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Annual Review of Public Health

Volume 38, 2017

Impact of Provider Incentives on Quality and Value of Health Care

Abstract

The use of financial incentives to improve quality in health care has become widespread. Yet evidence on the effectiveness of incentives suggests that they have generally had limited impact on the value of care and have not led to better patient outcomes. Lessons from social psychology and behavioral economics indicate that incentive programs in health care have not been effectively designed to achieve their intended impact. In the United States, Medicare's Hospital Readmission Reduction Program and Hospital Value-Based Purchasing Program, created under the Affordable Care Act (ACA), provide evidence on how variations in the design of incentive programs correspond with differences in effect. As financial incentives continue to be used as a tool to increase the value and quality of health care, improving the design of programs will be crucial to ensure their success.

Keyword(s): health care, pay-for-performance, quality, value, value-based purchasing
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2017-03-20
2024-04-20
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Literature Cited

  1. Abrams M, Nuzum R, Zezza M, Ryan J, Kiszia J, Guterman S. 1.  2015. The Affordable Care Act's payment and delivery system reforms: a progress report at five years Commonw. Fund Issue Brief 12, Washington, DC. http://www.commonwealthfund.org/publications/issue-briefs/2015/may/aca-payment-and-delivery-system-reforms-at-5-years
  2. 2. AHRQ (Agency for Healthc. Res. Quality) 2014. Interim Update on 2013 Annual Hospital-Acquired Condition Rate and Estimates of Cost Savings and Deaths Averted from 2010 to 2013 Rockville, MD: AHRQ http://www.ahrq.gov/professionals/quality-patient-safety/pfp/interimhacrate2013.pdf
  3. Akerlof G, Kranton R. 3.  2010. It is time to treat Wall Street like Main Street. Financial Times Feb. 24. https://www.ft.com/content/3a8c9e76-217c-11df-830e-00144feab49a
  4. Alshamsan R, Majeed A, Ashworth M, Car J, Millett C. 4.  2010. Impact of pay for performance on inequalities in health care: systematic review. J. Health Serv. Res. Policy 15:3178–84 [Google Scholar]
  5. Asch D, Troxel A, Stewart W, Sequist T, Jones J. 5.  et al. 2015. Effect of financial incentives to physicians, patients, or both on lipid levels. JAMA 314:181926–35 [Google Scholar]
  6. Bardach N, Wang J, De Leon S, Shih S, Boscardin W. 6.  et al. 2013. Effect of pay-for-performance incentives on quality of care in small practices with electronic health records. JAMA 310:101051–59 [Google Scholar]
  7. Berenson R, Rice T. 7.  2015. Beyond measurement and reward: methods of motivating quality improvement and accountability. Health Serv. Res. 50:S22155–86 [Google Scholar]
  8. Berwick D. 8.  2015. Keynote four Presented at Annu. Natl. Forum on Quality Improv. in Health Care, 27th, Orlando
  9. Bilimoria K. 9.  2015. Facilitating quality improvement—pushing the pendulum back towards process measures. JAMA 314:131333–34 [Google Scholar]
  10. Blumenthal D, Abrams M, Nuzum R. 10.  2015. The Affordable Care Act at 5 years. N. Engl. J. Med. 373:161580–58 [Google Scholar]
  11. Bradley EH, Sipsma H, Horwitz LI, Curry L, Krumholz HM. 11.  2014. Contemporary data about hospital strategies to reduce unplanned readmissions: What has changed?. JAMA Intern. Med. 174:1154–56 [Google Scholar]
  12. Camerer C, Malmendier U. 12.  2007. Behavioral economics of organizations. Behavioural Economics and Its Applications ed. P Diamond, H Vartiainen, 235–90 Princeton, NJ: Princeton Univ. Press [Google Scholar]
  13. Carey K, Lin M. 13.  2015. Readmissions to New York hospitals fell for three target conditions from 2008 to 2012, consistent with Medicare goals. Health Aff 34:6978–85 [Google Scholar]
  14. Casalino L. 14.  2014. Accountable Care Organizations—the risk of failure and the risks of success. N. Engl. J. Med. 371:181750–51 [Google Scholar]
