1Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, Korea.
2Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea.
Copyright © 2012 The Korean Society for Preventive Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
The authors have no conflicts of interest with the material presented in this paper.
This article is available at http://jpmph.org/.
Citation | Country | Program | Target | No. of eligible population | No. of study participants | Survey method |
---|---|---|---|---|---|---|
Pines JM et al., 2007 [35] | USA | CMS & JCAHO | Chairpersons and medical directors from hospitals with emergency medicine training programs in the USA | 129 | 90 | Online questionnaire |
Locke RG et al., 2008 [36] | USA | Non-specific P4P | Primary care osteopathic physician members of the American Osteopathic Association | 1000 | 123 | Mailed survey |
McDonald R et al., 2009 [28] | USA & UK | The California initiative & Quality and Outcomes Framework | In the England sample (20) physicians from 2 regions & in the California sample (20) physicians from 4 organizations that ranged in size from 600 to 3,000 physicians and health care clinicians | 20 (UK) & 20 (California) | 20 (UK) & 20 (California) | Face to face interview using the same topic guide |
Young G et al., 2010 [41] | USA | Managed care plan adopted a P4P program (SNS-A) & P4P for primary care physicians focused on a diabetes care component (SNS-B) | Physicians from CHCs in SNS-A and from medical group in SNS-B | 256 Physicians from 13 CHCs (SNS-A) & 156 physicians from three participating medical groups | 56% (SNS-A) & 63% (SNS-B) | Mailed survey |
Casalino LP et al., 2007 [32] | USA | Physician P4P program | General internist | 1168 from 1668 randomly selected general internists listed in the AMA physician master-file | 556 | Mailed survey |
Steiger B, 2005 [37] | USA | Non-specific P4P | ACPE members (physician executives) | 7444 | 932 | Poll |
Damberg CL, 2009 [34] | USA | Integrated Healthcare Association P4P program | 182 Physician organizations contracted with the seven largest HMOs in California | 35 Physician organizations | 35 Physician organizations: in 14 organizations replaced with similar organizations | Interview |
Reiter KL et al., 2006 [38] | USA | Statewide hospital- level P4P system between Blue Cross Blue Shield of Michigan and 86 hospitals with which it contracts | 86 Hospitals | 86 Hospitals | 65 Hospitals | Structured interview |
Goldman LE et al., 2007 [40] | USA | Non-specific P4P | Safety-net hospitals | - | 37 Hospitals | Semi-structured interview |
Lee SI et al., 2010 [29] | Korea | Non-specific P4P | All healthcare organizations in Korea | All tertiary teaching hospitals, general hospital, and hospital and randomly selected 2000 clinics | 522 Healthcare organizations, including 31 tertiary teaching hospitals, 182 general hospitals, 158 hospitals, and 152 clinics | Web-based survey |
Young GJ et al., 2007 [30] | USA | Non-specific P4P | The members of physician organizations in Massachusetts and California | - | 1243 physicians: 689 from California and 554 from Massachusetts | Mailed survey |
Erekson EA et al., 2011 [31] | USA | Non-specific P4P | The members of the American Urogynecologic Society | A total 1203 members of the American Urogynecologic Society | 212 members of the American Urogynecologic Society | Web-based survey |
Natale JE et al., 2011 [33] | USA | Non-specific P4P | - | Medical directors from all 19 CCS- approved PICUs | 16 CCS-approved PICUs | Postal service and fax transmission |
Kaczorowski J et al., 2011 [39] | Canada | P4P incentives for preventive care | 246 physicians from 24 primary care network or family health network groups in 110 different sites across southwestern Ontario participated in the P-PROMPT project | - | 115 physicians completed both pre- intervention and postintervention survey | Fax survey |
USA, United States of America; CMS, Center for Medicare & Medicaid Services; JCAHO, Joint Commission on Accreditation of Healthcare Organizations; P4P, pay-for-performance; UK, United Kingdom; CHC, community health centers; AMA, American Medical Association; ACPE, American College of Physician Executives; HMO, Health Maintenance Organization; CCS, California Children’s Services; PICU, Pediatric Intensive Care Unit; P-PROMPT, Provider and Patient Reminders in Ontario: Multi-Strategy Prevention Tools.
