Physician incentive programs, such as the Medicare’s Value-Based Payment Modifier, are used to improve care quality, yet these programs have not been proven helpful in improving patient outcomes.
In a viewpoint article published in JAMA, Dhruv Khullar, MD, MPP, of the Department of Healthcare Policy and Research at Weill Cornell Medical College in New York, and colleagues discussed the factors and flaws associated with the failure of these programs to improve care quality.
According to the authors, physicians may feel that incentive programs are manipulative and burdensome, particularly when they are attempting to force physicians into achieving “narrow performance targets.” Rather than relying on the ability of physicians to perform their job without requiring incentives, these programs may elicit a feeling of mistrust and a potential decline in motivation to exceed the designated performance targets. Unfortunately, even prior to the introduction of these programs, variability in care was common because of a fragmented medical system.
Several physician incentive programs are individual based, which may result in reduced motivation to collaborate and participate in team learning. Programs may need to increase team-based rewards instead of offering purely individual incentives to physicians. Additionally, programs frequently use a management-drive design and evaluation yet lack “input from frontline physicians about the appropriateness of performance targets.” Providing physicians greater input in what measures they believe reflect higher care quality may be important for future programs, the authors argued.
“No single strategy for encouraging performance improvement is likely to be effective across organizations because of heterogeneity in their individual cultures and the attitudes of physicians in various specialties,” wrote Dr Khullar and colleagues. “But, a future state more aligned with human behavior, patient needs, and physician professionalism is possible. Getting there will require evidence-based research, leadership, and a commitment to act.”
Khullar D, Wolfson D, Casalino LP. Professionalism, performance, and the future of physician incentives [published online November 26, 2018]. JAMA. doi: 10.1001/jama.2018.17719