Pay-for-performance (P4P) does not result in markedly improved patient care, say at least two recent studies.

One study, published in the July/August issue of Health Affairs, suggests that patient care improved among physician groups regardless of association with P4P.1 Another study, published last year in the New England Journal of Medicine, saw a similar parallel improvement between study groups, regardless of P4P involvement.2

There has not been a study done that has been able to show improved quality of care, says David Cockrell, O.D., the AOA board of trustees liaison to the AOA Advocacy Group. He notes that P4P began as an attempt to reduce morbidity and mortality rates in hospitals through better recording of patients diagnosed conditions.

The Physicians Quality Reporting Initiative (PQRI), the reporting program administered by the Centers for Medicare and Medicaid Services, is too young of a program to show concrete benefit yet, either.

To participate [in PQRI] properly, Dr. Cockrell says, clinics have upgraded to electronic medical records systemsan extremely expensive undertaking, which may negate the 1.5% bonus allotted by PQRI or the gain resulting from a private P4P program in a small or mid-size clinic, he says. In a smaller setting, that expense is hard to offset.

PQRI is designed to aid participating doctorsonly around 6% of health care providers participated in 2007, notes Dr. Cockrellin coding more specifically, with the end result that more specific and detailed codes can provide a better body of knowledge with which to care for patients. With more specific coding, well hopefully see better management of more specific diseases, he says.

The authors of the study published in Health Affairs believe that P4P would benefit from key ingredients, such as a larger monetary incentive that is centered around a stronger base of quality-related goals, as well as more careful evaluation of the impact of P4P programs.

The premise behind P4P should work. Will it? The reality is, nothing has shown that its working yet. I think it will, but it takes a long time to change peoples behaviors, Dr. Cockrell says. And, it will take a while for the data to show that better coding allows us to do a better job of managing the patient.

1. Pearson SD, Schneider EC, Kleinman KP, et al. The impact of pay-for-performance on health care quality in Massachusetts, 2001-2003. Health Affairs 2008 Jul/Aug;27(4):1167-77.
2. Lindenauer PK, Remus D, Roman S, et al. Public reporting and pay for performance in hospital quality improvement. N Engl J Med 2007 Feb 1;356(5):486-96.