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Home / News & IndustryManaged Care Insight and Analysis
Updated: February 23, 2010
Getting The Measure Of Quality Improvement

Physician Incentives, Done Right, Make P4P Programs Work

Do P4P programs work? They do if the incentives are appropriately set based on the intensity of effort. That’s the conclusion of a study released by the national Bridges to Excellence (BTE) program.

"To work, the incentives have to be meaningful and relevant to the physicians," said François de Brantes, CEO of BTE. This lesson – increasing significantly the percentage of dollars in the program – shouldn’t be lost on Congress if 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 survey.

The findings were published in the May issue of The American Journal of Managed Care. The paper, "Physicians Respond to Pay-for-Performance Incentives: Larger Incentives Yield Greater Participation," can be found online at:

This P4P model also suggests that the current incentives 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 two-thirds 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

Composite Quality Measurement Makes Physician Evaluations Easier

Evaluating physician practices for P4P or other similar programs isn’t so difficult when using composite quality measures. That’s the conclusion of a new study.

Sherrie Kaplan, University of California at Irvine, and 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 in 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 practice "is critical for ensuring that the information is accurate and draws fair conclusions," Pawlson said.

Identifying thresholds that reflect physician impact in 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 Care.

For more information on the University of California at Irvine, visit

Addresses: National Committee for Quality Assurance, 1100 13th Street NW, Suite 1000, Washington DC 20005; (202) 955-3500, Bridges to Excellence, 13 Sugar St., Newtown, CT 06470;

  This article was taken from:
Healthcare Reimbursement Monitor

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