performance on results of an asthma improvement collaborative.Setting: Forty-four pediatric practices within greater Cincinnati.Participants: Forty-four pediatric practices with 13 380 children with asthma. Interventions:The pay-for-performance program rewarded practices for participating in the collaborative, achieving network-and practice-level performance thresholds, and building improvement capability. Pay for performance was coupled with additional improvement interventions related to the collaborative.Outcome Measures: Flu shot percentage, controller medication percentage for children with persistent asthma, and written self-management plan percentage. Results:The pay-for-performance program provided each practice with the potential to earn a 7% fee schedule increase. Three practices earned a 2% increase, 13 earned a 4% increase, 2 earned a 5% increase, 14 earned a 6% increase, and 11 earned a 7% increase. Between October 1, 2003, and November30,2006,thepercentageofthenetworkasthmapopulation receiving "perfect care" increased from 4% to 88%. The percentage of the network asthma population receiving the influenza vaccine increased from 22% to 41%, and then to 62% during the prior 3 flu seasons. Conclusion:Linking design characteristics of a pay-forperformance program to a collaborative focused on improving care for a defined population, building improvement capability, and driving system changes at the provider level resulted in substantive and sustainable improvement.Arch Pediatr Adolesc Med. 2007;161(7):650-655

Performance-Related Pay in the Public Sector: A Review of Theory and Evidence

“…An evaluation of performance pay pilot program for physicians found meaningful improvements for diabetes patients compared to the control group (D. and Horrigan 2005). Small positive or mixed effects were also found studies by (Amundson, Solberg, et al 2003;Casalino, Gillies, et al 2003;McMenamin, Schauffler, et al 2003;Levin-Scherz, DeVita, et al 2006;Coleman, Reiter, et al 2007;Felt-Lisk, Gimm, et al 2007;Mandel and Kotagal 2007;Young, Meterko, et al 2007).…”

Performance-Related Pay in the Public Sector: A Review of Theory and Evidence

“…An evaluation of performance pay pilot program for physicians found meaningful improvements for diabetes patients compared to the control group (D. and Horrigan 2005). Small positive or mixed effects were also found studies by (Amundson, Solberg, et al 2003;Casalino, Gillies, et al 2003;McMenamin, Schauffler, et al 2003;Levin-Scherz, DeVita, et al 2006;Coleman, Reiter, et al 2007;Felt-Lisk, Gimm, et al 2007;Mandel and Kotagal 2007;Young, Meterko, et al 2007).…”

Maintenance of Certification: The Profession's Response to Physician Quality

“…Two published qualtiy improvement studies by Miller et al and Mandel and Kotagal, which have been approved for MOC Part 4 credit, have shown improved outcomes of care and reduced costs in pediatric intensive care unit catheter-associated blood stream infections and outpatient asthma care, respectively. 4,5 This study shows that physicians will participate in MOC. The challenge for the boards is to develop activities that are potentially relevant and effective and to test them through multiple MOC PDSA cycles.…”

The impact of financial incentives on the implementation of asthma or diabetes self-management: A systematic review

“…The 12 papers were published between 2004–2017, seven were conducted in the United States of America [ 32 – 38 ], four in the UK [ 39 – 42 ] and one in Canada [ 43 ]. One study reported on an asthma-only scheme [ 36 ], three focused on diabetes-only schemes [ 32 , 33 , 43 ] and the remaining eight looked at diabetes within a multiple condition scheme [ 34 , 35 , 37 – 42 ].…”

“…The study designs varied ( Fig 2 ) and included: five quasi-experimental [ 32 – 35 , 37 ]; three interrupted time series [ 38 , 40 , 42 ]; two longitudinal [ 39 , 43 ]; one repeated measures [ 36 ] and one controlled before and after study [ 41 ].…”

“…One study described a scheme where physicians were paid a set amount per patient that received two HbA1c tests per year [ 43 ]. Eight studies looked at a target achievement scheme where there were pre-set “percentage of patients” targets that physicians had to achieve in order to receive the financial incentive [ 34 – 36 , 38 – 42 ] and ten studies had ‘certain’ incentives if practices successfully achieved targets [ 33 , 35 – 43 ]. One scheme had an ‘uncertain’ chance of receiving the financial incentive if they changed their behaviour at the start of the scheme (years 2003–2004) as the payments were only paid to top scoring groups [ 34 ].…”

Performance-Related Pay in the Public Sector: A Review of Theory and Evidence

“…An evaluation of performance pay pilot program for physicians found meaningful improvements for diabetes patients compared to the control group (D. and Horrigan 2005). Small positive or mixed effects were also found studies by (Amundson, Solberg, et al 2003;Casalino, Gillies, et al 2003;McMenamin, Schauffler, et al 2003;Levin-Scherz, DeVita, et al 2006;Coleman, Reiter, et al 2007;Felt-Lisk, Gimm, et al 2007;Mandel and Kotagal 2007;Young, Meterko, et al 2007).…”

