Physicians respond to pay-for-performance incentives: larger incentives yield greater participation.

OBJECTIVE: To determine the extent to which the size of the available financial incentive influences a physician's decision to participate in a pay-for-performance (P4P) program. STUDY DESIGN: Statistical analysis of historical data from Bridges to Excellence (BTE). METHODS: Setting available financial incentives as the independent variable and physician participation rates as the dependent variable, we applied regression analysis to BTE's data from selected sites to explore the relationship of fixed bonus-based incentive programs to physician participation rates in those programs. RESULTS: The amount of incentives available to physicians strongly affected their rate of participation. Participation rates varied with the type of program, and overall physician participation rates might grow as more purchasers/payers within a community offer similar incentives. CONCLUSION: Our analysis suggests that all stakeholders--health plans, physicians, and patients--would benefit from health plans collaborating on their P4P efforts to maximize physician participation.

Bridges to Excellence--recognizing high-quality care: analysis of physician quality and resource use.

OBJECTIVE: To examine whether physicians who sought and received Bridges to Excellence (BTE) recognition performed better than similar physicians on a standardized set of population-based performance measures. STUDY DESIGN: Cross-sectional comparison of performance data. METHODS: Using a claims dataset of all commercially insured members from 6 health plans in Massachusetts, we examined population-based measures of quality and resource use for physicians recognized by the BTE programs Physician Office Link and Diabetes Care Link, compared with nonrecognized physicians in the same specialties. Differences in performance were tested using generalized linear models. RESULTS: Physician Office Link-recognized physicians performed significantly better than their nonrecognized peers on measures of cervical cancer screening, mammography, and glycosylated hemoglobin testing. Diabetes Care Link-recognized physicians performed significantly better on all 4 diabetes process measures of quality, with the largest differences observed in microalbumin screening (17.7%). Patients of Physician Office Link-recognized physicians had a significantly greater percentage of their resource use accounted for by evaluation and management services (3.4%), and a smaller percentage accounted for by facility (-1.6%), inpatient ancillary (-0.1%), and nonmanagement outpatient services (-1.0%). After adjustment for patient age and sex, and case mix, Physician Office Link-recognized physicians had significantly fewer episodes per patient (0.13) and lower resource use per episode (dollars 130), but findings were mixed for Diabetes Care Link-recognized physicians. CONCLUSIONS: Our findings suggest that the BTE approach to ascertaining physician quality identifies physicians who perform better on claims-based quality measures and primary care physicians who use a less resource-intensive practice style.