Incentives to Improve Blood Pressure Control

All kinds of incentives, positive and negative, are being provided to physicians these days to engage in a variety of supposedly desirable behavior.  It is unlikely physicians can keep track of them all, so their effect has to be uncertain.  A study reported on in the Journal of the American Medical Association looked at the effects of individual physician incentives, incentives to a whole practice, or combined incentives with the goal of improving blood pressure control.   (JAMA Article)   Hypertension is a wide-spread and potentially dangerous and costly condition and one which many patients are not aware of and others struggle to reduce blood pressure to an acceptable level.  The study used 12 Veterans Affairs clinics and randomized the physicians who were participating to an individual incentive, a practice incentive, a combined incentive or no incentive.  The end measure was compliance with recommended blood pressure levels and treatment guidelines for uncontrolled hypertension.  The authors also looked at the extent to which physicians tracked results of the study and feedback reports.  During the study the average physician in the combined group received $4270, in the individual group $2672 and $1648 in the practice group.  While the absolute performance increased for each incentive group, the individual incentive group showed the only adjusted improvement.  When the incentive was stopped, the effect went away, which certainly suggests physicians are financially motivated.  The study did not test the effect of incentives of varying sizes, this might seem like a small incentive given typical physician pay, but everyone likes a little more.  No effort was made either to track any return on the investment in incentives–did spending decline, increase or stay the same.  And other measures, like mortality, hospitalizations, ER visits, etc.  were also not tracked.  The study nonetheless is a worthwhile addition to the science of optimizing incentives to improve care.