Pines JM et al., 2007 [35] |
Yes
|
Yes
|
Not mentioned |
1) Possible solutions are to encourage hospitals to improve overall operations by incentives focusing on the improvement of fundamental measures of patient flow |
1) The provision of antibiotics before chest radiograph results |
2) provide incentives to hospitals to improve patient safety across all diseases, or |
2) the prioritization of chest radiographs over other radiographs |
3) provide incentives for process improvement programs. Programs such as these do not focus on specific diseases and may benefit all patients. |
3) and the prioritization of patients with suspected pneumonia. |
Locke RG et al., 2008 [36] |
Yes
|
Yes
|
They are not ready to implement P4P in terms of technology (IT and EMR). Thus, they need educational support |
Almost two-thirds of respondents indicated that the insurer should rate them as individuals as opposed to being pooled in their practice group. |
1) These initiatives may focus attention on areas that are not of primary concern during a specific visit between patient and provider-which may cause physicians to miss other important quality goals. |
2) If a patient presents with a stressful social and medical issue (eg, depression, elder abuse), the physician might spend time addressing issues that could dramatically improve a patient’s life but are not part of measurement guidelines. |
3) The P4P measures, which will be difficult to implement for many primary care physicians, may also penalize practitioners who treat patients in underserved populations that may not have the resources to follow physician recommendations. |
McDonald R et al., 2009 [28] |
1) This study suggests that the unintended consequences of pay-for-performance programs are likely to vary according to the design and implementation of these programs. Therefore, when designing incentive schemes, more attention needs to be paid to factors likely to produce unintended consequences. |
1) The inability of Californian physicians to exclude individual patients from performance calculations caused frustration. |
1) Threats to the ongoing physician-patient relationship |
2) The potential adverse effects of external incentives on motivation are likely to be diminished where individuals identify with the goals and values of incentive programs and feel that they have a degree of autonomy in their delivery. |
2) Some physicians reported such undesirable behaviors as forced disenrollment of noncompliant patients. |
2) US-their autonomy was being challenged |
3) The computerized support required to deliver the targets. |
Young G et al., 2010 [41] |
Not mentioned |
The survey data did not point to any substantial concerns about unintended consequences. |
Safety net providers face complicated and diverse patient needs that compete with P4P’s quality goals for clinicians’ time and energy. One way to mitigate this factor is by improving these providers’ access to information technology. |
Casalino LP et al., 2007 [32] |
1) Health plans and government will work hard to make quality measures accurate. |
1) Measuring quality may lead physicians to avoid high- risk patients. |
Quality measures are not adequately adjusted for patients’ medical conditions or socioeconomic status. |
2) Both individual and group evaluation can be possible. |
2) Measuring quality will divert physicians’ attention from important types of care for which quality is not measured. |
Steiger B, 2005 [37] |
1) Additional data needed, in addition to claiming data |
1) Dumping: non-compliant or difficult patients |
Physicians spending more time making sure they are meeting certain guidelines rather than treating patients. Some poll participants say P4P is just a convenient way to get physicians and health care organization to adopt better technology. |
2) Large organization is now under more favorable conditions in current P4P setting so the rich get richer. |
2) Cherry Picking: they prefer the patients who give them high reimbursement |
3) More acute indicators and those reflecting clinical significance. |
|
4) Incentives are not new money so there are always winners and losers. |
|
Damberg CL, 2009 [34] |
Not mentioned |
Not mentioned |
Not mentioned |
Reiter KL et al., 2006 [38] |
Not mentioned |
Not mentioned |
Not mentioned |
Goldman LE et al., 2007 [40] |
1) Government should support to gather quality data. |
Not mentioned |
1) The cost and accuracy of data collection |
2) Government should reduce additional cost resulted from P4P. |
2) The difficulty of getting accurate performance data |
3) How to adjust case-mix, in particular, underserved patients |
Lee SI et al., 2010 [29] |
1) Voluntary participation |
Healthcare providers voiced significant concerns about the potential of unintended consequences including 1)avoiding of high-risk patients, 2) ignoring quality of care in unmeasured areas, 3) neglecting compulsory medical services to maximize financial reward, and 4) the possibility that medical records could be manipulated |
Not mentioned |
2) The organizational performance should be evaluated |
3) P4P should reward both high performers and performance improvers with financial incentives, but should not penalize low performers. |
4) Additional funding should be set aside for financial incentives. |
5) Not only medical claim data but also other clinical data should be used in evaluation. |
6) Government or health plans should pay for reporting. |
Young GJ et al., 2007 [30] |
Not mentioned |
Not serious |
A lack of quality improvement infrastructure is a major barrier to achieving pay-for-quality goal |
Erekson EA et al., 2011 [31] |
1) Performance measures not adjusting for the comorbidity of individual patients |
High risk patients will be penalized as they tend to have (worse) outcomes |
Not mentioned |
2) The need for the development and utilization of appropriate performance measures |
3) Doubt of adequacy of data |
4) Careful monitoring of unintended consequences |
5) Educating physicians about P4P |
Natale JE et al., 2011 [33] |
They are wary of the accuracy and validity of data used to generate these performance measures and are discouraged by the time and costs required to collect self information. |
Included among these worries that patient data and results can be manipulated by administrators and practitioners, making accurate comparison impossible. One such manipulation is the avoidance of high-risk patients or procedures by physicians. |
Not mentioned |
Kaczorowski J et al., 2011 [39] |
Not mentioned |
Not mentioned |
Not mentioned |