Do penalty-based pay-for-performance programs improve surgical care more effectively than other payment strategies? A systematic review

Kyung Mi Kim; Wendy Max; Justin S White; Susan A Chapman; Ulrike Muench

doi:10.1016/j.amsu.2020.11.060

Do penalty-based pay-for-performance programs improve surgical care more effectively than other payment strategies? A systematic review

Ann Med Surg (Lond). 2020 Nov 25:60:623-630. doi: 10.1016/j.amsu.2020.11.060. eCollection 2020 Dec.

Authors

Kyung Mi Kim¹, Wendy Max², Justin S White³, Susan A Chapman⁴, Ulrike Muench⁵

Affiliations

¹ Clinical Excellence Research Center, School of Medicine, Stanford University, 365 Lasuen St Stanford, CA, 94305, United States.
² Institute for Health & Aging, University of California, 3333 California Street, Suite 340, San Francisco, CA, 94118, United States.
³ Philip R. Lee Institute for Health Policy Studies & Department of Epidemiology & Biostatistics, School of Medicine, University of California, 3333 California Street, Suite 265, San Francisco, CA, 94118, United States.
⁴ Department of Social and Behavioral Sciences, School of Nursing, University of California, 3333 California Street, Room 455Q UCSF Box 0612, San Francisco, CA, 94118, United States.
⁵ Department of Social and Behavioral Sciences & Philip R. Lee Institute for Health Policy Studies, School of Nursing, University of California, San Francisco, 3333 California Street, Room 455H UCSF Box 0612, San Francisco, CA, 94118, United States.

Abstract

Background: The aim of this systematic review is to assess if penalty-based pay-for-performance (P4P) programs are more effective in improving quality and cost outcomes compared to two other payment strategies (i.e., rewards and a combination of rewards and penalties) for surgical care in the United States. Penalty-based programs have gained in popularity because of their potential to motivate behavioral change more effectively than reward-based programs to improve quality of care. However, little is known about whether penalties are more effective than other strategies.

Materials and methods: A systematic literature review was conducted according to the PRISMA guideline to identify studies that evaluated the effects of P4P programs on quality and cost outcomes for surgical care. Five databases were used to search studies published from 2003 to March 1, 2020. Studies were selected based on the PRISMA guidelines. Methodological quality of individual studies was assessed based on ROBINS-I with GRADE approach.

Results: This review included 22 studies. Fifteen cross-sectional, 1 prospective cohort, 4 retrospective cohort, and 2 case-control studies were found. We identified 11 unique P4P programs: 5 used rewards, 3 used penalties, and 3 used a combination of rewards and penalties as a payment strategy. Five out of 10 studies reported positive effects of penalty-based programs, whereas evidence from studies evaluating P4P programs with a reward design or combination of rewards and penalties was little or null.

Conclusions: This review highlights that P4P programs with a penalty design could be more effective than programs using rewards or a combination of rewards and penalties to improve quality of surgical care.

Keywords: Cost; Pay-for-performance; Payment strategy; Quality; Surgical care; Value.

Publication types

Review