Researchers examined the effect of financial incentives at the individual physician level, the practice level or both on hypertension treatment at 12 Veterans Affairs outpatient clinics. Performance of physicians in the incentive groups was compared with performance of physicians in a control group who did not receive incentives. The financial incentives aimed to influence three measures:
1. The number of patients achieving guideline-recommended blood pressure thresholds or receiving an appropriate response to uncontrolled blood pressure.
2. The number of patients prescribed guideline-recommended medications.
3. The number of patients who developed hypotension.
Physicians in the incentive groups received up to five payments every four months over the study period, totaling $4,270 for the combined incentive group, $2,672 for the individual incentive group and $1,648 for the practice incentive group.
Between February 2007 and April 2008, physicians in the individual-level incentive group increased the percentage of patients with blood pressure control or an appropriate response by an estimated 8.84 percent. This improvement was 8.36 percentage points higher than the change the control group made in the first measure. This difference means that in a panel size of 1,000 patients, about 84 additional patients would achieve blood pressure control or receive an appropriate response if their physicians had individual incentives than if their physicians had no incentives, according to the study.
However, the incentive groups and control group made similar improvements in the other two measures — the number of patients prescribed guideline-recommended medications and the number of patients who developed low blood pressure.
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