Experiences of general practices with a participatory pay-for-performance program: a qualitative study in primary care

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doi:10.1071/PY12032

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Experiences of general practices with a participatory pay-for-performance program: a qualitative study in primary care

Kirsten Kirschner ^A ^B , Jozé Braspenning ^A , J. E. Annelies Jacobs ^A and Richard Grol ^A

^A Scientific Institute for Quality of Healthcare, Radboud University Nijmegen Medical Centre, The Netherlands.
^B Corresponding author. Email: k.kirschner@iq.umcn.nl

Australian Journal of Primary Health 19(2) 102-106 http://dx.doi.org/10.1071/PY12032
Submitted: 23 March 2012 Accepted: 12 June 2012 Published: 9 August 2012





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Abstract

The involvement of target users in the design choices of a pay-for-performance program may enhance its impact, but little is known about the views of participants in these programs. To explore general practices’ experiences with pay-for-performance in primary care we conducted a qualitative study in general practices in the Netherlands. Thirty out of 65 general practices participating in a pay-for-performance program, stratified for bonus, were invited for a semistructured interview on feasibility, feedback and the bonus, spending of the bonus, unintended consequences, and future developments. Content analysis was used to process the resulting transcripts. We included 29 practices. The feasibility of the pay-for-performance program was questioned due to the substantial time investment. The feedback on clinical care, practice management and patient experience was mostly discussed in the team, and used for improvement plans, but was also qualified as annoying for one GP and for another GP it brought feelings of insecurity. Most practices considered the bonus a stimulus to improve quality of care, in addition to compensation for their effort and time invested. Distinctive performance features were not displayed, for instance, on a website. The bonus was mainly spent on new equipment or team building. Practices referred to gaming and focusing on those aspects that were incentivised (‘tunnel vision’) as unintended consequences. Future developments should be directed to absolute thresholds, new indicators to keep the process going, and an independent audit. Linking a part of the bonus to innovation was also suggested. The participants thought the pay-for-performance program was a labour-intensive positive breakthrough to stimulate quality improvement, but warned of unintended consequences of the program and the sustainability of the indicator set.

Additional keywords: evaluation, physician incentive plans.

References

Australian Medical Association (2002) ‘AMA submission to the Productivity Commission study on administrative and compliance costs associated with Commonwealth programs that impact specifically on general practice.’ Available at http://www.pc.gov.au/__data/assets/pdf_file/0016/18133/sub013.pdf [Verified 20 March 2012]

Australian National Audit Office (2010) Practice Incentives Program. Audit Report No. 5 2010–11. (Medicare Australia, Department of Health and Ageing: Canberra)

Baker G (2004) ‘Pay for performance incentive programs in healthcare: market dynamics and business process.’ (Med-Vantage: San Francisco)

Bridges to Excellence (2009) ‘Rewarding quality across the healthcare system.’ Available at www.bridgestoexcellence.org [Verified 22 September 2009]

Buetow S (2008) Pay-for-performance in New Zealand primary health care. Journal of Health Organization and Management 22, 36–47.
| CrossRef |

Campbell SM, McDonald R, Lester H (2008) The experience of pay for performance in English family practice: a qualitative study. Annals of Family Medicine 6, 228–234.
| CrossRef |

Dudley RA, Luft HS (2001) Managed care in transition. The New England Journal of Medicine 344, 1087–1092.
| CrossRef | CAS |

Dudley RA, Frolich A, Robinowitz DL, Talavera JA, Broadhead P, Luft HS (2004) ‘Strategies to support quality-based purchasing: a review of the evidence.’ (Agency for Healthcare Research and Quality: Rockville, MD)

Epstein AM, Lee TH, Hamel MB (2004) Paying physicians for high-quality care. The New England Journal of Medicine 350, 406–410.
| CrossRef | CAS |

Galvin R, Milstein A (2002) Large employers’ new strategies in health care. The New England Journal of Medicine 347, 939–942.
| CrossRef |

Hahn J (2006) ‘Pay-for-performance in health care.’ (The Library of Congress: Washington, DC)

Kirschner K, Braspenning J, Jacobs JA, Grol R (2012) Design choices made by target users for a pay-for-performance program in primary care: an action research approach. BMC Family Practice 13, 25
| CrossRef |

McDonald R, Roland M (2009) Pay for performance in primary care in England and California: comparison of unintended consequences. Annals of Family Medicine 7, 121–127.
| CrossRef |

McDonald R, White J, Marmor TR (2009) Paying for performance in primary medical care: learning about and learning from “success” and “failure” in England and California. Journal of Health Politics, Policy and Law 34, 747–776.
| CrossRef |

Medicare Australia (2009) Practice Incentives Program (PIP). Medicare Australia. Available at http://www.medicareaustralia.gov.au/provider/incentives/pip/index.jsp [Verified 22 September 2009]

Mehrotra A, Sorbero ME, Damberg CL (2010) Using the lessons of behavioral economics to design more effective pay-for-performance programs. The American Journal of Managed Care 16, 497–503.

Petersen LA, Woodard LD, Urech T, Daw C, Sookanan S (2006) Does pay-for-performance improve the quality of health care? Annals of Internal Medicine 145, 265–272.

Roland M (2004) Linking physicians’ pay to the quality of care – a major experiment in the United kingdom. The New England Journal of Medicine 351, 1448–1454.
| CrossRef | CAS |

Scott A, Sivey P, Ait OD, Willenberg L, Naccarella L, Furler J, Young D (2011) The effect of financial incentives on the quality of health care provided by primary care physicians. Cochrane Database of Systematic Reviews 9, CD008451

Teleki SS, Damberg CL, Pham C, Berry SH (2006) Will financial incentives stimulate quality improvement? Reactions from frontline physicians. American Journal of Medical Quality 21, 367–374.
| CrossRef |

Van Herck P, De SD, Annemans L, Remmen R, Rosenthal MB, Sermeus W (2010) Systematic review: effects, design choices, and context of pay-for-performance in health care. BMC Health Services Research 10, 247
| CrossRef |

Wetzel S, Galvin R, Buck CR, Cubbin J, Bradley B, Taylor B, Powers P, Milstein A (2000) Taking a giant leap forward in promoting quality. Health Affairs (Project Hope) 19, 275–276.
| CrossRef | CAS |

Young GJ, Meterko M, White B, Bokhour BG, Sautter KM, Berlowitz D, Burgess JF (2007a) Physician attitudes toward pay-for-quality programs: perspectives from the front line. Medical Care Research and Review 64, 331–343.
| CrossRef |

Young GJ, Meterko M, Beckman H, Baker E, White B, Sautter KM, Greene R, Curtin K, Bokhour BG, Berlowitz D, Burgess JF (2007b) Effects of paying physicians based on their relative performance for quality. Journal of General Internal Medicine 22, 872–876.
| CrossRef |

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