Pay-for-performance (P4P) programs may be especially effective in improving quality for those physicians who currently don’t perform well, according to a study in the Journal for Healthcare Quality.

Judy Ying Chen, MD, lead author and director of clinical development at Health Benchmarks, a division of IMS Health, also says the positive benefit of the P4P program may not be realized until the third or fourth year of the program.

“Our findings reveal that a P4P program appears to be effective in aiding low-performing physicians to sustain improvement,” says Chen.

The researchers wanted to assess the effect of a P4P program (which paid an additional 1.5 to 7.5 percent of the physicians’ base professional fee) on quality scores for physicians who practiced in a preferred provider organization (PPO) setting over a four-year period, compared with a group of physicians practicing in a PPO setting without a P4P program. They reviewed administrative claims data from a commercial PPO health plan in Hawaii (the study group), which implemented a P4P program and a commercial PPO health plan in the South (the comparison group) without any performance incentive programs.

Results showed that a P4P program in a PPO setting can improve quality of care. This was especially true for selected quality measures, such as mammography, cervical cancer screening, and childhood immunization practices.

The low performing physicians using P4P improved significantly more than the comparison group (which did not implement a P4P program) for many measures. This was especially true in the first and second year of measurement. However, improvements for low performers in the non-P4P comparison group consistently decreased with time.

Quality scores of low-performing physicians

Overall, quality scores for both groups were good; physicians performed quality care for at least 70% of the eligible patients in all quality measures except colorectal cancer screening.

Source: Chen JY, Kang N, Juarez DT, et al. Impact of a pay-for-performance program on low-performing physicians. J for Healthcare Quality. 2010;32(1):13–22.

ACE inhibitor use


Cervical cancer screening

Colorectal cancer screening

Hemoglobin A1c testing

Varicella vaccine

Mumps, measles, rubella vaccine

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