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Steven D. Pearson, Eric C. Schneider, Ken P. Kleinman, Kathryn L. Coltin, and Janice A. Singer The Impact Of Pay-For-Performance On Health Care Quality In Massachusetts, 2001–2003 Health Affairs, July/August 2008; 27(4): 1167-1176. [Abstract] [Full Text] [PDF] [Technical Appendix] [Reprints & Permissions]

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P4P: Time To Get Real

Francois S. de Brantes   ( 14 August 2008 )

P4P: Time To Get Real 14 August 2008
Francois S. de Brantes, CEO Bridges To Excellence Send comment to journal: Re: P4P: Time To Get Real francois.debrantes{at}bridgestoexcellence.org Francois S. de Brantes	Pearson and colleagues report that early P4P programs had little measured effect on the quality of care. While this result raises valid concerns and questions, we should not lose sight of the study’s unanswered questions. What is the level of incentives that will motivate physicians to actively participate in a P4P program? In the Pearson study, the relatively small amount of incentives per physician (even when combined across health plans) is an important variable. The distinction between “highly incentivized” and other groups was trivial, since even the most highly incentivized groups derived 98% of their income from routine care activities, and only 2% based on results. Bridges to Excellence's (BTE’s) research suggests that the numbers need to get significantly higher if we really want to change physician behavior. Do “trickle-down economics” work in motivating physician practices? Interviews of physician practices in MA by Masspro [1] (Massachusetts’ Quality Improvement Organization) funded by BTE suggest that most practices and physicians are unaware of the size of the incentives at stake for the group. BTE’s research [2] and prior work by Rosenthal [3] suggest that physician engagement in quality improvement depends on the size of the incentive and the difficulty of achieving the goal. This article should therefore be viewed as a rallying cry for all payers and purchasers to “get real” and stop fiddling at the edges of the reimbursement system. If we want real change, then let’s put a real punch behind the actions, not a limp handshake. References: 1. See http://www.bridgestoexcellence.org/Content/Content/84/Documents/Updated%20BTE%20Physician%20Testimonials%20Report%20111607.pdf 2. de Brantes, F, D’Andrea, G, “Collaboration in P4P: Solving a Prisoner’s Dilemma”, in review 3. Rosenthal MB, Fernandopulle R, Song HR, Landon B, “Paying for quality: providers' incentives for quality improvement”. Health Aff (Millwood). 2004 Mar-Apr;23(2):127-41