Removing Financial Incentives May Reduce Performance

Researchers note decline in screening rates, performance when financial incentives are dropped
By Monica Smith
HealthDay Reporter

WEDNESDAY, May 12 (HealthDay News) -- The focus of clinicians may change and their performance levels could drop when previously established financial incentives are removed, according to research published May 11 in BMJ.

Helen Lester, M.D., of the NIHR School for Primary Care Research in Manchester, U.K., and colleagues conducted a longitudinal analysis involving 2,523,659 adult members of Kaiser Permanente Northern California to evaluate the effect of financial incentives on quality indicators common in pay-for-performance plans.

The researchers found that rates of screening for diabetic retinopathy rose from 84.1 to 88.1 percent during the five years financial incentives were attached, and dropped to 80.5 percent in the following four years without financial incentives. Rates also rose for cervical cancer screening during the two years with financial incentives (from 77.4 to 78 percent), and declined over the next five years to 74.3 percent after the incentives were removed. Across the 35 facilities evaluated, the removal of incentives was associated with an average 3 and 1.6 percent per year decrease in performance for diabetic retinopathy and cervical cancer screening, respectively.

"Policy makers and clinicians should be aware that removing facility directed financial incentives from clinical indicators may mean that performance levels decline," the authors write.

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