title: Beyond Measurement and Reward: Methods of Motivating Quality Improvement and Accountability.
abstract: OBJECTIVE
  The article examines public policies designed to improve quality and accountability that do not rely on financial incentives and public reporting of provider performance.
  
  
  RESULTS
  Payment policy should help temper the current "more is better" attitude of physicians and provider organizations. Incentive neutrality would better support health professionals' intrinsic motivation to act in their patients' best interests to improve overall quality than would pay-for-performance plans targeted to specific areas of clinical care. Public policy can support clinicians' intrinsic motivation through approaches that support systematic feedback to clinicians and provide concrete opportunities to collaborate to improve care. Some programs administered by the Centers for Medicare & Medicaid Services, including Partnership for Patients and Conditions of Participation, deserve more attention; they represent available, but largely ignored, approaches to support providers to improve quality and protect beneficiaries against substandard care.
  
  
  CONCLUSIONS
  Public policies related to quality improvement should focus more on methods of enhancing professional intrinsic motivation, while recognizing the potential role of organizations to actively promote and facilitate that motivation. Actually achieving improvement, however, will require a reexamination of the role played by financial incentives embedded in payments and the unrealistic expectations placed on marginal incentives in pay-for-performance schemes.
authors.affiliation: Health Policy Center, The Urban Institute, Washington, DC.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Berenson
authors.affiliation: Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rice
mesh_terms: D006302:Health Services Research; D006801:Humans; D009042:Motivation; D010816:Physician Incentive Plans / Q000191:economics*; D011640:Public Policy; D058996:Quality Improvement; D011787:Quality of Health Care; D012052:Reimbursement, Incentive / Q000191:economics*; D014481:United States
keywords: Physician payment; financial incentives; nonfinancial incentives; pay-for-performance; quality improvement; value-based purchasing