Citation |
General attitudes |
Effects |
||||
---|---|---|---|---|---|---|
Awareness | Agree/disagree | Reasons | Behavioral change | Effect on quality of care | Financial impact | |
Pines JM et al., 2007 [35] | Not mentioned | Disagree on PN-5b | Pn-5b will not lead to improvement in quality of care | Yes | Disagree | Not mentioned |
Respondents report a number of operational changes that are being implemented to improve time to antibiotics for pneumonia. | Emergency department do not agree that P4P incentives targeting early administration of antibiotics for patients with pneumonia will lead to improvement in quality of care for these patients. | |||||
Locke RG et al., 2008 [36] | Not mentioned | Skeptical | The majority of survey respondents were skeptical that P4P would appropriately capture the quality of their work and did not believe that health outcomes should influence their reimbursement. | No | Not mentioned | No impact |
“Attention to meet these performance goals” would not cause significant change in the healthcare of their patients | 72% felt that health outcome measurements should not influence their reimbursement. | |||||
McDonald R et al., 2009 [28] | Our study found, however, that many physicians were unaware of the target contents or had a poor understanding of the relation between their performance and incentives payments received | UK- Supportive US- Challenging to their autonomy | Not mentioned | UK - P4P changed the nature of the office visit. US - It appeared to have little impact on the nature of the office visit. | Not mentioned | Not mentioned |
Young G et al., 2010 [41] | Not mentioned | Agree We did not uncover any opposition against P4P | Not mentioned | Not mentioned | P4P may have minimal short-term effect on quality improvement. | No impact on safety net setting |
Casalino LP et al., 2007 [32] | Not mentioned | Supportive | Not mentioned | Not mentioned | It can lead to increase | Not mentioned |
Steiger B, 2005 [37] | Not mentioned | Supportive | Not mentioned | Not mentioned | P4P can improve quality | Not mentioned |
Damberg CL, 2009 [34] | Not mentioned | Agree benefits outweigh adverse consequences | Not mentioned | Yes | Limited | Not mentioned |
P4P has directly affected organizational behavior by increasing accountability for quality, influencing the speed of IT adoption for quality management, and creating greater organizational focus and support for quality programs and goals | These changes did not translate into the breakthrough improvement in quality desired by plans and purchasers | |||||
Reiter KL et al., 2006 [38] | Not mentioned | Not mentioned | Not mentioned | Structure and process changes in organizations | Not mentioned | Not mentioned |
Goldman LE et al., 2007 [40] | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Improving quality | Not mentioned |
Lee SI et al., 2010 [29] | Overall low awareness to P4P. Higher level organizations were more aware of P4P than lower level organizations | Disagree except tertiary teaching hospitals | Proponents- It is natural that high performing healthcare organizations receive a financial reward. Opponents- P4P could become a method of government control over healthcare organizations | Positive behavioral change but clinics disagreed | Increased but clinics disagreed | No significant financial effects |
Young GJ et al., 2007 [30] | Low level of awareness | Agree | Not mentioned | No or minimal change | It can improve quality | Minimal financial impact |
Erekson EA et al., 2011 [31] | Low level of awareness | Not mentioned | Not mentioned | Not mentioned | Neutral | Not mentioned |
Natale JE et al., 2011 [33] | Not mentioned | Mixed agree and disagree | Physicians should be financially rewarded for better patient outcomes. P4P is not an effective way to improve patient outcomes | Agree | Negative | Not mentioned |
PICU physicians would change their behavior to obtain a financial incentive | ||||||
Kaczorowski J et al., 2011 [39] | Not mentioned | Agree | Not mentioned | The established target levels and bonuses provided appropriate financial incentive to substantially increase the uptake of mammography and Papanicolaou test | Not mentioned | Positive effect Physicians were given bonus |
Citation | Desirable design and implementation methods |
Concerns |
|
---|---|---|---|
Clinical unintended consequences | Other concerns | ||
Pines JM et al., 2007 [35] | Yes | Yes | Not mentioned |
1) Possible solutions are to encourage hospitals to improve overall operations by incentives focusing on the improvement of fundamental measures of patient flow | 1) The provision of antibiotics before chest radiograph results | ||
