Incentives to Improve Quality
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Baylor College of Medicine
Eleven Sites Nationwide
Hypertension
VA Medical Centers
African Americans |
PROJECT
Monetary incentives are given to providers and provider teams to follow recommended hypertension care guidelines.
Health care personnel are eligible to receive a monetary bonus for each patient with hypertension. Half of the bonus is based upon the physician’s use of guideline-recommended medications. The other half is based upon the proportion of patients with hypertension achieving blood pressure control or receiving a guideline-recommended response to uncontrolled blood pressure. Bonuses can be paid in two ways; to physicians only or to groups comprised of physicians and non-physician team members.
Group bonus payments are based upon the aggregate performance of physicians in the group. The group can choose to divide the payments equally or use them to purchase health care equipment or supplies to improve quality of care. Physician-only bonuses are received as additions to their normal pay.
Monetary rewards are distributed approximately every four months. Audit and feedback reports summarizing performance over each of five performance periods are provided to participants via a password-protected study website. Feedback reports include data reflecting individual and group scores, earnings for the study period, and total earnings to date, as appropriate.
RATIONALE
The incentive systems are designed to change physician behavior without causing undesired, unintended consequences (i.e., gaming), setting unrealistic goals, or providing incentives that are too small.
The financial incentive structures are designed to reward a combination of process-of-care measures for which there is evidence that better performance leads to better outcomes (e.g., documentation of prescribing a medication) and the outcome of interest; blood pressure control.
Payment amounts are set so that they are large enough to make a difference and influence physician behavior. They are paid out every four months to make a clear and timely link between the desired behavior and the reward.
EVALUATION PLAN
Funded by Finding Answers in 2008.
Researchers are conducting a randomized controlled trial to test the effectiveness of financial incentives to promote guideline-based hypertension care and its impact on blood pressure control.
Twelve different hospital-based VA outpatient clinics from 11 different states are participating in a randomized controlled trial. Each hospital is randomized to one of four study arms: (1) physician-level incentive plus audit/feedback; (2) group-level incentive plus audit/feedback; (3) physician- and grouplevel incentives plus audit/feedback; and (4) audit/feedback only (control).
Provider participants are full-time VA staff primary care physicians. All enrolled physicians in a medical center are placed in the same study arm. At those study sites randomized to the two arms testing a group-level incentive, the physician participants are nominating up to 15 non-physician participants who work with them—both clinical and administrative support staff—to participate as part of their group.
The proportion of patients receiving guideline-recommended anti-hypertensive medications and the proportion of patients achieving appropriate levels of blood pressure control or receiving an appropriate clinical response to an elevated blood pressure are being evaluated.
Principal Investigator:
- Laura A. Petersen, MD, MPH
For More Information
Please Contact:
Kate L. Simpson
ksimpson@bcm.edu |