  15. Casalino L, Elster A, Eisenberg A, Lewis E, Montgomery J, Ramos D. 15.  2007. Will pay-for-performance and quality reporting affect health care disparities?. Health Aff 26:3w405–14 [Google Scholar]
  16. Chokshi D. 16.  2014. Improving health care for veterans—a watershed moment for the VA. N. Engl. J. Med. 371:4297–99 [Google Scholar]
  17. 17. CMS (Cent. Medicare Medicaid Serv.) 2006. Pioneer ACO model Updated Sept. 27, CMS Baltimore, Md.: https://innovation.cms.gov/initiatives/Pioneer-ACO-Model/
  18. 18. CMS (Cent. Medicare Medicaid Serv.) 2014. Medicare Hospital Quality Chartbook: Performance Report on Outcome Measures Baltimore, MD: CMS https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/hospitalqualityinits/downloads/medicare-hospital-quality-chartbook-2014.pdf
  19. 19. CMS (Cent. Medicare Medicaid Serv.) 2015. Hospital Value-Based Purchasing Baltimore, MD: CMS http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf
  20. 20. CMS (Cent. Medicare Medicaid Serv.) 2015. Summary of 2015 Physician Value-Based Payment Modifier Policies Baltimore, MD: CMS http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2015-Value-Modifier-Results.pdf
  21. 21. CMS (Cent. Medicare Medicaid Serv.) 2016. Value-based payment modifier Updated Sept. 15 CMS Baltimore, Md: https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeedbackprogram/valuebasedpaymentmodifier.html#
  22. Cohen L, Rothschild H. 22.  1979. The bandwagons of medicine. Perspect. Biol. Med. 22:4531–38 [Google Scholar]
  23. Conrad DA, Perry L. 23.  2009. Quality-based financial incentives in health care: Can we improve quality by paying for it?. Annu. Rev. Public Health 30:1357–71 [Google Scholar]
  24. Damberg CL, Elliott M, Ewing BA. 24.  2015. Pay-for-performance schemes that use patient and provider categories would reduce payment disparities. Health Aff 34:1134–42 [Google Scholar]
  25. Damberg CL, Sorbero ME, Lovejoy SL, Martsolf G, Raaen L, Mandel D. 25.  2014. Measuring Success in Health Care Value-Based Purchasing Programs Summary and Recommendations Santa Monica, CA: RAND Corp http://www.rand.org/pubs/research_reports/RR306z1.html
  26. De Brantes F, Woolhandler S. 26.  2013. Should physician pay be tied to performance?. Wall Street Journal June 16. http://www.wsj.com/articles/SB10001424127887323528404578454432476458370
  27. Deci E, Koestner R, Ryan R. 27.  1999. A meta-analytic review of experiments examining the effects of extrinsic rewards on intrinsic motivation. Psychol. Bull. 125:6627–68 [Google Scholar]
  28. Doran T. 28.  2015. Incentivising improvements in health care delivery: a response to Adam Oliver. Health Econ. Policy Law 10:3351–56 [Google Scholar]
  29. Doran T, Fullwood C, Kontopantelis E, Reeves D. 29.  2008. Effect of financial incentives on inequalities in the delivery of primary clinical care in England: analysis of clinical activity indicators for the quality and outcomes framework. Lancet 372:728–36 [Google Scholar]
  30. Doran T, Kontopantelis E, Reeves D, Sutton M, Ryan A. 30.  2014. Setting performance targets in pay for performance programmes: What can we learn from QOF?. BMJ348:g1595
  31. Doran T, Kontopantelis E, Valderas JM, Campbell S, Roland M. 31.  et al. 2011. Effect of financial incentives on incentivised and non-incentivised clinical activities: longitudinal analysis of data from the UK Quality and Outcomes Framework. BMJ342:d3590
  32. Eijkenaar F. 32.  2013. Key issues in the design of pay for performance programs. Eur. J. Health Econ. 14:1117–31 [Google Scholar]
  33. Eijkenaar F, Emmert M, Scheppach M, Schöffski O. 33.  2013. Effects of pay for performance in health care: a systematic review of systematic reviews. Health Policy 110:23115–30 [Google Scholar]
  34. Emanuel E, Ubel P, Kessler J, Meyer G, Muller R. 34.  et al. 2015. Using behavioral economics to design physician incentives that deliver high-value care. Ann. Intern. Med. 164:2114–19 [Google Scholar]
  35. Emmert M, Eijkenaar F, Kemter H, Esslinger A, Schöffski O. 35.  2011. Economic evaluation of pay-for-performance in health care: a systematic review. Eur. J. Health Econ. 13:6755–67 [Google Scholar]
