Pay-for-Performance and Veteran Care in the VHA and the Community: a Systematic Review

Abstract

The evidence to support the effectiveness of P4P on Veteran health is limited. Key informants recognize the potential for unintended consequences, such as overtreatment in VHA settings, and suggest that implementation of P4P in the community focus on relationship building and target areas such as documentation and coordination of care.

Effects of Monetary Incentives in Physician Groups: A Systematic Review of Reviews

“…However, Petersen et al [23] found that effects for group-level incentives were weaker. This was supported by Kondo et al [25], who also stated that physician-level incentives were more effective. A possible explanation was provided by Petersen et al [23], who argued that this might be because the link between individual performance and the incentive is less direct in the group-level context.…”

“…The other reviews explicitly included “provider groups” in their analyses, but only some differentiated between individual- and group-specific incentives, which provides less reliable results for interpretation. Petersen et al [ 23 ], Van Herck et al [ 24 ], and Kondo et al [ 25 ] included the incentive level (individual vs. group).

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“…Additionally, studies often covered a very short period of time, and some effects, e.g., habituation or consequences of varying payments among physicians, take more time and therefore require a longer period of observation. [40] Moderate QOF ↗ QOF ⇆ Hamilton et al [32] Moderate QOF ↗ QOF ⇆ Huang et al [26] High ↗ ↗ Kondo et al [25] Moderate ⇆ Mendelson et al [38] Moderate ⇆ ⇆; QOF ↗ Petersen et al [23] Moderate ⇆ ↗ ⇆ Schatz [37] Low ⇆ ⇆ Scott et al [28] High ⇆ ⇆ Van Herck et al [24] High ⇆ ⇆ Capitation Chaix-Couturier et al [27] Low ⇆ ⇆ Hodgson et al [18] Low ⇆ ⇆ Johri et al [19] Low ↘ ↘ Steiner and Robinson [29] Moderate ⇆ ⇆ ND Wranik et al [30] Moderate ↗ Accountable care organizations Aviki et al [17] Moderate ↗ ⇆ Kaufman et al [20] Moderate ↗ ⇆ Nejati et al [22] Moderate ↗…”

“…The concept of P4P has recently attracted widespread interest. It was examined in ten reviews [22,23,25,32,33,35,[65][66][67][68], of which three were of high, six were of moderate, and one was of low quality.…”

“…The high-quality review reported weak evidence regarding coordination, patient centeredness, continuity, and cost effectiveness. Kondo et al [25] analyzed P4P in veteran care and community settings, where the evidence for effectiveness of P4P was limited and insufficient for clear conclusions.…”