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Paying Physicians for Quality: Evidence and Themes from the Field

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Background: Health plans, self-insured employers, health plans, and provider organizations are currently introducing financial incentives that reward physicians for delivering high-quality medical care. Yet a review of existing research reveals virtually no empirical studies of the effect of direct, internal quality incentives on physician performance. Key-informant interviews with leaders of provider organizations should shed new light on evolving quality incentives within organizations.

Methods: Structured key-informant interviews with administrators and medical directors in 22 medical groups and 9 hospitals affiliated with 10 large, integrated health systems were conducted from July 2003 through January 2004.

Findings: Views on the role of financial incentives varied widely and were related to a number of other factors, including institutional culture, community context, organizational strategy and structure, organizational stability, quality measurement, nature and size of incentives, and the sustainability of interventions.

Discussion: These findings have implications for the acceptability and structure of financial incentives for quality directed to health care provider organizations. A set of considerations for the design and implementation of quality incentives relate to the incentives' scope, controllability, transparency, size, and orientation (individual or team), as well as the relationship between the extrinsic financial incentives and professionals' intrinsic motivation.

Document Type: Research Article

Publication date: August 1, 2006

More about this publication?
  • Published monthly, The Joint Commission Journal on Quality and Patient Safety is a peer-reviewed publication dedicated to providing health professionals with the information they need to promote the quality and safety of health care. The Joint Commission Journal on Quality and Patient Safety invites original manuscripts on the development, adaptation, and/or implementation of innovative thinking, strategies, and practices in improving quality and safety in health care. Case studies, program or project reports, reports of new methodologies or new applications of methodologies, research studies on the effectiveness of improvement interventions, and commentaries on issues and practices are all considered.

    Also known as Joint Commission Journal on Quality Improvement and Joint Commission Journal on Quality and Safety
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