Professional societies in the United States have given qualified approval to incentive programs, but express concern with the validity of quality indicators, patient and physician autonomy and privacy, and increased administrative burdens.
Current methods of healthcare payment may actually reward less-safe care, since some insurance companies will not pay for new practices to reduce errors, while physicians and hospitals can bill for additional services that are needed when patients are injured by mistakes.
[1] However, early studies showed little gain in quality for the money spent,[2] as well as evidence suggesting unintended consequences, like the avoidance of high-risk patients, when payment was linked to outcome improvements.
"[5] A second Institute of Medicine report Rewarding Provider Performance: Aligning Incentives in Medicare (September 2006) stated "The existing systems do not reflect the relative value of health care services in important aspects of quality, such as clinical quality, patient-centeredness, and efficiency...nor recognize or reward care coordination...(in) prevention and the treatment of chronic conditions."
[6] However, significant limitations exist in current clinical information systems in use by hospitals and health care providers, which are often not designed to collect data valid for quality assessment.
[7] After reviewing the medical literature in 2014, pediatrician Aaron E. Carroll wrote in The New York Times that pay for performance in the US and UK has brought "disappointingly mixed results".
These disappointing results were confirmed in 2018 by health economist Igna Bonfrer and co-authors in The BMJ, based on an observational study among 1,371,364 US patients aged 65 years and older.
[citation needed] In the United States, most professional medical societies have been nominally supportive of incentive programs to increase the quality of health care.
[18] In France, P4P in ambulatory care was introduced as individual contracts between physicians and statutory health insurance in 2009 and termed CAPI (Contrat d'Amélioration des Pratiques Individuelles).
The additional payment took into account the size of the population and the achievements for a number of indicators (clinical care, prevention, generic prescription), for which final as well as intermediate targets were defined.
With effect in 2012, CAPI were renamed ROSP (Rémunération sur Objectifs de Santé Publique) and incorporated into the collective agreements between doctors and statutory health insurance, with an expanded list of objectives and an extension to specialties such as cardiology.
[19] In the United Kingdom, the National Health Service (NHS) began a major pay for performance initiative in 2004, known as the Quality and Outcomes Framework (QOF).
Unlike proposed quality incentive programs in the United States, funding for primary care was increased 20% over previous levels.
A 2006 study found that most of the doctors actually did get most of the points, although some practices seemed to have gotten high scores by excluding patients with high-risk factors from their percentage targets.
Under the VBP system, doctors and health care providers have to meet clearly defined quality metrics that focus on prevention and managing chronic diseases.
Through care coordination, providers are incentivized for keeping their patients in the ACO healthy, minimizing expensive emergency room visits, hospital stays and costly duplicative medical tests.
GBUACO stands ready to be an active participant in providing lessons learned and sharing best practices for statewide VBP implementation."
In the United States, Medicare has various pay-for-performance ("P4P") initiatives in offices, clinics and hospitals, seeking to improve quality and avoid unnecessary health care costs.
This rule, effective October 2008, would reduce payments for medical complications such as "never events" as defined by the National Quality Forum, including hospital infections.
However, pilot programs now underway focus on simple indicators such as improvement in lab values or use of emergency services, avoiding areas of complexity such as multiple complications or several treating specialists.
[14] Patients with low health literacy, inadequate financial resources to afford expensive medications or treatments, and ethnic groups traditionally subject to healthcare inequities may also be deselected by providers seeking improved performance measures.