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Incentive Implementation in Physician Practices: A Qualitative Study of Practice Executive Perspectives on Pay for Performance

ENRM Veterans Hospital and Boston University

James F. Burgess, Jr.

Boston University and Department of Veterans Affairs

Julie M. Hook

Bert White

Boston University

Dan Berlowitz

ENRM Veterans Hospital and Boston University

Matthew R. Guldin

Boston University

Mark Meterko

Gary J. Young

Department of Veterans Affairs and Boston University

Pay-for-performance (P4P) programs offer health care providers financial incentives to achieve predefined quality targets. Practice executives sit at a key nexus point for determining how P4P programs are implemented in physician practices. Using a qualitative interview design, this article examines the role practice executives play in the implementation of P4P programs and how their perspectives and decisions can influence the success of these programs. The authors identified five key findings related to practice executives' views on P4P: quality incentives are better than utilization incentives, quality incentives are bonus rewards, quality incentives are agents for change, providers do not feel they have control over attaining quality targets, and the ways in which quality is measured are problematic. The authors discuss five different ways in which practice executives distribute rewards to physicians. These findings may help payers more effectively design and implement financial rewards for quality.

Key Words: pay for performance • incentives in health care • payment systems • quality improvement • qualitative research

Medical Care Research and Review, Vol. 63, No. 1 suppl, 73S-95S (2006)
DOI: 10.1177/1077558705283645


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