Effects of Individual Physician-Level and Practice-Level Financial Incentives on Hypertension Care

A Randomized Trial

A doctor takes a patient's blood pressure during an office visit.

The Issue:

Financial rewards to promote high-quality care in the clinical setting have produced contradictory results. This study tested pay for performance targeted to both individual physicians, health care practice teams, and a combined incentive to both the physician and the team for delivery of guideline-recommended care of hypertension.

Key Findings

  • Physicians in the individual incentive group were much more likely to improve treatment of hypertension.

  • After the 12-month washout period, performance gains did not hold.

Conclusions:

Physician-level financial incentives resulted in greater blood pressure control or response to uncontrolled blood pressure. To understand the factors that contributed to these results, further study is needed to test how incentives promote quality care in the clinical setting.

About the Study:

Eighty-three physicians and 42 nonphysician personnel from 12 hospital-based primary care clinics were included representing five Veterans Affairs Networks. The four-month performance baseline period began in August 2007. Beginning in April 2008, study participants received up to five payments at the end of four consecutive four-month periods. Data was then collected during a four-month washout period (May through August 2011).