Effect of Financial Bonus Size, Loss Aversion, and Increased Social Pressure on Physician Pay-for-Performance

Autor: Navathe, Amol S., Volpp, Kevin G., Caldarella, Kristen L., Bond, Amelia, Troxel, Andrea B., Zhu, Jingsan, Matloubieh, Shireen, Lyon, Zoe, Mishra, Akriti, Sacks, Lee, Nelson, Carrie, Patel, Pankaj, Shea, Judy, Calcagno, Don, Vittore, Salvatore, Sokol, Kara, Weng, Kevin, McDowald, Nichia, Crawford, Paul, Small, Dylan, Emanuel, Ezekiel J.
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Zdroj: JAMA Network Open
ISSN: 2574-3805
Popis: Key Points Question Does increasing bonus size or adding the behavioral economic principles of social pressure or loss aversion improve pay-for-performance effectiveness among physicians? Findings In this randomized clinical trial of 54 physicians and cohort study including 66 physicians and 8188 patients, increased bonus size was associated with improved quality relative to a comparison group, although adding increased social pressure and opportunities for loss aversion did not improve quality. Meaning Increasing pay-for-performance bonus sizes may be associated with improved effectiveness, whereas adding the behavioral economic principles of social pressure and loss aversion may not be.
This randomized clinical trial and cohort study tests whether increasing bonus size or adding the behavioral economic principles of social pressure or loss aversion improves the effectiveness of pay-for-performance among a sample of physicians and their patients.
Importance Despite limited effectiveness of pay-for-performance (P4P), payers continue to expand P4P nationally. Objective To test whether increasing bonus size or adding the behavioral economic principles of increased social pressure (ISP) or loss aversion (LA) improves the effectiveness of P4P. Design, Setting, and Participants Parallel studies conducted from January 1 to December 31, 2016, consisted of a randomized clinical trial with patients cluster-randomized by practice site to an active control group (larger bonus size [LBS] only) or to groups with 1 of 2 behavioral economic interventions added and a cohort study comparing changes in outcomes among patients of physicians receiving an LBS with outcomes in propensity-matched physicians not receiving an LBS. A total of 8118 patients attributed to 66 physicians with 1 of 5 chronic conditions were treated at Advocate HealthCare, an integrated health system in Illinois. Data were analyzed using intention to treat and multiple imputation from February 1, 2017, through May 31, 2018. Interventions Physician participants received an LBS increased by a mean of $3355 per physician (LBS-only group); prefunded incentives to elicit LA and an LBS; or increasing proportion of a P4P bonus determined by group performance from 30% to 50% (ISP) and an LBS. Main Outcomes and Measures The proportion of 20 evidence-based quality measures achieved at the patient level. Results A total of 86 physicians were eligible for the randomized trial. Of these, 32 were excluded because they did not have unique attributed patients. Fifty-four physicians were randomly assigned to 1 of 3 groups, and 33 physicians (54.5% male; mean [SD] age, 57 [10] years) and 3747 patients (63.6% female; mean [SD] age, 64 [18] years) were included in the final analysis. Nine physicians and 864 patients were randomized to the LBS-only group, 13 physicians and 1496 patients to the LBS plus ISP group, and 11 physicians and 1387 patients to the LBS plus LA group. Physician characteristics did not differ significantly by arm, such as mean (SD) physician age ranging from 56 (9) to 59 (9) years, and sex (6 [46.2%] to 6 [66.7%] male). No differences were found between the LBS-only and the intervention groups (adjusted odds ratio [aOR] for LBS plus LA vs LBS-only, 0.86 [95% CI, 0.65-1.15; P = .31]; aOR for LBS plus ISP vs LBS-only, 0.95 [95% CI, 0.64-1.42; P = .81]; and aOR for LBS plus ISP vs LBS plus LA, 1.10 [95% CI, 0.75-1.61; P = .62]). Increased bonus size was associated with a greater increase in evidence-based care relative to the comparison group (risk-standardized absolute difference-in-differences, 3.2 percentage points; 95% CI, 1.9-4.5 percentage points; P
Databáze: OpenAIRE
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