Pay-for-Performance May Offer Little Gain in Quality: Study

TUESDAY, Oct. 11 (HealthDay News) -- Pay-for-performance programs for doctors don''t seem to do much to improve health care quality, according to a study by researchers at the Harvard School of Public Health.

The study concluded that paying doctors to reach a common, fixed performance target may result in little overall gain in quality and may largely benefit doctors with better quality performance at baseline.

The study, published in the Oct. 12 issue of the Journal of the American Medical Association, noted that there has been rapid growth in the number of health care pay-for-performance programs in the United States. However, there is little published research on the effectiveness of such programs.

The Harvard team evaluated California medical groups that were subject to pay-for-performance and a comparison group in the Pacific Northwest (Oregon and Washington). The assessments were made in three areas: cervical cancer screening; mammography; and hemoglobin A1c testing.

The study found the following improvements in clinical quality scores: cervical cancer screening, 5.3 percent for California versus 1.7 percent for Pacific Northwest; for mammography, 1.9 percent versus 0.2 percent; and for hemoglobin A1c testing, 2.1 percent versus 2.1 percent.

In all three areas of measurement, physician groups with a baseline performance at or above the performance threshold necessary for receiving a bonus improved the least but received the largest portion (75 percent) of bonus payments, the study said.

"Our findings give rise to a number of speculations about the effects of pay-for-performance," the study authors wrote. "First, groups with baseline performance already above the targeted threshold appeared to understand that they needed only to maintain the status quo to receive the bonus payments. More surprising, perhaps, is that low-performing groups improved as much as they did, given that their short-run chances of receiving a bonus were likely to be low.

"One possibility is that the groups viewed the QIP (quality incentive plan) as a larger signal of a changing environment in which they would face increasing pressure to improve their care systems and decided to begin moving in that direction. Paying explicitly for quality improvement might alter the incentives for high-performing and low-performing groups, distribute bonus dollars more toward the latter group, and possibly increase the overall impact of pay-for-performance."

More information

The U.S. Agency for Healthcare Research and Quality offers advice on improving health care quality.

SOURCE: JAMA/Archives news release, Oct. 11, 2005

Last Updated: Oct. 12, 2005