AHRQ Innovations Exchange | Financial Incentives for Physicians Lead to Increased Adoption of Health Information Technologies and Other Quality/Safety Improvements

Financial Incentives for Physicians Lead to Increased Adoption of Health Information Technologies and Other Quality/Safety Improvements

Summary
The Massachusetts General Physicians Organization, working with Massachusetts General Hospital, designed an incentive and communications campaign to encourage doctors to use health information technologies (including a new electronic medical record system and electronic radiology ordering system), and to adopt other, department-specific quality and safety measures. The innovative program, which offers rewards of up to $5,000 annually for physicians who meet pre-established goals, led to increased use of these technologies and to other quality and safety improvements.
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Developing Organizations
Massachusetts General Physicians Organization

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Date First Implemented
2006
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Patient Population
Geographic Location > City

What They Did
Problem Addressed
Despite recommendations from the Institute of Medicine that hospitals and medical groups adopt electronic medical record (EMR) systems, electronic order entry and prescribing, and other process improvements to improve patient care and safety, many organizations have failed to do so, as busy physicians resist learning new systems and processes because of the requisite changes in workflow and time required for training.
Low usage rates among physicians: Recent estimates suggest that fewer than one-quarter of physicians in the United States regularly use basic health information technology (HIT), such as EMR systems.1
Encouragement often not enough: Simply encouraging physicians to use EMRs and other HIT systems may not be enough. For example, after Massachusetts General Physicians Organization and Massachusetts General Hospital made major investments in HIT (including an EMR system, computerized radiology order entry, and electronic prescribing), few of the organization's physicians used the systems, despite their administration's exhortation, pressure from payer-based contracts, and additional investments to make the systems more user friendly to clinicians.
Financial incentives as a potential solution: A national survey found that three-quarters of physicians support financial incentives tied to quality of care measurements, including use of EMRs and other HIT systems, although some respondents expressed concern about potential unintended consequences of such incentives).2
Description of the Innovative Activity
Massachusetts General Physicians Organization, working closely with Massachusetts General Hospital, created an incentive program that awards up to $5,000 per year to physicians who achieve hospital-wide and department-specific patient care and safety improvement goals that are focused on increasing use of new HIT systems, including the EMR, electronic ordering of imaging studies, and other quality goals. The incentive program is part of a broader, organization-wide effort to foster a culture of quality and safety. The incentives are structured to make it relatively easy for most physicians to initially achieve the maximum payout as a way of increasing their long-term effectiveness. Key elements of the incentive program are described below:
Incentive design: The incentive program was carefully designed to have maximum impact within the available resources.
Widespread eligibility: To encourage compliance with the organizational goals of broad use of HIT, nearly all physicians within the group are eligible to participate in the incentive program. To participate, physicians had to participate in most of the group's managed care contracts and meet a minimum level of clinical productivity.
Adequate incentive to get physician’s attention: The maximum incentive is set at three levels—$1,000, $2,500, or $5,000 over two payment periods—based on a physician's workload. The size of the incentive was chosen so as to be meaningful enough to most physicians to motivate behavior change. The incentive was positioned to physicians not as compensation, but rather as recognition of the effort made to learn and adopt HIT systems.
Quick distribution of incentives, regular performance feedback: To keep physicians focused on the metrics, payment occurred over 6 months. To maximize visibility, separate bonus checks are mailed to the physician’s home, and an individualized performance report that summarizes the physician’s performance is made available. The incentive checks and performance reports are accompanied by a cover letter from the physician organization’s leadership and the department chief of service. The letter includes a description of future goals and targets for the incentive program, and also describes an easy appeals process for doctors who feel they did not receive a fair payment.
Selection of safety and quality measures and targets: The incentive is tied to progress in two distinct areas; the first half is linked to achievement of two hospital-wide metrics, while the second half is tied to achievement of one department-specific patient safety or quality goal. Metrics may change over time as physicians meet established targets. In order to encourage behavior change, incentives were initially structured to make it relatively easy for physicians to earn the maximum payout, as outlined below:
Hospital-wide metrics: The two hospital-wide metrics initially related to use of EMRs and electronic radiology order entry. The first payment was based solely on participation in the program, not on performance.
Department-specific metrics: Each department sets its own metric, many of which also relate to HIT adoption, such as timely completion of electronic notes or use of electronic prescribing. Some departments choose to focus on other areas, such as performing medication reconciliation, using perioperative antibiotics appropriately, or reducing inappropriate use of high-cost imaging tests. A parallel, department-specific executive incentive program pays bonuses to leaders whose departments meet their specific goal.
Regular, clear communications to maintain awareness: Many mechanisms are used to build and maintain physician buy-in and awareness, including regular newsletter updates about the program, general and targeted e-mail communications, Web site postings and publications, electronic reminders throughout the performance measurement period, “town-hall” and/or individual meetings with physicians, and discussions at regular meetings of department chiefs. These frequent communications are intended to be a strong signal to physicians of how important the program is to organizational leaders.
References/Related Articles
Meyer G, Torchiana D, Colton D, et al. The use of modest incentives to boost adoption of safety practices and systems. Agency for Healthcare Research and Quality’s Advances in Patient Safety: New Directions and Alternative Approaches. Vol 4. Available at: http://www.ahrq.gov/downloads/pub/advances2/vol3/Advances-Meyer_41.pdf
Contact the Innovator
Gregg S. Meyer, MD, MSc
Senior Vice President for Quality and Safety
MGH/MGPO, Bulfinch 284
55 Fruit St.
Boston, MA 02114
Phone: 617-724-9194
Fax: 617-726-4304
E-mail: gmeyer@partners.org


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AHRQ Innovations Exchange | Financial Incentives for Physicians Lead to Increased Adoption of Health Information Technologies and Other Quality/Safety Improvements