Pay-for-performance success may hinge on payment usage, study finds

Although pay-for-performance programs have gained “rapid and widespread” appeal as ways to increase care quality, a new study in the Journal of General Internal Medicine finds that how practices utilize incentive payments may determine their impact on quality and that putting payments toward physician productivity and efficiency may negatively affect the patient experience.

According to the news release, a new UCLA study shows that patient-care performance ratings for 25 medical groups across California improved significantly following the launch of a statewide pay-for-performance program in 2004 - but not when incentives focused on doctors' productivity.

Reporting in the December edition of the Journal of General Internal Medicine, Hector P. Rodriguez, assistant professor in the department of health services at the UCLA School of Public Health, and colleagues found evidence that certain kinds of financial incentives for the purpose of improving patient care, in combination with public reporting of medical group performance ratings, have a positive effect on patient care experiences. However, they also found that some types of incentives may have a negative overall impact on how patients experienced their care.

The study found the greatest improvements were seen within those groups which placed less emphasis on physician productivity and greater emphasis on clinical quality and patient experience. And within groups where financial incentives were paid directly to physicians - rather than being used more broadly - the researchers found that placing too much emphasis on physician productivity actually had a negative impact on the experiences patients had when visiting their primary care doctor.  

(SOURCES: Advisory Board Daily Briefing,, December 2, 2009; UCLA School of Public Health,, accessed December 4, 2009)