Pay for performance alone cannot drive quality

Arch Pediatr Adolesc Med. 2007 Jul;161(7):650-5. doi: 10.1001/archpedi.161.7.650.


Objective: To determine whether aligning design characteristics of a pay-for-performance program with objectives of an asthma improvement collaborative builds improvement capability and accelerates improvement.

Design: Interrupted time series analysis of the impact of pay for performance on results of an asthma improvement collaborative.

Setting: Forty-four pediatric practices within greater Cincinnati.

Participants: Forty-four pediatric practices with 13 380 children with asthma.

Interventions: The pay-for-performance program rewarded practices for participating in the collaborative, achieving network- and practice-level performance thresholds, and building improvement capability. Pay for performance was coupled with additional improvement interventions related to the collaborative.

Outcome measures: Flu shot percentage, controller medication percentage for children with persistent asthma, and written self-management plan percentage.

Results: The pay-for-performance program provided each practice with the potential to earn a 7% fee schedule increase. Three practices earned a 2% increase, 13 earned a 4% increase, 2 earned a 5% increase, 14 earned a 6% increase, and 11 earned a 7% increase. Between October 1, 2003, and November 30, 2006, the percentage of the network asthma population receiving "perfect care" increased from 4% to 88%. The percentage of the network asthma population receiving the influenza vaccine increased from 22% to 41%, and then to 62% during the prior 3 flu seasons.

Conclusion: Linking design characteristics of a pay-for-performance program to a collaborative focused on improving care for a defined population, building improvement capability, and driving system changes at the provider level resulted in substantive and sustainable improvement.

Publication types

  • Evaluation Study

MeSH terms

  • Asthma / therapy*
  • Child
  • Child Health Services / economics
  • Child Health Services / standards*
  • Cooperative Behavior
  • Fee Schedules
  • Health Services Research
  • Humans
  • Ohio
  • Pediatrics / economics
  • Pediatrics / standards*
  • Physician Incentive Plans / economics*
  • Program Development
  • Program Evaluation
  • Quality Assurance, Health Care / economics*
  • Reimbursement, Incentive*