Hypertension Control: Financial Incentives Effects

Laura A. Petersen, MD, MPH MEDVAMC Associate Chief of Staff, Research Director, VA HSR&D Center of Excellence (152) 2002 Holcombe Blvd. Houston TX 77030 Professor of Medicine Chief, Section of Health Services Research Baylor College of Medicine www.houston.hsrd.research.va.govAshley Motter HSR&D Center of Excellence Michael E. DeBakey Veterans Affairs Medical CenterMedicalResearch.com Interview with:
Laura A. Petersen, MD, MPH

MEDVAMC Associate Chief of Staff, Research
Director, VA HSR&D Center of Excellence (152)
Houston TX 77030
Professor of Medicine
Chief, Section of Health Services Research
Baylor College of Medicine
HSR&D Center of Excellence
Michael E. DeBakey Veterans Affairs Medical Center
Houston, Texas 77030

MedicalResearch.com: What are the main findings of the study?

Dr. Petersen: VA physicians randomized to the individual incentive group were more likely than controls to improve their treatment of hypertension.  The adjusted changes over the study period in Veterans meeting the combined BP/appropriate response measure were 8.8 percentage points for the individual-level, 3.7 for the practice-level, 5.5 for the combined, and 0.47 for the control groups.  Therefore, a physician in the individual group caring for 1000 patients with hypertension would have about 84 additional patients achieving blood pressure control or appropriate response after 1 year.  The effect of the incentive was not sustained after the washout period. Although performance did not decline to pre-intervention levels, the decline was significant.  None of the incentives resulted in increased incidence of hypotension compared with controls.  While the use of guideline-recommended medications increased significantly over the course of the study in the intervention groups, there was no significant change compared to the control group.  The mean individual incentive earnings over the study represented approximately 1.6% of a physician’s salary, assuming a mean salary of $168,000.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Petersen: I thought the change would be sustained after the intervention stopped.  It was a long intervention and I thought people’s practices would change over time.  However, it shows that the incentives were working.  If their performance had not fallen off after the incentives were stopped, then we might question whether the incentives caused the effect in the first place.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Petersen: These results do show that financial incentives can be an important tool in positively impacting patient care. As similar types of pay for performance initiatives are instituted by the Affordable Care Act, more research into the way that providers and patients respond will be important to guide health care policy

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Petersen: Future research should explore who system-level changes to promote sustained changes in physician behavior can be incentivized

Citation:

Petersen LA, Simpson K, Pietz K, et al. Effects of Individual Physician-Level and Practice-Level Financial Incentives on Hypertension Care: A Randomized Trial. JAMA. 2013;310(10):1042-1050. doi:10.1001/jama.2013.276303.

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