Filling the Gaps between Performance Incentive Programs and Health Care Quality Improvement

Physicians’ participation in the Physicians’ Quality Reporting Initiative and their perceptions of its impact on quality of care

“…These are consistent with research demonstrating that physicians have concerns about the reliability and utility of quality measures [14,[20][21][22][23][24]. The literature on performance of physician-level P4P programs in the US is mixed, with some studies showing small or modest improvements in quality and others showing no improvements [4][5][6][7][8][25][26][27]. Overall, research on physician-level P4P is consistent with our finding that most physicians believe the PQRI has little or no impact on quality.…”

“…Research has shown that P4P programs in the United States targeting individual physicians, like the PQRI, usually have only a small impact on quality, and often have none [4][5][6][7][8]. Missing from this body of research are studies assessing physicians' views of the impact of P4P [9].…”

Can Incentives to Improve Quality Reduce Disparities?

“…However, much quality improvement that we track in the National Healthcare Quality Report and National Healthcare Disparities Report is not associated with significant decreases in care disparities across populations. Moreover, some have speculated that activities to improve quality could actually increase disparities if some groups are less able to respond to such activities than others (Casalino et al 2007; Hasnain‐Wynia and Jean‐Jacques 2009). For example, mailed patient reminder cards may be less effective in populations with limited literacy or limited English proficiency.…”

Medicare Readmissions Policies and Racial and Ethnic Health Disparities: A Cautionary Tale

“…One concern however, is that these policy efforts may induce unintended negative consequences including the paradoxical effect of increasing racial and ethnic health disparities (Casalino et al, 2007; Hasnain-Wynia & Jean-Jacques, 2009; Ho, Moy, & Clancy, 2010; Hood, 2007; Werner & Asch, 2005). Given the risks of unintended consequences, examining how these quality initiatives differentially affect hospitals caring primarily for minority patients should be thoroughly considered, particularly if minority patients are at higher risk for the outcomes of interest.…”