Maintenance of Certification: The Profession's Response to Physician Quality

“…Two published qualtiy improvement studies by Miller et al and Mandel and Kotagal, which have been approved for MOC Part 4 credit, have shown improved outcomes of care and reduced costs in pediatric intensive care unit catheter-associated blood stream infections and outpatient asthma care, respectively. 4,5 This study shows that physicians will participate in MOC. The challenge for the boards is to develop activities that are potentially relevant and effective and to test them through multiple MOC PDSA cycles.…”

The impact of financial incentives on the implementation of asthma or diabetes self-management: A systematic review

“…The 12 papers were published between 2004–2017, seven were conducted in the United States of America [ 32 – 38 ], four in the UK [ 39 – 42 ] and one in Canada [ 43 ]. One study reported on an asthma-only scheme [ 36 ], three focused on diabetes-only schemes [ 32 , 33 , 43 ] and the remaining eight looked at diabetes within a multiple condition scheme [ 34 , 35 , 37 – 42 ].…”

“…The study designs varied ( Fig 2 ) and included: five quasi-experimental [ 32 – 35 , 37 ]; three interrupted time series [ 38 , 40 , 42 ]; two longitudinal [ 39 , 43 ]; one repeated measures [ 36 ] and one controlled before and after study [ 41 ].…”

“…One study described a scheme where physicians were paid a set amount per patient that received two HbA1c tests per year [ 43 ]. Eight studies looked at a target achievement scheme where there were pre-set “percentage of patients” targets that physicians had to achieve in order to receive the financial incentive [ 34 – 36 , 38 – 42 ] and ten studies had ‘certain’ incentives if practices successfully achieved targets [ 33 , 35 – 43 ]. One scheme had an ‘uncertain’ chance of receiving the financial incentive if they changed their behaviour at the start of the scheme (years 2003–2004) as the payments were only paid to top scoring groups [ 34 ].…”

Performance-Related Pay in the Public Sector: A Review of Theory and Evidence

“…An evaluation of performance pay pilot program for physicians found meaningful improvements for diabetes patients compared to the control group (D. and Horrigan 2005). Small positive or mixed effects were also found studies by (Amundson, Solberg, et al 2003;Casalino, Gillies, et al 2003;McMenamin, Schauffler, et al 2003;Levin-Scherz, DeVita, et al 2006;Coleman, Reiter, et al 2007;Felt-Lisk, Gimm, et al 2007;Mandel and Kotagal 2007;Young, Meterko, et al 2007).…”

Maintenance of Certification: The Profession's Response to Physician Quality

“…Two published qualtiy improvement studies by Miller et al and Mandel and Kotagal, which have been approved for MOC Part 4 credit, have shown improved outcomes of care and reduced costs in pediatric intensive care unit catheter-associated blood stream infections and outpatient asthma care, respectively. 4,5 This study shows that physicians will participate in MOC. The challenge for the boards is to develop activities that are potentially relevant and effective and to test them through multiple MOC PDSA cycles.…”

The impact of financial incentives on the implementation of asthma or diabetes self-management: A systematic review

“…The 12 papers were published between 2004–2017, seven were conducted in the United States of America [ 32 – 38 ], four in the UK [ 39 – 42 ] and one in Canada [ 43 ]. One study reported on an asthma-only scheme [ 36 ], three focused on diabetes-only schemes [ 32 , 33 , 43 ] and the remaining eight looked at diabetes within a multiple condition scheme [ 34 , 35 , 37 – 42 ].…”

“…The study designs varied ( Fig 2 ) and included: five quasi-experimental [ 32 – 35 , 37 ]; three interrupted time series [ 38 , 40 , 42 ]; two longitudinal [ 39 , 43 ]; one repeated measures [ 36 ] and one controlled before and after study [ 41 ].…”

“…One study described a scheme where physicians were paid a set amount per patient that received two HbA1c tests per year [ 43 ]. Eight studies looked at a target achievement scheme where there were pre-set “percentage of patients” targets that physicians had to achieve in order to receive the financial incentive [ 34 – 36 , 38 – 42 ] and ten studies had ‘certain’ incentives if practices successfully achieved targets [ 33 , 35 – 43 ]. One scheme had an ‘uncertain’ chance of receiving the financial incentive if they changed their behaviour at the start of the scheme (years 2003–2004) as the payments were only paid to top scoring groups [ 34 ].…”