  36. Figueroa J, Tsugawa Y, Zheng J, Orav E, Jha A. 36.  2016. Association between the value-based purchasing pay for performance program and patient mortality in US hospitals: observational study. BMJ353:i2214
  37. Flodgren G, Eccles M, Shepperd S, Scott A, Parmelli E, Beyer F. 37.  2011. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. Cochrane Database Syst. Rev.7CD009255
  38. Frølich A, Talavera J, Broadhead P, Dudley R. 38.  2007. A behavioral model of clinician responses to incentives to improve quality. Health Policy 80:1179–93 [Google Scholar]
  39. Fryer R, Levitt S, List J, Sadoff S. 39.  2012. Enhancing the efficacy of teacher incentives through loss aversion: a field experiment Natl. Bur. Econ. Res. Work. Pap. 18237. http://www.nber.org/papers/w18237
  40. Gerhardt G, Yemane A, Apostle K, Oelschlaeger A, Rollins E, Brennan N. 40.  2014. Evaluating whether changes in utilization of hospital outpatient services contributed to lower Medicare readmission rate. Med. Med. Res. Rev. 4:1e1–13 [Google Scholar]
  41. Gerhardt G, Yemane A, Hickman P, Oelschlaeger A, Rollins E, Brennan N. 41.  2013. Medicare readmission rates showed meaningful decline in 2012. Med. Med. Res. Rev. 3:2 pii:mmrr.003.02.b01 [Google Scholar]
  42. Gigerenzer G, Brighton H. 42.  2009. Homo heuristicus: why biased minds make better inferences. Topics Cogn. Sci. 1:107–43 [Google Scholar]
  43. Gillam S, Siriwardena A, Steel N. 43.  2012. Pay-for-performance in the United Kingdom: impact of the quality and outcomes framework—a systematic review. Ann. Fam. Med. 10:5461–68 [Google Scholar]
  44. Gilman M, Hockenberry JM, Adams EK, Milstein AS, Wilson IB, Becker ER. 44.  2015. The financial effects of value-based purchasing and the Hospital Readmission Reduction Program on safety net hospitals in 2014: a cohort study. Ann. Intern. Med. 163:6427–36 [Google Scholar]
  45. Glucksberg S. 45.  1962. The influence of strength of drive on functional fixedness and perceptual recognition. J. Exp. Psychol. 63:136–41 [Google Scholar]
  46. Gneezy U, Rustichini A. 46.  2000. Pay enough or don't pay at all. Q. J. Econ. 115:3791–810 [Google Scholar]
  47. Gravelle H, Sutton M, Ma A. 47.  2010. Doctor behaviour under a pay for performance contract: treating, cheating, and case finding?. Econ. J. 120:542f129–56 [Google Scholar]
  48. Halpern S, French B, Small D, Saulsgiver K, Harhay M. 48.  et al. 2015. Randomized trial of four financial-incentive programs for smoking cessation. N. Engl. J. Med. 372:222108–17 [Google Scholar]
  49. Heath I. 49.  2004. The cawing of the crow…Cassandra-like, prognosticating woe. Brit. J. Gen. Pract. 54:501320–21 [Google Scholar]
  50. Houle S, McAlister F, Jackevicius C, Chuck A, Tsuyuki R. 50.  2012. Does performance-based remuneration for individual health care practitioners affect patient care? A systematic review. Ann. Intern. Med. 157:12889–99 [Google Scholar]
  51. 51. IOM (Inst. Med.) 2001. Crossing the Quality Chasm: A New Health System for the 21st Century: Health and Medicine Division Washington, DC: IOM. http://www.nationalacademies.org/hmd/Reports/2001/Crossing-the-Quality-Chasm-A-New-Health-System-for-the-21st-Century.aspx
  52. 52. IOM (Inst. Med.) 2002. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care: Health and Medicine Division Washington, DC: IOM http://www.nationalacademies.org/hmd/Reports/2002/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care.aspx
  53. Jha AK. 53.  2013. Time to get serious about pay for performance. JAMA 309:4347–48 [Google Scholar]
  54. Jha AK, Epstein A, Orav EJ. 54.  2011. The effect of financial incentives on hospitals that serve poor patients. Ann. Intern. Med. 154:5370–71 [Google Scholar]
  55. Jha AK, Joynt KE, Orav EJ, Epstein AM. 55.  2012. The long-term effect of premier pay for performance on patient outcomes. N. Engl. J. Med. 366:171606–15 [Google Scholar]
  56. Joynt KE, Jha AK. 56.  2013. Characteristics of hospitals receiving penalties under the hospital readmissions reduction program. JAMA 309:4342–43 [Google Scholar]
