According to Bridges to Excellence, a national effort to recognize and reward high-performing physicians, pay-for-performance programs garner greater participation when the rewards are higher.
Physician response rates to rewards were assessed using BTE’s Master Physician Lists from each of its four initial pilot sites - Louisville, Ky., Cincinnati, Albany, N.Y., and Boston. An analysis shows that physician participation is largely a function of the size of the incentive/bonus for which they are eligible.
According to BTE this suggests that more than two-thirds of physicians in the country will respond to the incentives offered by the HITECH portion of the American Recovery and Reinvestment Act because it represents a “significant” incentive - however, participation is likely to be skewed toward practices with more than three physicians. As a result, BTE recommends that the Department of Health and Human Services support smaller practices with technical assistance in addition to the financial incentives in order to ensure the broadest possible participation.
Based on the study’s findings, physicians are likely go through their own “return on investment” analysis when considering participation in a P4P program, and rewards that are sufficient for participation in one type of program may not be adequate for another. BTE suggests that P4P program architects test different incentive amounts to determine which would motivate the change they are seeking to stimulate.
"The bottom line is simple: P4P works. However, to work the incentives have to be meaningful and relevant to the physicians," said Francois de Brantes, CEO of BTE. "As Congress readies to work on payment reform, this is an important lesson. If they want the Medicare incentives to work, they have to significantly increase the percentage of dollars at stake. If they do, the positive effects of better quality will occur, otherwise they won't."
BTE also suggests that health plans with moderate to low market shares collaborate with other plans on a P4P effort to increase physician participation.
