The Use of Physician Financial Incentives and Feedback to Improve Pediatric Preventive Care in Medicaid Managed Care

Hillman, Alan L.; Ripley, Kimberly; Goldfarb, Neil I.; Weiner, Janet; Nuamah, Isaac; Lusk, Edward J.

doi:10.1542/peds.104.4.931

Cited by 117 publications

(128 citation statements)

References 9 publications

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“…Three studies (Grady et al 1997;Hillman et al 1998;Hillman et al 1999) didn't detect any significant effect of P4P bonus rewards or bonus rewards combined with performance feedback on physician compliance with cancer screening, pediatric immunization and mammography referrals. Two studies (Fairbrother et al 1999;Fairbrother et al 2001) found that a bonus or bonus with performance feedback incentives increased documented coverage levels for childhood immunization, but the measured increase 6 was primarily due to better documentation not better immunization practices.…”

Section: Empirical Evidence On Physician Response To P4pmentioning

confidence: 97%

Physician Response to Pay-for-Performance: Evidence from a Natural Experiment

Hurley

DeCicca

et al. 2011

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Explicit financial incentives, especially pay-for-performance (P4P) incentives, have been extensively employed in recent years by health plans and governments in an attempt to improve the quality of health care services. This study exploits a natural experiment in the province of Ontario, Canada to identify empirically the impact of pay-for-performance (P4P) incentives on the provision of targeted primary care services, and whether physicians' responses differ by age, practice size and baseline compliance level. We use an administrative data source which covers the full population of the province of Ontario and nearly all the services provided by practicing primary care physicians in Ontario. With an individual-level data set of physicians, we employ a difference-in-differences approach that controls for both "selection on observables" and "selection on unobservables" that may cause estimation bias in the identification. We also implemented a set of robustness checks to control for confounding from the other contemporary interventions of the primary care reform in Ontario. The results indicate that, while all responses are of modest size, physicians responded to some of the financial incentives but not the others. The differential responses appear related to the cost of responding and the strength of the evidence linking a service with quality. Overall, the results provide a cautionary message regarding the effectiveness of pay-for-performance schemes for increasing quality of care.

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Section: Empirical Evidence On Physician Response To P4pmentioning

confidence: 97%

Physician Response to Pay-for-Performance: Evidence from a Natural Experiment

Hurley

DeCicca

et al. 2011

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“…Hutchison et al (1996), for example, show that Canadian physicians paid via capitation and a supplementary incentive payment for low hospital utilization rates do not have significantly lower hospital admission rates among their patients than physicians paid exclusively via FFS. Similarly, Hillman et al (1998) and Hillman et al (1999) do not observe a significant effect of P4P incentives coupled with performance feedback on physician compliance with cancer screening and pediatric preventive care guidelines in a U.S. Medicaid Health Maintenance Organization (HMO). A study by Strong et al (2009) reports that the U.K. Quality and Outcomes Framework (QOF), the most comprehensive P4P program to date, does not lead to an improvement in the quality of ambulatory care.…”

Section: Literature Reviewmentioning

confidence: 99%

Money Talks - Paying Physicians for Performance

2013

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“…Pay-forperformance had the greatest effect on low rather than high performers [3,9,16,33,44,64,72]. Approaches with purely positive incentives (versus winners and losers) [12,16,34,35,48] and paying clinicians rather than hospitals were more effective [16,61]. Pay-for-performance focused on the individual provider found no relationship between frequency [17] and size of incentive on effect sizes [72].…”

Section: Search Strategies and Criteriamentioning

confidence: 93%

“…The answer to the first question was, in most cases, a qualified yes; only three studies [34,35,65] did not report improvement. However, the overall effect was small and highly context-specific [16,28,49,61,66,67,72].…”

Section: Search Strategies and Criteriamentioning

confidence: 98%

The Use of Three Strategies to Improve Quality of Care at a National Level

Wright

2012

Clinical Orthopaedics &Amp; Related Research

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Background Improving the quality of care is essential and a priority for patients, surgeons, and healthcare providers. Strategies to improve quality have been proposed at the national level either through accreditation standards or through national payment schemes; however, their effectiveness in improving quality is controversial. Questions/purposes The purpose of this review was to address three questions: (1) does pay-for-performance improve the quality of care; (2) do surgical safety checklists improve the quality of surgical care; and (3) do practice guidelines improve the quality of care? These three strategies were chosen because there has been some research assessing their effectiveness in improving quality, and implementation had been attempted on a large scale such as entire countries.Methods We performed a literature review from 1950 forward using Medline to identify Level I and II studies. We evaluated the three strategies and their effects on processes and outcomes of care. When possible, we examined strategy implementation, patients, and systems, including provider characteristics, which may affect the relationship between intervention and outcomes with a focus on factors that may have influenced effect size. Results Pay-for-performance improved the process and to a lesser extent the outcome of care. Surgical checklists reduced morbidity and mortality. Explicit practice guidelines influenced the process and to a lesser extent the outcome of care. Although not definitively showed, clinician involvement during development of intervention and outcomes, with explicit strategies for communication and implementation, appears to increase the likelihood of positive results. Conclusion Although the cost-effectiveness of these three strategies is unknown, quality of care could be enhanced by implementing pay-for-performance, surgical safety checklists, and explicit practice guidelines. However, this review identified that the effectiveness of these strategies is highly context-specific.

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The Use of Physician Financial Incentives and Feedback to Improve Pediatric Preventive Care in Medicaid Managed Care

Cited by 117 publications

References 9 publications

Physician Response to Pay-for-Performance: Evidence from a Natural Experiment

Physician Response to Pay-for-Performance: Evidence from a Natural Experiment

Money Talks - Paying Physicians for Performance

The Use of Three Strategies to Improve Quality of Care at a National Level

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