The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates.

Department of Epidemiology and Social Medicine, Bronx, NY 10467, USA.
American Journal of Public Health (Impact Factor: 4.23). 02/1999; 89(2):171-5. DOI: 10.2105/AJPH.89.2.171
Source: PubMed

ABSTRACT The purpose of this study was to examine the effects on immunization coverage of 3 incentives for physicians--a cash bonus for practice--wide increases, enhanced fee for service, and feedback.
Incentives were applied at 4-month intervals over 1 year among 60 inner-city office-based pediatricians. At each interval, charts of 50 randomly selected children between 3 and 35 months of age were reviewed per physician.
The percentage of children who were up to date for diphtheria, tetanus, and pertussis and Haemophilus influenzae type b; polio; and measles-mumps-rubella immunization in the study's bonus group improved by 25.3 percentage points (P < .01). No significant changes occurred in the other groups. However, percentage of immunizations received outside the participating practice also increased significantly in the bonus group (P < .01). Levels of missed opportunities to immunize were high in all groups and did not change over time. Physicians' knowledge of contraindications was low.
Bonuses sharply and rapidly increased immunization cover-age in medical records. However, much of the increase was the result of better documentation. A bonus is a powerful incentive, but more structure or education may be necessary to achieve the desired results.

  • [Show abstract] [Hide abstract]
    ABSTRACT: Pay-for-performance (P4P) is a quality improvement strategy that links a portion of reimbursement to provider health care performance measures with the goal of better and more efficient health care. P4P programs are increasingly common at both the hospital and physician level, including the introduction of Medicare’s Hospital Inpatient Value-Based Purchasing program later this year and a physician value-based purchasing program in development. Although many clinicians view P4P as a threat to autonomy and income, an alternative view is that P4P presents an important opportunity for clinicians to partner with payers to improve health care outcomes for our patients. Indeed, financial incentives are powerful tools for behavior change, and an ideal health care system should not reward the volume of care in the absence of quality. In this review, we provide practicing pulmonary clinicians with an overview of P4P in health care, discuss the potential adverse consequences inherent in P4P, and provide concrete strategies to help clinicians engage policy makers and health care payers in these initiatives. Among these strategies are participating in existing P4P programs such as Medicare’s Physician Quality Reporting System, working through professional medical associations to create quality metrics that are important to both physicians and patients, and educating the next generation of physicians about the importance of linking reimbursement to quality. Only through active engagement can the pulmonary community ensure that P4P programs best serve our patients and the health care system at large.
    Clinical Pulmonary Medicine 01/2012; 19(5):206-214. DOI:10.1097/CPM.0b013e318267097a
  • Source
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: EXECUTIVE SUMMARY Pay-for-performance compensation systems are proliferating, yet their impact on key stakeholders remains uncertain. This paper explores ethical dimensions of pay-for-performance within a framework that considers its fundamental and guiding principles, its process of implementation, and its potential effects on patients and physicians. It then proposes recommendations for ensuring ethical and effective performance-based physician compensation. Fundamental and guiding principles of pay-for-performance. These include rewarding quality health care and aligning physicians' financial incentives with the best interests of patients. Although this inherent appeal to physician self-interest might be in tension with professional ideals of altruism and beneficence, the principles that inform pay-for-performance are not inherently unethical. It seems just, for example, to financially reward physicians who demonstrate outstanding levels of patient-centered and evidence-based care. Nevertheless, current pay-for-performance approaches are guided by a flawed understanding of health care quality. This understanding typically equates quality with the achievement of non-individualized, pre-determined health goals for broad populations and fails to consider contributions from stakeholders other than physicians (such as health plans) that also have partial responsibility for ensuring quality.


Available from