Does the frequency of pay-for-performance payment matter?--Experience from a randomized trial

Abstract

Objective: To examine the effects of incentive payment frequency on quality measures in a physician-specific pay-for-performance (P4P) experiment.

Study setting: A multispecialty physician group practice.

Study design: In 2007, all primary care physicians (n=179) were randomized into two study arms differing by the frequency of incentive payment, either four quarterly bonus checks or a single year-end bonus (maximum of U.S.$5,000/year for both arms).

Data collection/extraction methods: Data were extracted from electronic health records. Quality measure scores between the two arms over four quarters were compared.

Principal findings: There was no difference between the two arms in average quality measure score or in total bonus amount earned.

Conclusions: Physicians' responses to a P4P program with a small maximum bonus do not differ by frequency of bonus payment.

Figure 1

Provider Workbook: An Example of the “Diabetes HbA1C Control” Measure for the Family Medicine at Quarter 1, 2007

Figure 2

Average Percent Score over the Four Quarters of 2007—Comparison between Quarterly and Year-End Arms Note. No statistical difference in the average percent score was detected between the two arms, after controlling for indicators of quarter and measure. Similarly, there was no difference in trend in percent score over the four quarters between the two arms.

Figure 3

Average Quarterly Bonus Amount over the Four Quarters of 2007—Comparison between Quarterly and Year-End Arms Note. No statistical difference in the average bonus amount was detected between the two arms. Similarly, there was no difference in trend in percent score over the four quarters between the two arms.