The Measure Of Quality Improvement
Physician Incentives, Done
Right, Make P4P Programs Work
Do P4P programs work? They do if the incentives
appropriately set based on the intensity of effort. That’s
conclusion of a study released by the national Bridges to Excellence
"To work, the incentives have to be meaningful and
relevant to the physicians," said François de Brantes, CEO
BTE. This lesson – increasing significantly the percentage of
dollars in the program – shouldn’t be lost on
it wants Medicare incentives to work, he added.
De Brantes and Guy D’Andrea, president
of Discern Consulting, a healthcare policy consulting firm, oversaw the
The findings were published in the May issue of
American Journal of Managed Care. The paper, "Physicians Respond to
Pay-for-Performance Incentives: Larger Incentives Yield Greater
Participation," can be found online at: www.ajmc.com/media/pdf/AJMC_09May_deBrantes305to310.pdf.
This P4P model also suggests that the current
being offered for the Health Information Technology for Economic and
Clinical Health (HITECH) Act provision included in the recently passed
American Recovery and Reinvestment Act are significant enough to work.
BTE’s research suggests that more than
of all physicians will participate in the HITECH incentives, with the
participation likely to be skewed toward practices with more than three
physicians. As a result, the Department of Health and Human Services
should look to support smaller practices with technical assistance in
addition to the financial incentives to ensure the broadest possible
participation, BTE said.
An analysis of the potential impact of the HITECH
stimulus provision can be found at http://bridgestoexcellence.org/Documents/BTE-HITECH.pdf.
Composite Quality Measurement
Makes Physician Evaluations Easier
Evaluating physician practices for P4P or other
programs isn’t so difficult when using composite quality
measures. That’s the conclusion of a new study.
Sherrie Kaplan, University of California at
Dr. Greg Pawlson, National Committee for Quality Assurance (NCQA)
executive vice president, co-authored the study, "Improving the
Reliability of Physician Performance Assessment."
Relying on data submitted by physicians recognized
the NCQA Diabetes Physician Recognition Program (DPRP), researchers
zeroed in on diabetes treatments. They studied a sample of 35 patients
from each of the participating practices, analyzing data from 11
diabetes measures. They found that combining performance on 5 to 9
measures could reliably separate practices into three levels of quality
– high, average and low.
Careful testing and evaluation of the physician
"is critical for ensuring that the information is accurate and draws
fair conclusions," Pawlson said.
Identifying thresholds that reflect physician
contrast to the influence of the other factors, such as patient
characteristics, is of critical importance for fair and reliable
performance assessment, Kaplan said.
The results of the study were published in Medical
For more information on the University of
California at Irvine, visit www.uci.edu.
Addresses: National Committee for Quality
Assurance, 1100 13th Street NW, Suite 1000, Washington DC 20005; (202)
Bridges to Excellence, 13 Sugar St., Newtown, CT 06470; www.bridgestoexcellence.org.