A behavioral model of clinician responses to incentives to improve quality

Frølich, Anne; Talavera, Jason A; Broadhead, Peter; Dudley, R. Adams

doi:10.1016/j.healthpol.2006.03.001

Cited by 97 publications

(111 citation statements)

References 59 publications

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“…13,22 This study has a number of limitations, however. Our sampling method was not designed to provide representative views of those working in primary medical care; rather, we wanted to contribute to existing conceptual models of pay for performance and to identify areas of importance that may need more detailed investigation.…”

Section: Discussionmentioning

confidence: 95%

Pay for Performance in Primary Care in England and California: Comparison of Unintended Consequences

McDonald¹,

Roland²

2009

The Annals of Family Medicine

162

145

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PURPOSEWe undertook an in-depth exploration of the unintended consequences of pay-for-performance programs In England and California. METHODSWe interviewed primary care physicians in California (20) and England (20) and compared unintended consequences in each setting. Interview recordings were transcribed verbatim and subjected to thematic analysis. RESULTSUnintended consequences reported by physicians varied according to the incentive program. English physicians were much more likely to report that the program changed the nature of the offi ce visit. This change was linked to a larger number of performance measures and heavy reliance on electronic medical records, with computer prompts to facilitate the delivery of performance measures. Californian physicians were more likely to express resentment about pay for performance and appeared less motivated to act on fi nancial incentives, even in the program with the highest rewards. The inability of Californian physicians to exclude individual patients from performance calculations caused frustration, and some physicians reported such undesirable behaviors as forced disenrollment of noncompliant patients. English physicians are assessed using data extracted from their own medical records, whereas in California assessment mostly relies on data collected by multiple third parties that may have different quality targets. Assessing performance based on these data contributes to feelings of resentment, lack of understanding, and lack of ownership reported by Californian physicians.CONCLUSIONS Our study fi ndings suggest that unintended consequences of incentive programs relate to the way in which these programs are designed and implemented. Although unintended, these consequences are not necessarily unpredictable. When designing incentive schemes, more attention needs to be paid to factors likely to produce unintended consequences. Ann Fam Med 2009;7:121-127. DOI: 10.1370/afm.946. INTRODUCTIONT o improve health care quality, payers are increasingly using fi nancial incentives to reward physicians and medical groups that meet specifi c performance targets. There has been a rapid recent growth in the number of these pay-for-performance programs, which provide fi nancial incentives for quality improvement, in primary health care. 122 PAY F O R P ER F O R M A NC Emultispecialty medical groups and independent practice associations, or IPAs,5,6 which contract with health plans on their behalf), and incentive payments are made to these larger organizations as opposed to individual physicians or practices. In England, payments are made directly to practices, which are mostly groups of between 1 and 10 primary care physicians. These payments contribute as much as 30% of practice income. In most (but not all) of the California settings, the amount received by physicians is much lower.Although pay-for-performance programs may deliver on their stated goals, 7,8 they could have unintended effects on other aspects of care or on physician motivation. These effects include...

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Section: Discussionmentioning

confidence: 95%

Pay for Performance in Primary Care in England and California: Comparison of Unintended Consequences

McDonald¹,

Roland²

2009

The Annals of Family Medicine

162

145

View full text Add to dashboard Cite

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“…On the basis of evidence from early schemes and readings of economic and psychological theory, several researchers have produced blueprints for secondgeneration pay-for-performance frameworks. Their recommendations for designers include making rewards large enough to be meaningful; using penalties in addition to rewards; aligning incentives to professional priorities; using absolute rather than relative performance targets; providing frequent, discrete rewards or punishments; and making an explicit long-term commitment to incentives (23,32,38). Provide frequent rewards/punishments, separated from usual compensation.…”

Section: Insights On Physician Response To Incentives From Social Psymentioning

confidence: 99%

Impact of Provider Incentives on Quality and Value of Health Care

Doran

Maurer

Ryan

2017

Annu. Rev. Public Health

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The use of financial incentives to improve quality in health care has become widespread. Yet evidence on the effectiveness of incentives suggests that they have generally had limited impact on the value of care and have not led to better patient outcomes. Lessons from social psychology and behavioral economics indicate that incentive programs in health care have not been effectively designed to achieve their intended impact. In the United States, Medicare's Hospital Readmission Reduction Program and Hospital ValueBased Purchasing Program, created under the Affordable Care Act (ACA), provide evidence on how variations in the design of incentive programs correspond with differences in effect. As financial incentives continue to be used as a tool to increase the value and quality of health care, improving the design of programs will be crucial to ensure their success.

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“…A general review of the literature on incentive use in health care had mixed findings (37). Among studies that provided incentives to individual providers, five had positive results and two had negative results; among studies that provided incentives to groups, one had a positive result and two had negative results.…”

Section: Provider Reimbursement and Incentivesmentioning

confidence: 99%