Impact of a Pay‐for‐Performance Program on Care for Black Patients with Hypertension: Important Answers in the Era of the Affordable Care Act

OBJECTIVE: Evaluate the effect of a pay-for-performance intervention on the quality of hypertension care provided to black patients and determine whether it produced risk selection. DATA SOURCE/STUDY SETTING: Primary data collected between 2007 and 2009 from Veterans Affairs physicians and their primary care panels. STUDY DESIGN: Nested study within a cluster randomized controlled trial of three types of financial incentives and no incentives (control). We compared the proportion of physicians' black patients meeting hypertension performance measures for baseline and final performance periods. We measured risk selection by comparing the proportion of patients who switched providers, patient visit frequency, and panel turnover. Due to limited power, we prespecified in the analysis plan combining the three incentive groups and oversampling black patients. DATA COLLECTION/EXTRACTION METHOD: Data collected electronically and by chart review. PRINCIPAL FINDINGS: The proportion of black patients who achieved blood pressure control or received an appropriate response to uncontrolled blood pressure in the final period was 6.3 percent (95 percent confidence interval, 0.8-11.7 percent) greater for physicians who received an incentive than for controls. There was no difference between intervention and controls in the proportion of patients who switched providers, visit frequency, or panel turnover. CONCLUSIONS AND RELEVANCE: A pay-for-performance intervention improved blood pressure control or appropriate response to uncontrolled blood pressure in black patients and did not produce risk selection.