Implementation of pay for performance in primary care: a qualitative study 8 years after introduction

Lester, Helen; Matharu, Tatum; Mohammed, Mohammed A.; Lester, David; Foskett-Tharby, Rachel

doi:10.3399/bjgp13x668203

Cited by 34 publications

(61 citation statements)

References 28 publications

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“…They seem to concern more about issues related to payment, governance, and [11]. Nevertheless, issues concerning physicians' decreased clinical autonomy and loss of professionalism need to be addressed with considerable care and sensitivity while implementing P4P programs [24][25][26]. A systematic review conducted by Mendelson et al in 2017 emphasized that value-based payments are likely to improve quality of care and reduce costs [27].…”

Section: Discussionmentioning

confidence: 99%

Awareness of, attitude toward, and willingness to participate in pay for performance programs among family physicians: a cross-sectional study

et al. 2020

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Background: The National Health Insurance Administration of Taiwan has introduced several pay-for-performance programs to improve the quality of healthcare. This study aimed to provide government with evidence-based research findings to help primary care physicians to actively engage in pay-for-performance programs. Methods: We conducted a questionnaire survey among family physicians with age-stratified sampling from September 2016 to December 2017. The structured questionnaire consisted of items including the basic demographics of the surveyee and their awareness of and attitudes toward the strengths and/or weaknesses of the pay-forperformance programs, as well as their subjective norms, and the willingness to participate in the pay-for-performance programs. Univariate analysis and multivariate logistic regression analysis were performed to compare the differences between family physicians who participate in the pay-for-performance programs versus those who did not. Results: A total of 543 family physicians completed the questionnaire. Among family physicians who participated in the pay-for-performance programs, more had joined the Family Practice Integrated Care Project [Odds ratio (OR): 2.70; 95% Confidence interval (CI): 1.78~4.09], had a greater awareness of pay-for-performance programs (OR: 2.37; 95% CI: 1.503 .83), and a less negative attitude to pay-for-performance programs (OR: 0.50; 95% CI: 0.31~0.80) after adjusting for age and gender. The major reasons for family physicians who decided to join the pay-for-performance programs included believing the programs help enhance the quality of healthcare (80.8%) and recognizing the benefit of saving health expenditure (63.4%). The causes of unwillingness to join in a pay-for-performance program among non-participants were increased load of administrative works (79.6%) and inadequate understanding of the contents of the pay-for-performance programs (62.9%). Conclusions: To better motivate family physicians into P4P participation, hosting effective training programs, developing a more transparent formula for assessing financial risk, providing sufficient budget for healthcare quality improvement, and designing a reasonable profit-sharing plan to promote collaboration between different levels of medical institutions are all imperative.

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Section: Discussionmentioning

confidence: 99%

Awareness of, attitude toward, and willingness to participate in pay for performance programs among family physicians: a cross-sectional study

et al. 2020

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“…“Localism” is regularly recycled as a theme in NHS policy-making [ 37 ]. In order to increase clinical autonomy and therefore have maximal impact upon patient care, there are continuing calls for greater professional involvement in developing pay-for-performance indicators [ 38 ]. This is order to increase professional buy-in with such schemes and ensure that indicators are developed from within and not imposed from the outside [ 26 ].…”

Section: Discussionmentioning

confidence: 99%

`Just another incentive scheme’: a qualitative interview study of a local pay-for-performance scheme for primary care

et al. 2014

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BackgroundA range of policy initiatives have addressed inequalities in healthcare and health outcomes. Local pay-for-performance schemes for primary care have been advocated as means of enhancing clinical ownership of the quality agenda and better targeting local need compared with national schemes such as the UK Quality and Outcomes Framework (QOF). We investigated whether professionals’ experience of a local scheme in one English National Health Service (NHS) former primary care trust (PCT) differed from that of the national QOF in relation to the goal of reducing inequalities.MethodsWe conducted retrospective semi-structured interviews with primary care professionals implementing the scheme and those involved in its development. We purposively sampled practices with varying levels of population socio-economic deprivation and achievement. Interviews explored perceptions of the scheme and indicators, likely mechanisms of influence on practice, perceived benefits and harms, and how future schemes could be improved. We used a framework approach to analysis.ResultsThirty-eight professionals from 16 general practices and six professionals involved in developing local indicators participated. Our findings cover four themes: ownership, credibility of the indicators, influences on behaviour, and exacerbated tensions. We found little evidence that the scheme engendered any distinctive sense of ownership or experiences different from the national scheme. Although the indicators and their evidence base were seldom actively questioned, doubts were expressed about their focus on health promotion given that eventual benefits relied upon patient action and availability of local resources. Whilst practices serving more affluent populations reported status and patient benefit as motivators for participating in the scheme, those serving more deprived populations highlighted financial reward. The scheme exacerbated tensions between patient and professional consultation agendas, general practitioners benefitting directly from incentives and nurses who did much of the work, and practices serving more and less affluent populations which faced different challenges in achieving targets.ConclusionsThe contentious nature of pay-for-performance was not necessarily reduced by local adaptation. Those developing future schemes should consider differential rewards and supportive resources for practices serving more deprived populations, and employing a wider range of levers to promote professional understanding and ownership of indicators.

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“…Incentivisation of care processes and specific activities can result in 'tick-box' or even 'one-size-fits-all' medicine, which is in no-one's best interests and is subject to the problems identified above. 23,24 The case for outcomes as a 'health currency'…”

Section: Alternative Commissioning And/or Payment Models Which Underpmentioning

confidence: 99%

Paying for what matters most: the future of outcomes-based payments in healthcare

Dunbar-Rees

2018

Future Healthcare Journal

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Payment by results' (PbR) is probably one of the most widely debated misnomers in the NHS. At best, rather than reimbursing results, it can be considered as payment for providing collections of acute care activities. Better prevention is often cited as the only solution to sustainability, but currencies which reward prevention seemingly remain very hard to create. This review article explores the impact of legacy payment systems on health and care systems nationally and internationally. It examines alternative models, such as payment for outcomes, and questions whether any alternative payment systems may better support prevention, and fi nally achieve the 'holy grail' of a truly sustainable care system. If payment for outcomes offers a potential solution, then what are the key barriers and enablers? The case for alternative, novel metrics for success is proposed, which may better support care systems to measure their progress towards sustainability than existing indicators.ABSTRACT This somewhat baffling system of different healthcare payment currencies has largely simply evolved over time. It is remarkable that healthcare functions as effectively as it does, given the complexity of legacy payment and reimbursement systems. The important question remains as to what the impact of this is on the sustainability of health and care, and what alternative options exist, which may better align with best clinical practice, and what matters most to patients.

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Implementation of pay for performance in primary care: a qualitative study 8 years after introduction

Cited by 34 publications

References 28 publications

Awareness of, attitude toward, and willingness to participate in pay for performance programs among family physicians: a cross-sectional study

Awareness of, attitude toward, and willingness to participate in pay for performance programs among family physicians: a cross-sectional study

`Just another incentive scheme’: a qualitative interview study of a local pay-for-performance scheme for primary care

Paying for what matters most: the future of outcomes-based payments in healthcare

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