May 3, 2019: Effect of Financial Bonus Sizes, Loss Aversion, and Increased Social Pressure on Physician Pay-for-Performance: A Randomized Trial and Cohort Study (Amol Navathe, MD, PhD)

Speaker

Amol S. Navathe, MD, PhD
Assistant Professor of Medicine and Health Policy
University of Pennsylvania

Topic

Effect of Financial Bonus Sizes, Loss Aversion, and Increased Social Pressure on Physician Pay-for-Performance: A Randomized Trial and Cohort Study

Keywords

Behavioral economics; Performance incentives; Evidence-based quality-of-care measures; Primary care quality; Pay for performance; Value-based medicine

Key Points

  • Pay-for-performance (P4P) programs are increasingly being used by health insurers and healthcare systems to incentivize physicians to practice higher value medicine, yet the evidence for P4P to affect quality and value of care remains mixed.
  • Behavioral economic principles in this study included increased social pressure and loss aversion added to larger bonus sizes to evaluate whether the intervention would lead to higher achievement of evidence-based quality measures.

Discussion Themes

Study findings included that, while a larger bonus size was associated with significantly improved quality for chronic care patients relative to a propensity-matched comparison group, adding increased social pressure and the opportunity for loss aversion did not lead to further quality improvement.

Attrition during the trial contributed some variability to the analysis.

Read more about pay for performance in healthcare in JAMA Network Open (Navathe et al, 2019) and NEJM Catalyst (2018).

Tags

#behavioraleconomics, #pctGR, @Collaboratory1