(Wiley Blackwell: Woodland Hills, CA) -- Pay-for-performance (P4P) programs are payment models that reward workers for meeting certain performance measures for quality and efficiency. In the health care setting, P4P programs use a variety of methods to reward physicians financially for achieving targets, including fee differentials and bonuses.

A new study in the Journal for Healthcare Quality reveals that P4P programs appear to be effective in incentivizing low-performing physicians. The article is part of the January/February 2010 special issue on pay-for-performance in the health care system.

According to the article, studies have shown that the lowest performing physicians in P4P programs improved the most; however, it was unclear whether this would have occurred without the P4P program or if it could be sustained.

The objective of this study was to investigate the impact of P4P in a preferred provider organization (PPO) on low-performing physicians over a four-year period. The authors, Judy Ying Chen, Ning Kang, Deborah Taira Juraez, Krista A. Hodges, and Richard S. Chung, used administrative claims data from a PPO health plan in Hawaii, which implemented a P4P program, and a PPO plan in the South, which did not implement a P4P program. The difference-in-difference model was used to compare the quality scores between the two physician groups in preventive measures, a heart failure measure, and an HbA1c testing measure.

Results found that a P4P program in a PPO setting can improve quality of care. This was true especially for selected quality measures, such as mammography, cervical cancer screening, and childhood immunization measures. The low-performing physicians using P4P improved significantly more than the comparison group (which did not implement a P4P program) for many measures. In addition, the study found that the positive benefit of the P4P program may not be realized until the third or fourth year, highlighting the importance of sustaining P4P over longer periods of time.

“Our findings reveal that a P4P program appears to be effective in incentivizing low performing physicians to sustain improvement,” the authors note.