2) provide incentives to hospitals to improve patient safety across all diseases, or | 2) the prioritization of chest radiographs over other radiographs | ||
3) provide incentives for process improvement programs. Programs such as these do not focus on specific diseases and may benefit all patients. | 3) and the prioritization of patients with suspected pneumonia. | ||
Locke RG et al., 2008 [36] | Yes | Yes | They are not ready to implement P4P in terms of technology (IT and EMR). Thus, they need educational support |
Almost two-thirds of respondents indicated that the insurer should rate them as individuals as opposed to being pooled in their practice group. | 1) These initiatives may focus attention on areas that are not of primary concern during a specific visit between patient and provider-which may cause physicians to miss other important quality goals. | ||
2) If a patient presents with a stressful social and medical issue (eg, depression, elder abuse), the physician might spend time addressing issues that could dramatically improve a patient’s life but are not part of measurement guidelines. | |||
3) The P4P measures, which will be difficult to implement for many primary care physicians, may also penalize practitioners who treat patients in underserved populations that may not have the resources to follow physician recommendations. | |||
McDonald R et al., 2009 [28] | 1) This study suggests that the unintended consequences of pay-for-performance programs are likely to vary according to the design and implementation of these programs. Therefore, when designing incentive schemes, more attention needs to be paid to factors likely to produce unintended consequences. | 1) The inability of Californian physicians to exclude individual patients from performance calculations caused frustration. | 1) Threats to the ongoing physician-patient relationship |
2) The potential adverse effects of external incentives on motivation are likely to be diminished where individuals identify with the goals and values of incentive programs and feel that they have a degree of autonomy in their delivery. | 2) Some physicians reported such undesirable behaviors as forced disenrollment of noncompliant patients. | 2) US-their autonomy was being challenged | |
3) The computerized support required to deliver the targets. | |||
Young G et al., 2010 [41] | Not mentioned | The survey data did not point to any substantial concerns about unintended consequences. | Safety net providers face complicated and diverse patient needs that compete with P4P’s quality goals for clinicians’ time and energy. One way to mitigate this factor is by improving these providers’ access to information technology. |
Casalino LP et al., 2007 [32] | 1) Health plans and government will work hard to make quality measures accurate. | 1) Measuring quality may lead physicians to avoid high- risk patients. | Quality measures are not adequately adjusted for patients’ medical conditions or socioeconomic status. |
2) Both individual and group evaluation can be possible. | 2) Measuring quality will divert physicians’ attention from important types of care for which quality is not measured. | ||
Steiger B, 2005 [37] | 1) Additional data needed, in addition to claiming data | 1) Dumping: non-compliant or difficult patients | Physicians spending more time making sure they are meeting certain guidelines rather than treating patients. Some poll participants say P4P is just a convenient way to get physicians and health care organization to adopt better technology. |
2) Large organization is now under more favorable conditions in current P4P setting so the rich get richer. | 2) Cherry Picking: they prefer the patients who give them high reimbursement | ||
3) More acute indicators and those reflecting clinical significance. | |||
4) Incentives are not new money so there are always winners and losers. | |||
Damberg CL, 2009 [34] | Not mentioned | Not mentioned | Not mentioned |
Reiter KL et al., 2006 [38] | Not mentioned | Not mentioned | Not mentioned |
Goldman LE et al., 2007 [40] | 1) Government should support to gather quality data. | Not mentioned | 1) The cost and accuracy of data collection |
2) Government should reduce additional cost resulted from P4P. | 2) The difficulty of getting accurate performance data | ||
3) How to adjust case-mix, in particular, underserved patients | |||
