Navigation Links
Pay for performance encouraged physicians to follow blood pressure guidelines

HOUSTON (Sept. 11, 2013) When health care pundits began to suggest that pay-for-performance would solve some of health care's woes, Dr. Laura Petersen, professor of medicine at Baylor College of Medicine and director of the Houston VA Health Services Research and Development Center of Excellence, had questions.

How do we know that it will solve those problems? she asked. How do we know whether or not it will create new problems? And how will we structure these payments? As a recognized expert in the area of health care services and quality, she set out to find the answers in a multi-year study involving 83 physicians and 42 other health care personnel in 12 different Veterans Affairs hospital-based outpatient clinics.

She and her colleagues found that modest monetary incentives to individual physicians resulted in a significant 8.36 percent increase in patients whose blood pressure was brought down to desired levels or who received an appropriate medical response when it was found that their blood pressure was uncontrolled. However, incentives to a whole health care team or to the physician plus health care team did not have a significant effect. There was virtually no change at all in the control group that received no incentives. A report on their work appears in the Journal of the American Medical Association.

"This is not a panacea for everything that is wrong in health care, but it can have a significant effect in improving care," said Petersen, who is also associate chief of staff for research at the Michael E. DeBakey VA Medical Center. "Pay for performance is attractive because it would be a system-wide plan that could be implemented on a wide scale. With this, we have demonstrated that you can implement this kind of program at 12 sites at one time. And we were able to show a significant effect in the VA health care system where high blood pressure is already well controlled overall." Studies show that the baseline blood pressure control rates in the VA system are already at 75 percent.

The incentives had an important effect on physicians, she said. If the average primary care provider has 1,000 patients, then, with incentives, an 84 additional patients would meet hypertension goals after a year.

"To me, that's an important effect," she said.

However, in the year after the incentive program ended, the effects also diminished, which Petersen found disappointing.

"I thought the change would continue," she said. "It was a long intervention and I thought people's practices would change over time. However, it shows that the incentives were working. If their performance had not fallen off, then we might question whether the incentives caused the effect in the first place."

In the study, the clinics were assigned to one of four incentive groups: Physician-level incentives alone; practice-level incentives; combined incentives that included both physician incentives and practice incentives; and a control or no incentive group. The incentives were paid every four months for five periods. Those who took part also received feedback reports that detailed their performance in controlling their patients' blood pressure.

There was no change in the use of guideline-recommended medications among the groups.

Change was documented in detailed reviews of individual charts of patients chosen at random.

Total payments were modest: $2,672 for individual physicians, $4,270 for the combined group and $1,648 for the practice level groups. The main outcomes measured included patients who achieved guideline-recommended blood pressure thresholds or received an appropriate response to uncontrolled blood pressure or had been prescribed medications recommended in national guidelines (Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure). Directors of the participating hospital regions contributed $250,000 for the incentives.

While there were changes in the measurements of physician plus health care team and the practice level groups, none were statistically significant, which Petersen found surprising.

"I really thought that if you incentivize a whole team of care physicians, nurses, clerks, pharmacists the effect would be powerful. You would get everyone's incentives on the team aligned and all working better together," she said.

On the other side of the coin, some had been concerned that providing incentives might result in patients being over treated. However, the study found no difference in low blood pressure (hypotension) between the incentive groups and the controls.

She hopes that it might be possible to simplify the methods of reviewing patient records using a database. If so, it might be possible to roll out a similar plan more cheaply and widely, she said.


Contact: Graciela Gutierrez
Baylor College of Medicine

Related medicine news :

1. Tronics Delivered Its Millionth High-Performance Inertial MEMS Sensor
2. Professional Center for Enhanced Performance Offering Special for Neurofeedback
3. Performance pH White Paper ‘Optimizing Business Performance’ Featured in Latest WELCOA Newsletter
4. 368 Performance Becomes an Authorized AdvoCare Distributor
5. Footlogics Canada to Launch Hockey PLUS, High Performance Sports Insole for Skates
6. Performance Health Supports Evidence-Based Practice with Annual Research Meeting -- Collaborative Product Research Enables Evidence-Led Decisions That Benefit Patients
7. Houston Texans Install Brock PowerBase Underneath New Synthetic Practice Field to Maximize Player Safety and Performance
8. Golf Strength Training
9. How “Power Golf Training” Helps People Improve Their Golf Performance – V-kool
10. 368 Performance Launches Find Your Fit Challenge Powered by TLS®
11. Myofascial Rolling Shown to Increase Flexibility Without Inhibiting Performance
Post Your Comments:
(Date:10/13/2017)... ... October 13, 2017 , ... As health professionals work to improve their approach ... patient is doing more than filling out a survey; in many cases health professionals ... emphasis in health care and research on the importance of active engagement with patients ...
(Date:10/13/2017)... ... October 13, 2017 , ... ... Hannah Randall, PharmD ‘17, and Jennifer Huggins, PharmD ’17, along with clinical ... the primary prevention of cardiovascular diseases during the 15th Annual Women’s Health ...
(Date:10/13/2017)... ... October 13, 2017 , ... Ellevate Network, the leading ... to advocate for action towards gender equality at their inaugural Summit in New York ... globe, and reached a social audience of over 3 million. To watch the Mobilize ...
(Date:10/13/2017)... ... ... “The Journey: From the Mountains to the Mission Field”: the story of ... Philippines. “The Journey: From the Mountains to the Mission Field” is the creation of ... taught all ages and currently teaches a class of ladies at her church, which ...
(Date:10/12/2017)... ... October 12, 2017 , ... The company has developed ... consumer and regulatory authorities worldwide. From Children’s to Adults 50+, every formula has ... highest standard. , These products are also: Gluten Free, Non-GMO, Vegan, Soy ...
Breaking Medicine News(10 mins):
(Date:9/27/2017)... their devotion to personalized service, SMP Pharmacy Solutions announces their ... South Florida Business Journal,s 50 Fastest-Growing Companies, and listed for ... specialty pharmacy has found its niche.  To that end, the ... by SFBJ as the 2017 Power Leader in Health Care. ... award in October, Bardisa said of the three achievements, "It,s ...
(Date:9/23/2017)... HORSHAM, Pa. , Sept. 22, 2017 ... received a complete response letter from the U.S. Food ... (BLA) seeking approval of sirukumab for the treatment of ... response letter indicates additional clinical data are needed to ... of moderately to severely active RA. ...
(Date:9/19/2017)... 19, 2017   ZirMed Inc ., a recognized leader ... that it has been ranked #1 by its users for ... Rankings 2017 User Survey. ZirMed was recognized as the top-ranked ... and medical centers over 200 beds and holds one of ... user survey history. ...
Breaking Medicine Technology: