The challenges in achieving successful P4P programs.

(1) Study results indicate that neither the quality scorecard nor the quality incentive payment program had a significant positive effect on general clinical quality. (2) Three main factors likely combined to weaken program effects: (1) modest size of the incentive; (2) use of rewards only; (3) targeting incentive payments to the group rather than to individuals. (3) The researchers found that, relative to the scorecard and reporting alone, the addition of the Quality Incentive Payment Structure (QIP) was associated with a reduction in quality, a result contrary to the intent of the payment incentive program.