Lee SI et al., 2010 [29] | 1) Voluntary participation | Healthcare providers voiced significant concerns about the potential of unintended consequences including 1)avoiding of high-risk patients, 2) ignoring quality of care in unmeasured areas, 3) neglecting compulsory medical services to maximize financial reward, and 4) the possibility that medical records could be manipulated | Not mentioned |
2) The organizational performance should be evaluated | |||
3) P4P should reward both high performers and performance improvers with financial incentives, but should not penalize low performers. | |||
4) Additional funding should be set aside for financial incentives. | |||
5) Not only medical claim data but also other clinical data should be used in evaluation. | |||
6) Government or health plans should pay for reporting. | |||
Young GJ et al., 2007 [30] | Not mentioned | Not serious | A lack of quality improvement infrastructure is a major barrier to achieving pay-for-quality goal |
Erekson EA et al., 2011 [31] | 1) Performance measures not adjusting for the comorbidity of individual patients | High risk patients will be penalized as they tend to have (worse) outcomes | Not mentioned |
2) The need for the development and utilization of appropriate performance measures | |||
3) Doubt of adequacy of data | |||
4) Careful monitoring of unintended consequences | |||
5) Educating physicians about P4P | |||
Natale JE et al., 2011 [33] | They are wary of the accuracy and validity of data used to generate these performance measures and are discouraged by the time and costs required to collect self information. | Included among these worries that patient data and results can be manipulated by administrators and practitioners, making accurate comparison impossible. One such manipulation is the avoidance of high-risk patients or procedures by physicians. | Not mentioned |
Kaczorowski J et al., 2011 [39] | Not mentioned | Not mentioned | Not mentioned |
Inclusion criteria | Exclusion criteria |
---|---|
1. Pay-for-performance definition: The programs include our concept of pay-for-performance, regarding of its name | 1. Articles that did not deal with pay-for-performance |
2. Respondents: healthcare providers | 2. Articles in which respondents were not healthcare providers |
3. Primary data gathered by the methods of survey, interview, and/or poll | 3. Articles that used secondary data from other studies |
4. Peer reviewed original articles or reports in Korean or English | 4. Review articles |
5. Articles should include at least one item of the following content: | |
1) Providers’ awareness of pay-for-performance | |
2) Providers’ general attitudes to pay-for-performance (i.e., agree vs. disagree) | |
3) Providers’ opinions on the effects of pay-for-performance such as the its effect on quality of care, behavioral change, or financial perspectives | |
4) Providers’ opinions on desirable pay-for-performance design and implementation | |
5) Concerns on implementation of pay-for-performance including unintended consequences | |
6) Description on barriers or limitation for pay-for-performance implementation |
Citation | Country | Program | Target | No. of eligible population | No. of study participants | Survey method |
---|---|---|---|---|---|---|
Pines JM et al., 2007 [35] | USA | CMS & JCAHO | Chairpersons and medical directors from hospitals with emergency medicine training programs in the USA | 129 | 90 | Online questionnaire |
Locke RG et al., 2008 [36] | USA | Non-specific P4P | Primary care osteopathic physician members of the American Osteopathic Association | 1000 | 123 | Mailed survey |
McDonald R et al., 2009 [28] | USA & UK | The California initiative & Quality and Outcomes Framework | In the England sample (20) physicians from 2 regions & in the California sample (20) physicians from 4 organizations that ranged in size from 600 to 3,000 physicians and health care clinicians | 20 (UK) & 20 (California) | 20 (UK) & 20 (California) | Face to face interview using the same topic guide |
Young G et al., 2010 [41] | USA | Managed care plan adopted a P4P program (SNS-A) & P4P for primary care physicians focused on a diabetes care component (SNS-B) | Physicians from CHCs in SNS-A and from medical group in SNS-B | 256 Physicians from 13 CHCs (SNS-A) & 156 physicians from three participating medical groups | 56% (SNS-A) & 63% (SNS-B) | Mailed survey |
Casalino LP et al., 2007 [32] | USA | Physician P4P program | General internist | 1168 from 1668 randomly selected general internists listed in the AMA physician master-file | 556 | Mailed survey |
