Physician financial incentives and feedback: failure to increase cancer screening in Medicaid managed care.

Hillman, Alan L.; Ripley, Kimberly; Goldfarb, Neil I.; Nuamah, Isaac; Weiner, Janet; Lusk, Edward J.

doi:10.2105/ajph.88.11.1699

Cited by 140 publications

(155 citation statements)

References 23 publications

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“…Three studies (Grady et al 1997;Hillman et al 1998;Hillman et al 1999) didn't detect any significant effect of P4P bonus rewards or bonus rewards combined with performance feedback on physician compliance with cancer screening, pediatric immunization and mammography referrals. Two studies (Fairbrother et al 1999;Fairbrother et al 2001) found that a bonus or bonus with performance feedback incentives increased documented coverage levels for childhood immunization, but the measured increase 6 was primarily due to better documentation not better immunization practices.…”

Section: Empirical Evidence On Physician Response To P4pmentioning

confidence: 97%

Physician Response to Pay-for-Performance: Evidence from a Natural Experiment

Hurley

DeCicca

et al. 2011

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Explicit financial incentives, especially pay-for-performance (P4P) incentives, have been extensively employed in recent years by health plans and governments in an attempt to improve the quality of health care services. This study exploits a natural experiment in the province of Ontario, Canada to identify empirically the impact of pay-for-performance (P4P) incentives on the provision of targeted primary care services, and whether physicians' responses differ by age, practice size and baseline compliance level. We use an administrative data source which covers the full population of the province of Ontario and nearly all the services provided by practicing primary care physicians in Ontario. With an individual-level data set of physicians, we employ a difference-in-differences approach that controls for both "selection on observables" and "selection on unobservables" that may cause estimation bias in the identification. We also implemented a set of robustness checks to control for confounding from the other contemporary interventions of the primary care reform in Ontario. The results indicate that, while all responses are of modest size, physicians responded to some of the financial incentives but not the others. The differential responses appear related to the cost of responding and the strength of the evidence linking a service with quality. Overall, the results provide a cautionary message regarding the effectiveness of pay-for-performance schemes for increasing quality of care.

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Section: Empirical Evidence On Physician Response To P4pmentioning

confidence: 97%

Physician Response to Pay-for-Performance: Evidence from a Natural Experiment

Hurley

DeCicca

et al. 2011

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“…One P4P study in primary care setting was not successful at reaching targets. The reason was that physicians participated in many plans, so the bonus for healthcare management alternatives members alone may not have had the necessary impact on physicians' overall income [56]. In some P4P systems, physicians are rewarded for high delivery of care with no punishment, whereas other programs put the physician in risk with not paying until the physician achieves the predefined target [57].…”

Section: Discussionmentioning

confidence: 99%

Impact of Pay-for-Performance on Efficiency and Effectiveness in Hospitals: A Systematic Review

et al. 2014

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Ab s t r a c tPurpose: Pay-for-performance (P4P) refers to the transfer of money on taking a measurable action or achieving a predetermined performance target. In this systematic review, we will present the results of P4P impacts based on published articles. Methods:A systematic review of literature was done using following databases and search engines: PubMed, Web of knowledge, Sciencedirect, The Cochrane library, MagIran and SID. Keywords used were, Pay-for-performance, P4P, output based payment, result based payment, financial incentives, value based purchasing, effectiveness, efficiency, cost, quality, patient satisfaction, provider satisfaction, mortality, length of stay, clinical outcomes, charges, access, hospitalization, equity, patient outcome, outcome of care. No limitations were considered for time of publishing studies, and searching articles was continued until February 2013. Only impact of P4P on physicians and nurses in hospitals were considered. The literature search yielded 7172 records, of which 34 met our inclusion criteria. Results:Thirty-four studies were included in this systematic review taking part in different countries and settings with different type of studies. P4P effects can be judged to be encouraging or disappointing, depending on the design choices and characteristics of the context in which it was introduced. Conclusion:The impact of P4P targeting physicians and nurses seems to be positive on most of the effectiveness and efficiency indicators. However, implementation of P4P should be accompanied by robust evaluation plans.

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“…Pay-forperformance had the greatest effect on low rather than high performers [3,9,16,33,44,64,72]. Approaches with purely positive incentives (versus winners and losers) [12,16,34,35,48] and paying clinicians rather than hospitals were more effective [16,61]. Pay-for-performance focused on the individual provider found no relationship between frequency [17] and size of incentive on effect sizes [72].…”

Section: Search Strategies and Criteriamentioning

confidence: 93%

“…The answer to the first question was, in most cases, a qualified yes; only three studies [34,35,65] did not report improvement. However, the overall effect was small and highly context-specific [16,28,49,61,66,67,72].…”

Section: Search Strategies and Criteriamentioning

confidence: 98%

The Use of Three Strategies to Improve Quality of Care at a National Level

Wright

2012

Clinical Orthopaedics &Amp; Related Research

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Background Improving the quality of care is essential and a priority for patients, surgeons, and healthcare providers. Strategies to improve quality have been proposed at the national level either through accreditation standards or through national payment schemes; however, their effectiveness in improving quality is controversial. Questions/purposes The purpose of this review was to address three questions: (1) does pay-for-performance improve the quality of care; (2) do surgical safety checklists improve the quality of surgical care; and (3) do practice guidelines improve the quality of care? These three strategies were chosen because there has been some research assessing their effectiveness in improving quality, and implementation had been attempted on a large scale such as entire countries.Methods We performed a literature review from 1950 forward using Medline to identify Level I and II studies. We evaluated the three strategies and their effects on processes and outcomes of care. When possible, we examined strategy implementation, patients, and systems, including provider characteristics, which may affect the relationship between intervention and outcomes with a focus on factors that may have influenced effect size. Results Pay-for-performance improved the process and to a lesser extent the outcome of care. Surgical checklists reduced morbidity and mortality. Explicit practice guidelines influenced the process and to a lesser extent the outcome of care. Although not definitively showed, clinician involvement during development of intervention and outcomes, with explicit strategies for communication and implementation, appears to increase the likelihood of positive results. Conclusion Although the cost-effectiveness of these three strategies is unknown, quality of care could be enhanced by implementing pay-for-performance, surgical safety checklists, and explicit practice guidelines. However, this review identified that the effectiveness of these strategies is highly context-specific.

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Physician financial incentives and feedback: failure to increase cancer screening in Medicaid managed care.

Cited by 140 publications

References 23 publications

Physician Response to Pay-for-Performance: Evidence from a Natural Experiment

Physician Response to Pay-for-Performance: Evidence from a Natural Experiment

Impact of Pay-for-Performance on Efficiency and Effectiveness in Hospitals: A Systematic Review

The Use of Three Strategies to Improve Quality of Care at a National Level

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