Benefits of P4P Questionable
The current issue of the journal Health Affairs indicates that performance bonuses do not result in quality improvements that justify the increased expenditures. The public health journal examined findings from an array of different pay for performance (P4P) programs implemented in Massachusetts.
These findings are particularly of interest in light of the massive adoption of P4P programs. Over 150 different programs are operating around the country. These function on the concept that quality improvements result by rewarding compliance with evidence-based treatment guidelines.
The researchers had access to a broad array of data, a limitation of previous P4P examinations. P4P programs from five different insurance plans, which contract with more than 90 percent of the general practitioners across the state, were included in the study. The analysis included 81 different provider groups in Massachusetts that were eligible for P4P remuneration to 73 physician practices in the state that were not eligible.
Data examined indicated improvements between 2001 and 2003 with respect to preventive care. Importantly, there were no differences between the clinicians in P4P programs and those not participating.
These findings are contrasted with other P4P evaluations, which note improvements in the quality of care secondary to bonuses issued. Some trials note limited improvements in quality. Few of these studies incorporated control groups for comparison.
Some suggest that these findings indicate that the existing bonuses are not sufficient to make significant improvements in care quality. Notably, the incentive plans implemented in the U.S. average less than five percent. In Britain, a P4P plan developed provides bonuses of up to 200 percent for significant quality improvements.
July 28, 2008 Related topics: Trends, Quality, Safety, Errors