11 Jan Little Evidence Pay-For-Performance Improves Patient Outcomes
MedicalResearch.com Interview with:
Dr. Devan Kansagara
Devan Kansagara MD, MCR
Associate Professor of Medicine
Oregon Health and Science University
Director, Evidence-based Synthesis Program, Portland VA Medical Center
Staff Physician, Portland VA Medical Center
MedicalResearch.com: What is the background for this study?
Response: Historically, the US health care system has been dominated by a fee-for-service payment structure in which health care providers are paid for discrete procedures and visits regardless of care quality. Pay for performance programs are part of the move towards value-based care. They tie a portion of payments to individual health care providers, institutions, or health care systems to performance on a discrete set of measures of health care quality.
In theory, these programs are meant to encourage the right care at the right time and thereby improve the health of the patient population. Over the last decade, many studies in and outside the US have examined whether or not, in fact, these programs do result in improved care, reduced cost, and improved patient health. Our study is a systematic review of this literature.
MedicalResearch.com: What are the main findings?
Response: We reviewed and critically appraised nearly 70 studies.
Overall, we found little conclusive evidence that pay for performance programs improve patient health. Some but not all studies showed that pay for performance programs were associated with improvements in care processes, especially when the baseline level of performance was very poor. Typically, the most rigorous studies showed smaller effects or no effects. The evidence base was limited by the paucity of very well designed studies that could isolate the effects of the intervention from other contemporary changes in the health care landscape. Also, programs varied substantially in their structure, the size of the incentive, and the target population, which makes it difficult to compare results across studies.
MedicalResearch.com: What should readers take away from your report?
Response: Despite a growing body of literature, we do not yet have conclusive evidence that pay for performance programs improve patient outcomes. Some programs may improve care processes and it is possible that, over time, these changes will translate into improved patient health. It is likely that the success or failure of performance incentive programs depends on their structure and how they are implemented. Programs that target areas of poor performance may be the most successful. Given the lack of consistent evidence supporting benefit, health care administrators might need to consider the promise of performance incentive programs alongside the cost and reporting burden associated with the programs.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: We need a greater number of rigorous studies, including those that can account for trends in care and outcomes over time. We also need more studies to assess the potential downsides, burdens, and costs associated with these programs. Finally, we need more comparative studies that can test factors such as the number of metrics included in a program, the size of the incentive, and the best ways to implement programs.
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Last Updated on January 11, 2017 by Marie Benz MD FAAD