  57. Kahneman D, Tversky A. 57.  1979. Prospect theory: an analysis of decision under risk. Econometrica 47:2263–92 [Google Scholar]
  58. Khullar D, Chokshi D, Kocher R, Reddy A, Basu K. 58.  et al. 2015. Behavioral economics and physician compensation—promise and challenges. N. Engl. J. Med. 372:242281–83 [Google Scholar]
  59. Knutson B, Fong G, Kaiser E, Adams C, Hommer D. 59.  2000. Anticipation of monetary rewards activates nucleus accumbens. NeuroImage 11:5S237 [Google Scholar]
  60. Kontopantelis E, Springate D, Ashcroft D, Valderas JM, Van der Veer S. 60.  et al. 2015. Associations between exemption and survival outcomes in the UK's primary care pay-for-performance programme: a retrospective cohort study. BMJ Qual. Saf. 25:657–70 [Google Scholar]
  61. Kontopantelis E, Springate D, Ashworth M, Webb R, Buchan I, Doran T. 61.  2015. Investigating the relationship between quality of primary care and premature mortality in England: a spatial whole-population study. BMJ350:h904
  62. Kreif N, Grieve R, Hangartner D, Turner A, Nikolova S, Sutton M. 62.  2015. Examination of the synthetic control method for evaluating health policies with multiple treated units. Health Econ. 24:111300–17 [Google Scholar]
  63. Kristensen SR, Meacock R, Turner AJ, Boaden R, McDonald R. 63.  et al. 2014. Long-term effect of hospital pay for performance on mortality in England. N. Engl. J. Med. 371:540–48 [Google Scholar]
  64. Lazear EP. 64.  2000. Performance pay and productivity. Am. Rev. 90:51346–61 [Google Scholar]
  65. Lester H, Schmittdiel J, Selby J, Fireman B, Campbell S. 65.  et al. 2010. The impact of removing financial incentives from clinical quality indicators: longitudinal analysis of four Kaiser Permanente indicators. BMJ 340:c1898 [Google Scholar]
  66. Markovitz AA, Ryan AM. 66.  2016. Pay-for-performance: disappointing results or masked heterogeneity?. Med. Care Res. Rev. In press
  67. McCartney M, Treadwell J, Maskrey N, Lehman R. 67.  2016. Making evidence based medicine work for individual patients. BMJ 353:i2452 [Google Scholar]
  68. McDonald R, Roland M. 68.  2009. Pay for performance in primary care in England and California: comparison of unintended consequences. Ann. Fam. Med. 7:2121–27 [Google Scholar]
  69. McWilliams JM, Chernew ME, Landon BE, Schwartz AL. 69.  2015. Performance differences in year 1 of pioneer accountable care organizations. N. Engl. J. Med. 372:201927–36 [Google Scholar]
  70. McWilliams JM, Hatfield LA, Chernew ME, Landon BE, Schwartz AL. 70.  2016. Early performance of accountable care organizations in Medicare. N. Engl. J. Med. 374:2357–66 [Google Scholar]
  71. McWilliams JM, Landon BE, Chernew ME, Zaslavsky AM. 71.  2014. Changes in patients’ experiences in Medicare accountable care organizations. N. Engl. J. Med. 371:1715–24 [Google Scholar]
  72. Nyweide DJ, Lee W, Cuerdon TT, Pham HH, Cox M. 72.  et al. 2015. Association of Pioneer accountable care organizations versus traditional Medicare fee for service with spending, utilization, and patient experience. JAMA 313:212152–61 [Google Scholar]
  73. Pink D. 73.  2009. Drive New York: Riverhead Books
  74. Petersen LA, Simpson K, Pietz K, Urech TH, Hysong SJ. 74.  et al. 2013. Effects of individual physician-level and practice-level financial incentives on hypertension care. JAMA 310:101042–50 [Google Scholar]
  75. Rice T. 75.  2013. The behavioral economics of health and health care. Annu. Rev. Public Health 34:431–47 [Google Scholar]
  76. Roland M. 76.  2004. Linking physicians’ pay to the quality of care—a major experiment in the United Kingdom. N. Engl. J. Med. 351:141448–54 [Google Scholar]
  77. Roland M, Dudley R. 77.  2015. How financial and reputational incentives can be used to improve medical care. Health Serv. Res. 50:2090–15 [Google Scholar]
  78. Rosenthal MB. 78.  2015. Physician payment after the SGR—the new meritocracy. N. Engl. J. Med. 373:131187–89 [Google Scholar]
  79. Rosenthal M, Fernandopulle R, Song H, Landon B. 79.  2004. Paying for quality: providers’ incentives for quality improvement. Health Aff 23:2127–41 [Google Scholar]
