Pay-for-Performance Linked to Quality Improvement for Some Tests, Study Finds

Physicians who received pay-for-performance incentives when they met clinical standards for Pap smears improved their quality of care by a higher rate than those who received standard reimbursements, according to a study published on Wednesday in the Journal of the American Medical Association, the Washington Times reports. For the study, sponsored by the Commonwealth Fund, Meredith Rosenthal, an assistant professor at the Harvard School of Public Health, and colleagues tracked 200 physician groups in two PacifiCare Health Systems networks and examined whether they met clinical standards for Pap smears, mammography and hemoglobin-A tests between October 2001 and April 2004 (Higgins, Washington Times, 10/12).

Researchers compared improvements in the quality of care provided by physicians in the PacifiCare California network, which began a pay-for-performance program in 2003, with those in the Pacific Northwest network, which does not have a pay-for-performance program (CQ HealthBeat, 10/11). The study found that the quality of care for Pap smears provided by physicians in the pay-for-performance program improved by 5.3%, compared with 1.7% for those in the Pacific Northwest network (Reuters/Arizona Daily Star, 10/12).

The quality of care provided by physicians in both networks improved in the areas of mammography and hemoglobin tests, but there was no statistically significant difference in the rate of improvement (CQ HealthBeat, 10/11). In addition, the study found that physicians in the California network who had met clinical standards before the pay-for-performance program began accounted for 75% of the incentives distributed under the program (Washington Post, 10/12). Physicians who had provided the lowest quality of care before the pay-for-performance program began improved the most, the study found.

Anne-Marie Audet, quality improvement vice president at the Commonwealth Fund, said, "This study shows we still have some questions that need to be asked on what we can expect from pay-for-performance programs" (Washington Times, 10/12).

An abstract of the study is available online.