Effect of Pay-for-Performance Incentives on Quality of Care in Small Practices with Electronic Health Records

A patient fills out paperwork on a clipboard.

The Issue:

Current literature largely covers the impact of Pay-for-Performance (P4P) incentives in large group practices, however, many U.S. residents still receive care in small practices where quality of care has historically been lower. In electronic health record (EHR)-enabled small practices, quality performance in response to an incentive may improve quality of care.

Key Findings

  • Positive changes were noted from baseline for all measures in both the intervention and control clinics, indicating the effectiveness of the P4P incentive.

  • Improvement in patients with diabetes or multiple comorbidities was similar to the population without comorbidities.


Within small-group practices participating in the Primary Care Information Project (PCIP) in New York City, response to P4P incentives in EHR-enabled small practices led to modest improvements in cardiovascular processes and outcomes. Further study is needed to determine if this effect increases or decreases after periods longer than one year. Because this study took place in the setting of the PCIP, an underlying level of motivation may have existed—a possible limitation to this study.

About the Study:

The intervention clinics (mean of 4,592 patients) received financial incentives and benchmarked quarterly reports, while the control clinics (mean of 3,042 patients) received only quarterly reports. The trial took place in New York City from April 2009 through March 2010 among small primary care clinics (<10 physicians).