Incentive Implementation in Physician Practices: A Qualitative Study of Practice Executive Perspectives on Pay for Performance

Abstract

Pay-for-performance (P4P) programs offer health care providers financial incentives to achieve predefined quality targets. Practice executives sit at a key nexus point for determining how P4P programs are implemented in physician practices. Using a qualitative interview design, this article examines the role practice executives play in the implementation of P4P programs and how their perspectives and decisions can influence the success of these programs. The authors identified five key findings related to practice executives' views on P4P: quality incentives are better than utilization incentives, quality incentives are bonus rewards, quality incentives are agents for change, providers do not feel they have control over attaining quality targets, and the ways in which quality is measured are problematic. The authors discuss five different ways in which practice executives distribute rewards to physicians. These findings may help payers more effectively design and implement financial rewards for quality.

Sustainability of Quality Improvement Following Removal of Pay-for-Performance Incentives

“…17 In general, sustainability of quality improvements may depend on changes in clinical systems that do not consistently add to the workload of busy clinical staff. However, sustainability may also vary depending on who receives the incentives.…”

The Experience of Pay for Performance in English Family Practice: A Qualitative Study

“…To obtain active commitment rather than a grudging compliance, 4 previous research suggests it is important to align quality targets to professional priorities 9,22 and to ensure the underlying goals of quality targets are understood by those undertaking them. Our fi ndings, however, suggest that these issues are not necessarily relevant when targets are incentivized.…”

“…Despite this lack of enthusiasm, even those who criticized these new indicators were motivated to achieve the targets Previous research has suggested that fi nancial incentives are effective when they are deemed suffi cient to change the behavior necessary to meet the target and when they are used as bonus rewards in addition to existing income. 9 Professional motivation, while an important component of delivering quality improvement, is not always suffi cient on its own. 23 This nationally representative sample of doctors and nurses believed that the fi nancial incentives had been suffi cient to change behavior and to motivate achievement of QOF indicator targets.…”

“…[4][5][6][7][8][9][10][11] Such factors include levels of physician understanding of the purpose and involvement in the development of the scheme; the nature, appropriateness, and adequacy of measures used; the feasibility of implementation; and the magnitude of an incentive necessary to produce the behavioral change required to achieve targets. Other factors include the balance between team and individual incentives and the extent to which behavioral changes required to achieve targets are aligned to physician priorities and values.…”

As Good As It Gets? Managing Risks of Cardiovascular Disease in California’s Top-Performing Physician Organizations

“…e perspective of executives and directors, however, can provide an important strategic view of implementation. 42 Finally, we did not interview lower-performing physician organizations, so we are unable to contrast the care management and EHR capabilities Copyright 2014 The Joint Commission with the top-performing groups. Previous studies of "positive deviance" 43 in health care, however, underscore the usefulness of examining the experiences of top-performing organizations to identify facilitators of evidence-based practices.…”