Study: Pay for Performance Doesn’t Improve Quality of Care

In a study published in the British Medical Journal (BMJ), Jan. 25, British researchers found little evidence to support the theory that pay for performance improves quality of care and health outcomes. In looking at nearly half a million United Kingdom patients with hypertension over a seven year period, incentives paid to primary care physicians had no discernible effects on processes of care or on hypertension-related clinical outcomes, researchers say.

“It seems that doctors may be less responsive to performance based monetary incentives to improve the care of hypertension than most policy makers believe,” the researchers deduced.

The study sample consisted of 470,725 patients who received primary care for hypertension during January 2000 to July 2007. Since the pay for performance initiative began in 2004, researchers say, the quality of care and clinical outcomes for patients did not significantly improve.

Based on their findings, researchers insinuate in the study that primary care physicians are conscientious enough to raise the bar on health care standards without governmental intervention. “Doctors may have already been implementing the appropriate changes in practice to achieve the pay for performance standards,” researchers say.

Another explanation, researchers say, is that the bar was set too low. “Our study suggests that care for hypertension in the United Kingdom was already close (or along the way) to reaching the threshold required to achieve maximum payments set in the pay for performance policy … pay for performance may have simply supported existing practice for hypertension,” researchers conclude.

In closing, the researchers suggest that the pay for performance money could be better spent. “Effective alternative approaches to improving quality of primary care for hypertension exist, such as case management or co-management of hypertension and other chronic conditions with allied health professionals such as nurses and pharmacists,” researchers say. “Furthermore, evidence from studies of educational interventions suggests that fewer, simpler messages are more likely to achieve behaviour change than more complex, diffuse messages.”

Read the full study for complete details.


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