An Examination of Pay‐for‐Performance in General Practice in Australia

Abstract

Objective. This study examines the impact of Australia's pay-for-performance (P4P) program for general practitioners (GPs). The voluntary program pays GPs A$40 and A$100 in addition to fee-for-service payment for providing patients recommended diabetes and asthma treatment over a year, and A$35 for screening women for cervical cancer who have not been screened in 4 years. Design. Three approaches were used to triangulate the program's impact: (1) analysis of trends in national claims for incentivized services pre-and postprogram implementation; (2) fixed effects panel regression models examining the impact of GPs' P4P program participation on provision of incentivized services; and (3) in-depth interviews to explore GPs' perceptions of their own response to the program.Results. There was a short-term increase in diabetes testing and cervical cancer screens after program implementation. The increase, however, was for all GPs. Neither signing onto the program nor claiming incentive payments was associated with increased diabetes testing or cervical cancer screening. GPs reported that the incentive did not influence their behavior, largely due to the modest payment and the complexity of tracking patients and claiming payment. Implications. Monitoring and evaluating P4P programs is essential, as programs may not spark the envisioned impact on quality improvement. Key Words. Pay-for-performance, quality of care, quality improvement, chronic disease careResearch has documented deficiencies in health care quality in many industrialized countries (Seddon et al. 2001;McGlynn et al. 2003; The Study Group of Diagnosis of the Working Group on Heart Failure of the European Society of Cardiology et al. 2003;Hussey et al. 2004;Tomio et al. 2010). Health policy experts often attribute the suboptimal quality to fee-for-service compensation, which incentivizes visit quantity rather than quality (Harris and Zwar 2007;Collier 2009;Stremikis, Davis, and Guterman 2010). Pay-for-performance (P4P) programs, which pay clinicians based upon achieving or improving specific quality metrics, are increasingly being used to improve quality of care. P4P programs range from offering small bonuses (approximately $400)

Implementation Processes and Pay for Performance in Healthcare: A Systematic Review

“…We identified five retrospective cohort studies [29][30][31][32][33] and one cross-sectional survey 17 related to the outer setting. Studies provided no clear evidence related to factors associated with region, population density, or patient population.…”

“…33 Findings related to performance in urban compared with rural settings were inconsistent, with two studies reporting better performance by providers in rural settings, 29,32 and one finding no difference. 31 Findings from Key Informant Interviews. Key informants discussed the importance of taking patient populations into account when designing P4P programs, stressing the importance of flexibility in larger multi-site programs to allow for targets that are realistic and that meet the needs of local patient populations.…”

“…Outer setting Six studies 17,[29][30][31]33,34,48 examined implementation factors related to the outer setting.…”

Designing a Framework for “Iranian Pay for Performance” Program for Non-Medical Workforce in Hospitals

“…Since low and medium pay rates are not able to give employees more motivation (35), PFP plans require a large amount of money (36). In Iran, the average PFP was about 28% of the professional component of the services produced by the hospital doctors.…”

Fee-for-service payment – an evil practice that must be stamped out?

“…Pay-for-Performance (P4P) gives bonus payment for physicians who achieve pre-defined clinical targets. Although in theory P4P is an ideal payment mechanism, there is at most mixed evidence of their results, and much depends on the context (7,8). Critics also voiced concerns about strict metrics used to evaluate performance.…”