Health Care Costs and Financing

Physicians have positive attitudes about pay-for-quality programs, but are ambivalent about certain program features

Pay-for-quality (P4Q) programs have become a popular mechanism for improving care quality in the United States. P4Q programs offer providers (currently mostly primary care physicians) financial incentives for achieving predefined care quality targets. A recent survey of primary care physicians in California and Massachusetts, two States with substantial P4Q activity, revealed that physicians have positive attitudes about P4Q programs. However, when reflecting on their own experience, they are ambivalent about certain program features.

Of the 1,243 responding physicians, three-fourths (76 percent) were aware of at least 1 quality-related financial incentive that applied to them. More than 80 percent of these physicians were aware of one of the following care quality targets: asthma medication use, breast cancer screening, cervical cancer screening, coronary artery cholesterol check, and the HbA1c (blood sugar) test for people with diabetes. Three-fourths of physicians in each State agreed that physicians should be financially rewarded for providing higher quality care. The majority of doctors also agreed that P4Q could improve care quality and is more effective than peer recognition alone.

Physicians were most positive about the clinical relevance of quality targets. In contrast, they were fairly negative about their understanding of the details of P4Q programs, the amount of incentive money being offered to them, and the actual impact of the incentive programs on quality of care. Few programs at the time of the survey appeared to offer incentive money that would likely translate into more than 10 percent of a typical primary care doctor's annual income. Physicians in both States had some reservations about their capability to achieve P4Q quality targets, given other health system factors they cannot control.

Overall, the results suggest that primary care physicians in the two States are neither disaffected from nor fully engaged in P4Q programs, conclude Gary Young, J.D., Ph.D., and colleagues from the Boston University School of Public Health. Their study was supported in part by the Agency for Healthcare Research and Quality (HS13591).

See "Physician attitudes toward pay-for-quality programs: Perspectives from the front line," by Dr. Young, Mark Meterko, Ph.D., Bert White, M.B.A., and others, in the June 2007 Medical Care Research and Review 64(3), pp. 331-343.

Editor's Note: A related AHRQ-supported study (HS13591) by the same researchers found a modest one-time improvement in physician use of eye exams for people with diabetes a year after implementation of a pay-for-performance program. For more details, see: Young, G.J., Meterko, M., Beckman, H., and others (2007, June). "Effects of paying physicians based on their relative performance for quality." Journal of General Internal Medicine 22, pp. 872-876.

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