These data include responses from over 1,500 physicians to a survey questionnaire we fielded in several of the demonstration sites that focused on respondents' general attitudes toward P4Q and specific experiences with P4Q programs (Young et al.
We do not address this question in the form of a lesson because the demonstrations were not designed to provide definitive evidence on the impact of P4Q on clinical quality.
The spread of P4Q in the health care industry has occurred in the face of a vigorous debate about whether and to what degree providers will respond to financial incentives for improving quality of care.
Aside from money, provider responsiveness to P4Q programs appeared to reflect, at least in part, a feeling of professional responsibility for quality of care.
For instance, some providers found P4Q to be a one-size fits all proposition that can stand in the way of meaningful QI.
While evidence from the demonstrations indicates shifting attention to incentive-linked quality targets, program sponsors also faced difficult challenges to engage many providers fully in P4Q programs.
The apparent difficulties program sponsors faced in achieving provider engagement in P4Q is not surprising given the many barriers that exist.
However, even if program sponsors are successful in educating providers about the basic elements of a P4Q program, they still may lack their full commitment to the program.
A lack of quality infrastructure was ostensibly a barrier for many providers to achieve quality goals of P4Q program.
The implications for the future of P4Q in pursuing quality-related incentives without engaging individual physicians in the programs are extremely complex.
To compute an accurate return on investment for a P4Q program, it is necessary to track all financial costs and returns, including opportunity costs resulting from activities not undertaken given the development of the program.
These and other similar complex issues arising in comprehensive return on investment calculations suggest that more narrowly focused questions about the effectiveness of P4Q programs are more likely to be answered accurately.