Steiger B, 2005 [37] | USA | Non-specific P4P | ACPE members (physician executives) | 7444 | 932 | Poll |
Damberg CL, 2009 [34] | USA | Integrated Healthcare Association P4P program | 182 Physician organizations contracted with the seven largest HMOs in California | 35 Physician organizations | 35 Physician organizations: in 14 organizations replaced with similar organizations | Interview |
Reiter KL et al., 2006 [38] | USA | Statewide hospital- level P4P system between Blue Cross Blue Shield of Michigan and 86 hospitals with which it contracts | 86 Hospitals | 86 Hospitals | 65 Hospitals | Structured interview |
Goldman LE et al., 2007 [40] | USA | Non-specific P4P | Safety-net hospitals | - | 37 Hospitals | Semi-structured interview |
Lee SI et al., 2010 [29] | Korea | Non-specific P4P | All healthcare organizations in Korea | All tertiary teaching hospitals, general hospital, and hospital and randomly selected 2000 clinics | 522 Healthcare organizations, including 31 tertiary teaching hospitals, 182 general hospitals, 158 hospitals, and 152 clinics | Web-based survey |
Young GJ et al., 2007 [30] | USA | Non-specific P4P | The members of physician organizations in Massachusetts and California | - | 1243 physicians: 689 from California and 554 from Massachusetts | Mailed survey |
Erekson EA et al., 2011 [31] | USA | Non-specific P4P | The members of the American Urogynecologic Society | A total 1203 members of the American Urogynecologic Society | 212 members of the American Urogynecologic Society | Web-based survey |
Natale JE et al., 2011 [33] | USA | Non-specific P4P | - | Medical directors from all 19 CCS- approved PICUs | 16 CCS-approved PICUs | Postal service and fax transmission |
Kaczorowski J et al., 2011 [39] | Canada | P4P incentives for preventive care | 246 physicians from 24 primary care network or family health network groups in 110 different sites across southwestern Ontario participated in the P-PROMPT project | - | 115 physicians completed both pre- intervention and postintervention survey | Fax survey |
Citation | General attitudes |
Effects |
||||
---|---|---|---|---|---|---|
Awareness | Agree/disagree | Reasons | Behavioral change | Effect on quality of care | Financial impact | |
Pines JM et al., 2007 [35] | Not mentioned | Disagree on PN-5b | Pn-5b will not lead to improvement in quality of care | Yes | Disagree | Not mentioned |
Respondents report a number of operational changes that are being implemented to improve time to antibiotics for pneumonia. | Emergency department do not agree that P4P incentives targeting early administration of antibiotics for patients with pneumonia will lead to improvement in quality of care for these patients. | |||||
Locke RG et al., 2008 [36] | Not mentioned | Skeptical | The majority of survey respondents were skeptical that P4P would appropriately capture the quality of their work and did not believe that health outcomes should influence their reimbursement. | No | Not mentioned | No impact |
“Attention to meet these performance goals” would not cause significant change in the healthcare of their patients | 72% felt that health outcome measurements should not influence their reimbursement. | |||||
McDonald R et al., 2009 [28] | Our study found, however, that many physicians were unaware of the target contents or had a poor understanding of the relation between their performance and incentives payments received | UK- Supportive US- Challenging to their autonomy | Not mentioned | UK - P4P changed the nature of the office visit. US - It appeared to have little impact on the nature of the office visit. | Not mentioned | Not mentioned |
Young G et al., 2010 [41] | Not mentioned | Agree We did not uncover any opposition against P4P | Not mentioned | Not mentioned | P4P may have minimal short-term effect on quality improvement. | No impact on safety net setting |
Casalino LP et al., 2007 [32] | Not mentioned | Supportive | Not mentioned | Not mentioned | It can lead to increase | Not mentioned |
Steiger B, 2005 [37] | Not mentioned | Supportive | Not mentioned | Not mentioned | P4P can improve quality | Not mentioned |
Damberg CL, 2009 [34] | Not mentioned | Agree benefits outweigh adverse consequences | Not mentioned | Yes | Limited | Not mentioned |
P4P has directly affected organizational behavior by increasing accountability for quality, influencing the speed of IT adoption for quality management, and creating greater organizational focus and support for quality programs and goals | These changes did not translate into the breakthrough improvement in quality desired by plans and purchasers | |||||
