The pay-for-performance movement is already a bona fide phenomenon in the U.S. healthcare industry, with as many as 100 different initiatives offering some form of bonus or incentive to doctors, hospitals and health plans that meet certain standards.
And even though the first comprehensive study of a large pay-for-performance plan found mixed results, the trend is likely to continue to accelerate as more insurers-along with the federal government-turn to these incentives as a way to improve quality.
"I think what this means is that financial incentives do matter," said Karen Davis, president of the Commonwealth Fund, a New York City-based foundation that focuses on health and social-policy issues, including pay-for-performance plans.
A study in the Oct. 12 Journal of the American Medical Association-the first research of its kind to assess the impact of a pay-for-performance project in a large health plan-compared clinical data on doctors in the pay-for-performance program at PacifiCare Health Systems, one of the nation's largest health plans, with doctors in Oregon and Washington who did not receive incentives. PacifiCare doctors demonstrated a 5.3% improvement in cervical cancer screening, well above the 1.7% increase in a comparison group. But the improvement was almost the same between the two groups in mammography and hemoglobin testing.
"Paying clinicians to reach a common, fixed performance target may produce little gain in quality for the money spent and will largely reward those with higher performance at baseline," the authors concluded.
Suzanne Delbanco, chief executive officer of the Leapfrog Group, which recently launched a pay-for-performance plan for hospitals, said she believes the JAMA study will "inspire new designs that try to get at the challenges" identified by the report's authors, including the notion that better-performing groups need only maintain the status quo to collect their bonuses.
"Research like this is sorely needed," Delbanco said. " More time is needed to see, for instance, if the impact of paying top performers trickles down to motivate the poorer performers."
Other, more anecdotal evidence points to significant and rapid advances when doctors have incentives available. At the Marshfield Clinic in Wisconsin, about 725 doctors are participating in a CMS pay-for-performance demonstration plan involving 10 large group practices. Since the program debuted in April, preliminary data show key improvements in areas such as reductions in hospital stays and vaccinations against pneumococcal pneumonia, said Michael Hillman, a physician and the clinic's medical director of quality improvement and care management.
"The idea that physicians don't respond to incentives is ludicrous," he said. "Doctors react to pens, pizza, free pills. You don't have to pay a lot to get physicians to do something."