P4P: You need bigger carrots

A JAMA study reveals that P4P doesn’t improve outcomes:

Researchers looked at information from hospitals treating 105,383 patients over three years beginning in 2003. They evaluated such factors as whether the hospitals prescribed aspirin and widely accepted cardiac drugs called beta-blockers and ACE inhibitors, and whether patients were counseled to quit smoking.

Compliance rose to 94.2% from 87% at the pay-for-performance hospitals. At the others, compliance also rose, to 93.6% from 88%. Researchers found a “slightly higher rate of improvement for 2 of 6 targeted therapies” but concluded that “overall, there was no evidence that improvements in in-hospital mortality were incrementally greater at pay-for-performance sites.”

One reason? The “pay” part has to be significantly worthwhile – and often times it’s not:

“One read on this is that the carrots have to be bigger,” Duke’s Dr. Peterson said. Hospital officials involved in the Medicare pilot project said this winter in a conference call with reporters that financial incentives were small relative to their budgets.

Medicare, are you listening?

Comments are moderated before they are published. Please read the comment policy.

  • Happyman

    like medicare’s 1.5% bonus offering for participating in a p4p reporting pilot project.

    that’s like $2000/year for a typical primary care doctor, for ADDITIONAL work which will amount to perhaps 4 hrs/week. That comes out to a “bonus” of $10 per hour!

    meanwhile private insurers are sending their nonperforming CEO’s home with pay & severance packages in the BILLIONS!

  • Mike

    Hey Unhappyman, you should have been a CEO then.

    Even if it was 10,000K, it’s STILL not enough. For one thing, who will get the money??? Most likely, it wont be the treating physician, since each patient’s got like FIVE PCP’s.

    Also, does adding an ACE I in house REALLY improve short term mortality? I might precipitate renal failure and extend the hospitalization (true story).

  • Happyman

    hey angry, i’d have been a ceo if i could’ve gotten through all the fluffy touchy-feely group activities making & selling widgets in business school.

    instead i did med school & residency.

    your point about the multiple PCP’s is well-taken. if a true p4p reporting project is to succeed it’ll definitely need the patient to openly identify their primary (which itself is perhaps problematic)

  • Anonymous


    How do you even come close to 10$/hr bonus??? By my math you would have to be billing medicare at a rate of 667$/hr to be getting a 10$/hr raise. That would be quite impressive even for the most fraudulent clinic. I guess you are talking about the rate you would get paid to do the extra paperwork.

  • Happyman

    yes, you are right, “bonus” was perhaps the wrong term.

Most Popular