Should physicians get paid for quality improvement?(Pro & Con)

YES At HealthPartners we have been supplying medical groups with comparative performance data for 11 years, but it's only been since 1997, when we introduced bonuses tied to quality, that we've seen rapid improvement.

As the associate medical director for quality at a health plan, I structure the incentives for medical groups within our plan. The focus is to ensure that the medical groups change their systems to produce quality care without variation.

The only way to get there is by creating an infrastructure based on the best evidence. We've created a bonus system for medical groups that meet our clinical targets. The key is that bonus pools themselves need to be big enough so that it's difficult to ignore them. Our bonuses usually range between $90,000 and $250,000 per medical group.

And the targets we measure must be realistic. We usually choose a limited number of criteria to get the whole network focused on the same aspect of quality improvement.

We choose the targets using our comparative quality report on all of our medical groups. The Clinical Indicators Report includes measures on clinical topics such as behavioral health, heart disease care, diabetes care, preventive care, healthy lifestyle counseling, and treating tobacco addiction. We look at the previous performance in these important areas and set the goals to be achieved.

This is having a significant impact on the behavior of clinicians within our medical groups. We hear directly from medical groups in our plan that they wouldn't be able to focus on quality improvement measures without the bonuses.

There simply wouldn't be an imperative to make the changes otherwise. You have to have someone focused on quality improvement who works on forms, staffing, and getting feedback from patients. The bonus program doesn't pay for all those activities but it does provide enough of an incentive to shift the focus onto quality.