Physicians provide better care when their bonuses are bigger

A bigger bonus size for physicians is associated with higher-value medicine, according to a recent study published in JAMA Open Network.

“We found an increase in bonus size was associated with significantly improved quality for patients receiving care for chronic disease relative to a comparison group during a single year,” lead author Amol S. Navathe, MD, PhD, assistant professor of health policy and medicine at the Perelman School of Medicine at the University of Pennsylvania, et al. wrote.

Researchers wanted to measure pay-for-performance (P4P) used by health insurers and healthcare systems, which is also a basis of value-based care. Other studies have not shown consistent positive results for P4P, according to researchers.

Researchers looked at a total of 8,118 patients with one of five chronic conditions attributed to 66 physicians who treated patients at Advocate HealthCare.

Even when physicians had bonuses, more money was associated with higher quality care. An increase in the maximum bonus size of roughly $3,355, about $16 per patient, or 32 percent per physician was associated with a small improvement in evidence-based care received by patients. Physicians in the P4P program already had large bonuses of about $10,000 per year for approximately 200 patients.

“Our results suggest that in a general primary care physician program with substantial bonus sizes and a large budget, further increases in bonuses were associated with gains in quality,” Navathe and colleagues wrote.

However, with a final sample size of 33 physicians, the study was limited, researchers noted, and other behavioral effects could be factors in the findings. Furthermore, other incentives like loss aversion of increased social pressure did not have the same effect.