Reiter KL et al., 2006 [38] | Not mentioned | Not mentioned | Not mentioned | Structure and process changes in organizations | Not mentioned | Not mentioned |
Goldman LE et al., 2007 [40] | Not mentioned | Not mentioned | Not mentioned | Not mentioned | Improving quality | Not mentioned |
Lee SI et al., 2010 [29] | Overall low awareness to P4P. Higher level organizations were more aware of P4P than lower level organizations | Disagree except tertiary teaching hospitals | Proponents- It is natural that high performing healthcare organizations receive a financial reward. Opponents- P4P could become a method of government control over healthcare organizations | Positive behavioral change but clinics disagreed | Increased but clinics disagreed | No significant financial effects |
Young GJ et al., 2007 [30] | Low level of awareness | Agree | Not mentioned | No or minimal change | It can improve quality | Minimal financial impact |
Erekson EA et al., 2011 [31] | Low level of awareness | Not mentioned | Not mentioned | Not mentioned | Neutral | Not mentioned |
Natale JE et al., 2011 [33] | Not mentioned | Mixed agree and disagree | Physicians should be financially rewarded for better patient outcomes. P4P is not an effective way to improve patient outcomes | Agree | Negative | Not mentioned |
PICU physicians would change their behavior to obtain a financial incentive | ||||||
Kaczorowski J et al., 2011 [39] | Not mentioned | Agree | Not mentioned | The established target levels and bonuses provided appropriate financial incentive to substantially increase the uptake of mammography and Papanicolaou test | Not mentioned | Positive effect Physicians were given bonus |
Citation | Desirable design and implementation methods | Concerns |
|
---|---|---|---|
Clinical unintended consequences | Other concerns | ||
Pines JM et al., 2007 [35] | Yes | Yes | Not mentioned |
1) Possible solutions are to encourage hospitals to improve overall operations by incentives focusing on the improvement of fundamental measures of patient flow | 1) The provision of antibiotics before chest radiograph results | ||
2) provide incentives to hospitals to improve patient safety across all diseases, or | 2) the prioritization of chest radiographs over other radiographs | ||
3) provide incentives for process improvement programs. Programs such as these do not focus on specific diseases and may benefit all patients. | 3) and the prioritization of patients with suspected pneumonia. | ||
Locke RG et al., 2008 [36] | Yes | Yes | They are not ready to implement P4P in terms of technology (IT and EMR). Thus, they need educational support |
Almost two-thirds of respondents indicated that the insurer should rate them as individuals as opposed to being pooled in their practice group. | 1) These initiatives may focus attention on areas that are not of primary concern during a specific visit between patient and provider-which may cause physicians to miss other important quality goals. | ||
2) If a patient presents with a stressful social and medical issue (eg, depression, elder abuse), the physician might spend time addressing issues that could dramatically improve a patient’s life but are not part of measurement guidelines. | |||
3) The P4P measures, which will be difficult to implement for many primary care physicians, may also penalize practitioners who treat patients in underserved populations that may not have the resources to follow physician recommendations. | |||
McDonald R et al., 2009 [28] | 1) This study suggests that the unintended consequences of pay-for-performance programs are likely to vary according to the design and implementation of these programs. Therefore, when designing incentive schemes, more attention needs to be paid to factors likely to produce unintended consequences. | 1) The inability of Californian physicians to exclude individual patients from performance calculations caused frustration. | 1) Threats to the ongoing physician-patient relationship |
2) The potential adverse effects of external incentives on motivation are likely to be diminished where individuals identify with the goals and values of incentive programs and feel that they have a degree of autonomy in their delivery. | 2) Some physicians reported such undesirable behaviors as forced disenrollment of noncompliant patients. | 2) US-their autonomy was being challenged | |
3) The computerized support required to deliver the targets. | |||
Young G et al., 2010 [41] | Not mentioned | The survey data did not point to any substantial concerns about unintended consequences. | Safety net providers face complicated and diverse patient needs that compete with P4P’s quality goals for clinicians’ time and energy. One way to mitigate this factor is by improving these providers’ access to information technology. |
Casalino LP et al., 2007 [32] | 1) Health plans and government will work hard to make quality measures accurate. | 1) Measuring quality may lead physicians to avoid high- risk patients. | Quality measures are not adequately adjusted for patients’ medical conditions or socioeconomic status. |
2) Both individual and group evaluation can be possible. | 2) Measuring quality will divert physicians’ attention from important types of care for which quality is not measured. | ||
Steiger B, 2005 [37] | 1) Additional data needed, in addition to claiming data | 1) Dumping: non-compliant or difficult patients | Physicians spending more time making sure they are meeting certain guidelines rather than treating patients. Some poll participants say P4P is just a convenient way to get physicians and health care organization to adopt better technology. |
2) Large organization is now under more favorable conditions in current P4P setting so the rich get richer. | 2) Cherry Picking: they prefer the patients who give them high reimbursement | ||
3) More acute indicators and those reflecting clinical significance. | |||
4) Incentives are not new money so there are always winners and losers. | |||
Damberg CL, 2009 [34] | Not mentioned | Not mentioned | Not mentioned |
Reiter KL et al., 2006 [38] | Not mentioned | Not mentioned | Not mentioned |
Goldman LE et al., 2007 [40] | 1) Government should support to gather quality data. | Not mentioned | 1) The cost and accuracy of data collection |
2) Government should reduce additional cost resulted from P4P. | 2) The difficulty of getting accurate performance data | ||
3) How to adjust case-mix, in particular, underserved patients | |||
Lee SI et al., 2010 [29] | 1) Voluntary participation | Healthcare providers voiced significant concerns about the potential of unintended consequences including 1)avoiding of high-risk patients, 2) ignoring quality of care in unmeasured areas, 3) neglecting compulsory medical services to maximize financial reward, and 4) the possibility that medical records could be manipulated | Not mentioned |
2) The organizational performance should be evaluated | |||
3) P4P should reward both high performers and performance improvers with financial incentives, but should not penalize low performers. | |||
4) Additional funding should be set aside for financial incentives. | |||
5) Not only medical claim data but also other clinical data should be used in evaluation. | |||
6) Government or health plans should pay for reporting. | |||
Young GJ et al., 2007 [30] | Not mentioned | Not serious | A lack of quality improvement infrastructure is a major barrier to achieving pay-for-quality goal |
Erekson EA et al., 2011 [31] | 1) Performance measures not adjusting for the comorbidity of individual patients | High risk patients will be penalized as they tend to have (worse) outcomes | Not mentioned |
2) The need for the development and utilization of appropriate performance measures | |||
3) Doubt of adequacy of data | |||
4) Careful monitoring of unintended consequences | |||
5) Educating physicians about P4P | |||
Natale JE et al., 2011 [33] | They are wary of the accuracy and validity of data used to generate these performance measures and are discouraged by the time and costs required to collect self information. | Included among these worries that patient data and results can be manipulated by administrators and practitioners, making accurate comparison impossible. One such manipulation is the avoidance of high-risk patients or procedures by physicians. | Not mentioned |
Kaczorowski J et al., 2011 [39] | Not mentioned | Not mentioned | Not mentioned |
USA, United States of America; CMS, Center for Medicare & Medicaid Services; JCAHO, Joint Commission on Accreditation of Healthcare Organizations; P4P, pay-for-performance; UK, United Kingdom; CHC, community health centers; AMA, American Medical Association; ACPE, American College of Physician Executives; HMO, Health Maintenance Organization; CCS, California Children’s Services; PICU, Pediatric Intensive Care Unit; P-PROMPT, Provider and Patient Reminders in Ontario: Multi-Strategy Prevention Tools.
P4P, pay-for-performance
P4P, pay-for-performance; IT, information technology; EMR, electronic medical record.