Patient Safety and Quality

Physicians appear to be driven more by professional standards of quality than financial incentives

In recent years, a growing number of U.S. health plans and employer groups have established pay-for-performance programs (P4P). These programs offer health care providers financial incentives to achieve quality of care targets such as regular eye exams for patients with diabetes. However, physicians appear to be motivated more by professional standards of quality than financial incentives. Also, many physician organizations do not share the financial rewards with individual physicians.

Researchers, supported in part by the Agency for Healthcare Research and Quality (HS13591), interviewed 28 practice executives from 25 physician organizations in Massachusetts, where health plans have implemented a variety of P4P programs. Overall, the practice executives felt that quality incentives were better than utilization incentives (for example, financial rewards to perform fewer tests, get the patient out of the hospital faster, or use less expensive medication). They noted that physicians view quality incentives as more aligned with their natural tendency to provide good quality of care, even though they often feel they cannot control whether targets are achieved due to patients' lack of adherence to their treatment or advice. In contrast, physicians often view utilization incentives as barriers to quality care. In addition, while some practice executives viewed the incentives as agents for change, others emphasized that the incentives were just rewards for good quality of care already being provided, thus calling into question the effectiveness of incentives to change practice.

The interviews also revealed that physician organizations differ in how they distribute financial rewards. For example, some distribute them equally to primary care providers regardless of attainment of quality targets, while others distribute them based on performance. Some organizations retain the financial rewards and don't distribute them to physicians. The researchers suggest that health plans should better educate practice executives about the relative power of the incentives they propose. They should also advise physicians how implementation may alter the power of that incentive to improve quality of care.

See "Incentive implementation in physician practices: A qualitative study of practice executive perspectives on pay for performance," by Barbara G. Bokhour, Ph.D., James F. Burgess Jr., Ph.D., Julie M. Hook, and others, in the February 2006 Medical Care Research and Review 63(1S), pp. 73S-95S.

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