Pay-for-Performance in Pediatrics: Proceed With Caution

In response to overwhelming evidence of significant quality problems within adult and pediatric health care, pay-for-performance programs have proliferated rapidly in adult care settings and are beginning to spread into pediatrics.1–6 Outpatient pediatric health care is being targeted by performance incentives in all 11 of the state Medicaid programs that currently use performance-incentive strategies and 33 of the 93 performance-incentive programs listed in the Leapfrog Compendium (the largest publicly available listing of performance-incentives programs in the country).7,8 We recognize that the current payment system contributes to our problems with quality, and we agree with the cautionary tone and measured approach suggested by Profit et al9 in the May 2007 issue of Pediatrics when considering whether performance incentives, in the form of pay-for-performance and/or public reporting, should be implemented to promote the quality of care provided by NICUs. Because these programs require tremendous effort on the part of a wide variety of stakeholders (employers, health plans, health care organizations, and physicians), it is important to consider whether they are worth the effort. Current evidence indicates that performance incentive strategies may only be modestly effective,10–12 are not necessarily connected . . . [Full Text of this Article ]