The nature of financial incentives from P4P programs may impact patient care

The success of medical pay-for-performance programs on improving patient care varies and may depend on the allocation of funds and who receives them, according to researchers from UCLA.

Hector P. Rodriguez, an assistant professor in the department of health services at the UCLA School of Public Health, and colleagues found that the patient-care performance ratings for 25 medical groups in California significantly improved after the initiation of the Integrated Healthcare Association’s statewide pay-for-performance program. However, they discovered a negative impact on how patients experienced their care when incentives focused on physician productivity.

“As the Obama administration and Congress continue to grapple with health care reform, these findings provide timely information about the kinds of things medical groups can do — and can avoid doing — with financial incentives in order to improve the quality of patient health care experiences,” Rodriguez stated in a UCLA press release.

The study appears in the December issue of the Journal of General Internal Medicine.

The investigators reviewed information on more than 100,000 patients who were treated by more than 1,000 primary care physicians at 25 California medical groups during a 3-year period. All of the groups received financial incentives during the pay-for-performance program for their achievements in clinical care processes, patient care experiences and office-based information systems, and also participated in a public reporting program.

The groups could use the additional funds in different ways. Some opted to pay incentives directly to physicians, while others broadly used the incentives to focus on organizational priorities. The investigators interviewed the medical directors of the groups to determine how these financial incentives were used.

The investigators discovered that ratings on measures representing physician communication, care coordination and office-staff interaction greatly improved following the start of the pay-for-performance program and found that incentives focusing on the quality of doctor-patient interaction and overall patient care lead to better performance in those three areas. These results were more apparent when the medical groups broadly used the funds to reinforce patient-centered work cultures, according to the release.

The study revealed the greatest improvements in groups that focused more on clinical quality and patient experience and placed less emphasis on doctors’ productivity. However, the investigators found that groups that paid financial incentives directly to physicians and placed too much focus on physician productivity showed a negative impact on patients’ experiences.

“The current House bill being debated includes the establishment of a Center for Quality Improvement to identify and implement the best practices in the delivery of care,” Rodriguez said in the release. “Our study results suggest that the nature of financial incentives can affect the provision of patient-centered care. Therefore, quality improvement and reimbursement reform efforts should integrate patient-reported experiences of care as a central metric for evaluating reform effects.”

For more information:
Rodriguez HP, von Glahn T, Elliott MN, Rogers WH, Safran DG. The Effect of Performance-Based Financial Incentives on Improving Patient Care Experiences: A Statewide Evaluation. J Gen Intern Med. 2009 Oct 14. [Epub ahead of print]