Article

Effect of physician-specific pay-for-performance incentives in a large group practice.

Research Institute, Palo Alto Medical Foundation, 795 El Camino Real, Palo Alto, CA 94301, USA.
The American journal of managed care (impact factor: 2.46). 01/2010; 16(2):e35-42. pp.e35-42
Source: PubMed

ABSTRACT To assess the effect of a physician-specific pay-for-performance program on quality-of-care measures in a large group practice.
In 2007, Palo Alto Medical Clinic, a multispecialty physician group practice, changed from group-focused to physician-specific pay-for-performance incentives. Primary care physicians received incentive payments based on their quarterly assessed performance.
We examined 9 reported and incentivized clinical outcome and process measures. Five reported and nonincentivized measures were used for comparison purposes. The quality score of each physician for each measure was the main dependent variable and was calculated as follows: Quality Score = (Patients Meeting Target / Eligible Patients) x 100. Differences in scores between 2006 and 2007 were compared with differences in scores between 2005 and 2006. We also compared the performance of Palo Alto Medical Clinic with that of 2 other affiliated physician groups implementing group-level incentives.
Eight of 9 reported and incentivized measures showed significant improvement in 2007 compared with 2006. Three measures showed an improvement trend significantly better than the previous year's trend. A similar improvement trend was observed in 1 related measure that was reported but was nonincentivized. However, the improvement trend of Palo Alto Medical Clinic was not consistently different from that of the other 2 physician groups.
Small financial incentives (maximum, $5000/year) based on individual physicians' performance may have led to continued or enhanced improvement in well-established ambulatory care measures. Compared with other quality improvement programs having alternative foci for incentives (eg, increasing support for staff hours), the effect of physician-specific incentives was not evident.

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Keywords

2 physician groups
 
affiliated physician groups
 
group-level incentives
 
incentive payments
 
incentivized clinical outcome
 
incentivized measures
 
individual physicians' performance
 
main dependent variable
 
multispecialty physician group practice
 
nonincentivized measures
 
Palo Alto Medical Clinic
 
physician-specific incentives
 
physician-specific pay-for-performance incentives
 
physician-specific pay-for-performance program
 
Primary care physicians
 
process measures
 
quality improvement programs
 
quality-of-care measures
 
Small financial incentives
 
well-established ambulatory care measures
 

Sukyung Chung