  80. Ryan AM. 80.  2009. Effects of the Premier Hospital Quality Incentive Demonstration on Medicare patient mortality and cost. Health Serv. Res. 44:3821–42 [Google Scholar]
  81. Ryan AM. 81.  2013. Will value-based purchasing increase disparities in care?. N. Engl. J. Med. 369:262472–74 [Google Scholar]
  82. Ryan AM, Blustein J, Doran T, Michelow MD, Casalino L. 82.  2012. The effect of phase 2 of the Premier Hospital Quality Incentive Demonstration on incentive payments to hospitals caring for disadvantaged patients. Health Serv. Res. 47:41418–36 [Google Scholar]
  83. Ryan AM, Burgess JF, Pesko MF, Borden WB, Dimick JB. 83.  2015. The early effects of Medicare's mandatory pay-for-performance program. Health Serv. Res. 50:181–97 [Google Scholar]
  84. Ryan AM, Burgess JF Jr., Tompkins CP, Wallack SS. 84.  2009. The relationship between Medicare's process of care quality measures and mortality. Inquiry 46:3274–79 [Google Scholar]
  85. Ryan AM, Damberg CL. 85.  2013. What can the past of pay-for-performance tell us about the future of value-based purchasing in Medicare?. Healthcare 1:1–242–49 [Google Scholar]
  86. Ryan AM, Krinsky S, Kontopantelis E, Doran T. 86.  2016. Long-term evidence for the effect of pay-for-performance in primary care on mortality in the UK: a population study. Lancet 388:268–74 [Google Scholar]
  87. Ryan AM, Nallamothu B, Dimick J. 87.  2012. Medicare's public reporting initiative on hospital quality had modest or no impact on mortality from three key conditions. Health Aff 31:3585–92 [Google Scholar]
  88. Ryan RM, Deci E. 88.  2000. Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. Am. Psychol. 55:168–78 [Google Scholar]
  89. Scott A, Sivey P, Ait Ouakrim D, Willenberg L, Naccarella L. 89.  et al. 2011. The effect of financial incentives on the quality of health care provided by primary care physicians. Cochrane Database Syst. Rev. 9:CD008451 [Google Scholar]
  90. Sheingold SH, Zuckerman R, Shartzer A. 90.  2016. Understanding Medicare hospital readmission rates and differing penalties between safety-net and other hospitals. Health Aff. 35:1124–31 [Google Scholar]
  91. Simon H. 91.  1978. Rationality as the process and product of thought. Am. Econ. Rev. 68:1–16 [Google Scholar]
  92. Siva I. 92.  2010. Using the lessons of behavioral economics to design more effective pay-for-performance programs. Am. J. Manag. C 16:7497–503 [Google Scholar]
  93. Song Z, Rose S, Safran DG, Landon BE, Day MP, Chernew ME. 93.  2014. Changes in health care spending and quality 4 years into global payment. N. Engl. J. Med. 371:181704–14 [Google Scholar]
  94. Sutton M, Nikolova S, Boaden R, Lester H, McDonald R, Roland M. 94.  2012. Reduced mortality with hospital pay for performance in England. N. Engl. J. Med. 367:191821–28 [Google Scholar]
  95. Tversky A, Kahneman D. 95.  1974. Judgments under uncertainty: heuristics and biases. Science 185:1124–31 [Google Scholar]
  96. Victora C, Vaughan J, Barros F, Silva A, Tomasi E. 96.  2000. Explaining trends in inequities: evidence from Brazilian child health studies. Lancet 356:1093–98 [Google Scholar]
  97. Vladeck B. 97.  2004. Ineffective approach. Health Aff 23:2285–86 [Google Scholar]
  98. Vohs K. 98.  2006. The psychological consequences of money. Science 314:1154–56 [Google Scholar]
  99. Werner RM, Dudley RA. 99.  2012. Medicare's new Hospital Value-Based Purchasing Program is likely to have only a small impact on hospital payments. Health Aff. 31:91932–40 [Google Scholar]
  100. Zuckerman RB, Sheingold SH, Orav EJ, Ruhter J, Epstein AM. 100.  2016. Readmissions, observation, and the hospital readmissions reduction program. N. Engl. J. Med. 374:1543–51 [Google Scholar]
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Impact of Provider Incentives on Quality and Value of Health Care
Annual Review of Public Health 38, 449 (2017); https://doi.org/10.1146/annurev-publhealth-032315-021457
/content/journals/10.1146/annurev-publhealth-032315-021457
/content/journals/10.1146/annurev-publhealth-032315-021457
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