Baylor College of Medicine
Eleven Sites Nationwide
Hypertension
African American

Project

Monetary incentives are given to providers and provider teams to follow recommended hypertension care guidelines.

Health care personnel are eligible to receive a monetary bonus for each patient with hypertension. Half of the bonus is based upon the physician’s use of guideline-recommended medications. The other half is based upon the proportion of patients with hypertension achieving blood pressure control or receiving a guideline-recommended response to uncontrolled blood pressure. Bonuses can be paid in two ways; to physicians only or to groups comprised of physicians and non-physician team members.

Group bonus payments are based upon the aggregate performance of physicians in the group. The group can choose to divide the payments equally or use them to purchase health care equipment or supplies to improve quality of care. Physician-only bonuses are received as additions to their normal pay.

Monetary rewards are distributed approximately every four months. Audit and feedback reports summarizing performance over each of five performance periods are provided to participants via a password-protected study website. Feedback reports include data reflecting individual and group scores, earnings for the study period, and total earnings to date, as appropriate.

Rationale

The incentive systems are designed to change physician behavior without causing undesired, unintended consequences (i.e., gaming), setting unrealistic goals, or providing incentives that are too small.

The financial incentive structures are designed to reward a combination of process-of-care measures for which there is evidence that better performance leads to better outcomes (e.g., documentation of prescribing a medication) and the outcome of interest; blood pressure control.

Payment amounts are set so that they are large enough to make a difference and influence physician behavior. They are paid out every four months to make a clear and timely link between the desired behavior and the reward.

Summary Results

Physician-directed financial incentives showed mixed impact on guideline-appropriate care and clinical outcomes. The proportion of African American patients who either achieved BP control or received a clinically appropriate response to uncontrolled BP was significantly higher by 6.3% in the intervention group than in the control group. However, there was no significant difference in the proportion of African American patients receiving guideline-recommended antihypertensive medications between the intervention and control groups.

Publications

Principal Investigator

• Laura A. Petersen, MD, MPH