title: Effects of paying physicians based on their relative performance for quality.
abstract: BACKGROUND
  Studies examining the effectiveness of pay-for-performance programs to improve quality of care primarily have been confined to bonus-type arrangements that reward providers for performance above a predetermined threshold. No studies to date have evaluated programs placing providers at financial risk for performance relative to other participants in the program.
  
  
  OBJECTIVE
  The objective of the study is to evaluate the impact of an incentive program conferring limited financial risk to primary care physicians.
  
  
  METHODS
  There were 334 participating primary care physicians in Rochester, New York.
  
  
  METHODS
  The design of the study is a retrospective cohort study using pre/post analysis.
  
  
  METHODS
  The measurements adhere to 4 diabetes performance measures between 1999 and 2004.
  
  
  RESULTS
  While absolute performance levels increased across all measures immediately following implementation, there was no difference between the post- and pre-intervention trends indicating that the overall increase in performance was largely a result of secular trends. However, there was evidence of a modest 1-time improvement in physician adherence for eye examination that appeared attributable to the incentive program. For this measure, physicians improved their adherence rate on average by 7 percentage points in the year after implementation of the program.
  
  
  CONCLUSIONS
  This study demonstrates a modest effect in improving provider adherence to quality standards for a single measure of diabetes care during the early phase of a pay-for-performance program that placed physicians under limited financial risk. Further research is needed to determine the most effective incentive structures for achieving substantial gains in quality of care.
authors: Department of Health Policy and Management, Boston University School of Public Health, Talbot Building, 715 Albany Street, Boston, MA 02118-2526, USA. health@bu.edu
authors: Gary J
authors: GJ
authors: Young
authors: Mark
authors: M
authors: Meterko
authors: Howard
authors: H
authors: Beckman
authors: Errol
authors: E
authors: Baker
authors: Bert
authors: B
authors: White
authors: Karen M
authors: KM
authors: Sautter
authors: Robert
authors: R
authors: Greene
authors: Kathy
authors: K
authors: Curtin
authors: Barbara G
authors: BG
authors: Bokhour
authors: Dan
authors: D
authors: Berlowitz
authors: James F
authors: JF
authors: Burgess
mesh_terms: D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000191:economics*; D004470:Economics, Medical; D019983:Guideline Adherence / Q000191:economics*; D006801:Humans; D010820:Physicians / Q000191:economics; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000191:economics; D011364:Professional Practice / Q000191:economics; D011787:Quality of Health Care / Q000191:economics*; D012189:Retrospective Studies; D020414:Risk Sharing, Financial / Q000191:economics*; D012456:Salaries and Fringe Benefits / Q000191:economics