Article Figures & Data
Tables
- Table 1
Characteristics of In-Depth Interviewees (n = 48) and Survey (n = 150) Respondents
Characteristics In-Depth Interview % Survey % Type of clinician Family physician 50.0 57.0 Internist 10.4 8.5 Pediatrician 16.7 13.4 Internist and pediatrician 6.3 7.8 Nurse practitioner 10.4 7.0 Physician assistant 6.3 6.3 Sex Male 56.3 40.1 Female 43.8 59.9 Age, y <40 16.7 31.9 40–49 40.0 35.5 50–59 36.6 21.3 60+ 6.7 11.3 Years of Fairview employment <1 3.3 1.4 1–5 35.5 42.3 6–10 9.7 23.9 11–20 32.3 24.7 ≥21 19.4 7.8 Strengths Quality improvement for the team Compelled to do better so colleagues are not “hurt” Working harder with partners’ patients because of team incentive Less patient “dumping” (shifting patients with poor outcomes to other physicians) Mixed Positive team dynamics Greater collaboration and teamwork More learning from colleagues Report helping others to improve quality metrics Negative team dynamics Greater overall tension and peer pressure Resentment over how others are practicing/level of quality Weaknesses Lack of control over compensation Free riding
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The Article in Brief
Working Under a Clinic-Level Quality Incentive: Primary Care Clinician's Perceptions
Jessica Greene , and colleagues
Background Pay-for-performance programs are intended to align health care payments with quality performance. One decision in such programs is which entity should be incentivized. For example, should the incentive should be at the individual level, with each clinician receiving an incentive based on his or her own performance, or at the group or team level, with all clinicians receiving the same incentive based on the team's performance? This study examines primary care clinicians' perceptions of a quality incentive based on team performance.
What This Study Found After almost two and half years of working under a team-based incentive model, only a small minority (15 percent) of clinicians would base quality incentives entirely at the team level. According to clinicians, key benefits of team-level incentives included greater responsibility to the team, greater collaboration with colleagues, and less shifting of patients with poor outcomes to other clinicians. However, the team level incentive created substantial frustrations among clinicians who felt little control over their compensation and concerns about colleagues riding the coattails of higher performers. While only 15 percent of those surveyed would base quality incentives entirely at the team level, fewer still (7 percent) would base quality incentives exclusively at the individual level, fearing increases in shifting patients and decreased congeniality. Almost three-quarters of clinicians felt that a model that mixed individual- and team-level incentives would be ideal.
Implications
- These findings highlight the complexity of designing financial incentive programs.
- The authors call for future research to test whether programs that mix group and individual incentives can maintain some of the best elements of each design while reducing the negative impacts.
