Simply implementing a pay-for-performance program isn't enough to result in sustainable improvements in quality of care, according to a study in Archives of Pediatric and Adolescent Medicine. A physician-hospital organization (PHO) launched an asthma care collaborative — primary care practices that work together to reduce asthma-related emergency department visits, hospital admissions, and missed workdays and schooldays — with more than 13,000 children in 44 primary care practices (165 physicians). The PHO approached Anthem Blue Cross and Blue Shield of Ohio to fund for a program that rewarded, at the network and practice levels, measured improvements in asthma care. The program consisted of three reward levels, with practices having the potential to earn up to a 7-percent increase in fees.

Distribution of rewards

The asthma care collaborative engaged all levels of practice staff. Rewards went to the practice; physician-level incentives were not included. Rewards were earned by 43 practices: three practices earned only a 2 percent increase; 13 achieved a 4 percent increase; 2 received a 5 percent increase; 14 had an increase of 6 percent; and 11 were able to gain a 7 percent increase or bonus.

Source: Mandel KE, et al. Pay for performance alone cannot drive quality. 2007. Arch Pediatr Adolesc Med;161(7):650­655.

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