title: Pay for performance alone cannot drive quality.
abstract: OBJECTIVE
  To determine whether aligning design characteristics of a pay-for-performance program with objectives of an asthma improvement collaborative builds improvement capability and accelerates improvement.
  
  
  METHODS
  Interrupted time series analysis of the impact of pay for performance on results of an asthma improvement collaborative.
  
  
  METHODS
  Forty-four pediatric practices within greater Cincinnati.
  
  
  METHODS
  Forty-four pediatric practices with 13 380 children with asthma.
  
  
  METHODS
  The pay-for-performance program rewarded practices for participating in the collaborative, achieving network- and practice-level performance thresholds, and building improvement capability. Pay for performance was coupled with additional improvement interventions related to the collaborative.
  
  
  METHODS
  Flu shot percentage, controller medication percentage for children with persistent asthma, and written self-management plan percentage.
  
  
  RESULTS
  The pay-for-performance program provided each practice with the potential to earn a 7% fee schedule increase. Three practices earned a 2% increase, 13 earned a 4% increase, 2 earned a 5% increase, 14 earned a 6% increase, and 11 earned a 7% increase. Between October 1, 2003, and November 30, 2006, the percentage of the network asthma population receiving "perfect care" increased from 4% to 88%. The percentage of the network asthma population receiving the influenza vaccine increased from 22% to 41%, and then to 62% during the prior 3 flu seasons.
  
  
  CONCLUSIONS
  Linking design characteristics of a pay-for-performance program to a collaborative focused on improving care for a defined population, building improvement capability, and driving system changes at the provider level resulted in substantive and sustainable improvement.
authors.affiliation: Physician-Hospital Organization, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA. keith.mandel@cchmc.org
authors.forename: Keith E
authors.initials: KE
authors.lastname: Mandel
authors.forename: Uma R
authors.initials: UR
authors.lastname: Kotagal
mesh_terms: D001249:Asthma / Q000628:therapy*; D002648:Child; D002662:Child Health Services / Q000191:economics / Q000592:standards*; D003299:Cooperative Behavior; D005245:Fee Schedules; D006302:Health Services Research; D006801:Humans; D009820:Ohio; D010372:Pediatrics / Q000191:economics / Q000592:standards*; D010816:Physician Incentive Plans / Q000191:economics*; D016730:Program Development; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000191:economics*; D012052:Reimbursement, Incentive