Pay-for-performance Incentives Encourage Therapists More Than Patients

Connie K. Ho for — Your Universe Online

Money can be a powerful object — it can buy clothes, cars, a range of material items. It can even inspire employees to work harder. A new study looked at the impact of financial incentives for both therapists and their patients. In the study, the researchers focused on whether pay-for-performance could be an effective way to treat adolescents who use drugs or alcohol.

To begin, pay-for-performance incentives haven risen in popularity with various health systems. The study, published in the Archives of Pediatrics & Adolescent Medicine, allowed researchers to work with therapists who could receive bonuses based on their work. They found that these therapists were more likely to show better understanding of the Adolescent Community Reinforcement Approach.

“Pay-for-performance – the idea that you can tie payment to the quality of healthcare – is a movement in the healthcare field, but we don’t know that much about it,” Dr. Alyna Chien, a researcher at the Children’s Hospital Boston and Harvard Medical School, told Reuters Health.

In total, 986 adolescent patients who used alcohol or marijuana, 29 community-based treatment organizations, and 105 therapists were involved in the study. Each organization was to be under the implementation-as-usual control condition or the pay-for-performance experimental condition. Each organization also received standardized levels of funding, training, and coaching.  For those who were in the pay for performance group, they received $50 for each month where patients showed progress due to the treatment as well as $200 for each patient who improved due to specific number of treatment procedures and sessions. These procedures included discussions on social life, progress towards specific goals, and assessments of personal happiness.

Therapists who were part of the pay-for-performance program tended to do better, with 17 percent offering full recommended amount of treatment to participants.

“Relatively small incentives led to very large improvements in performance,” researcher Bryan Garner told Reuters Health.

In the accompanying editorial, Chien described how the study is innovative in its focus on the treatment of kids, an area that researchers of pay-for-performance hadn´t examined as much in previous experiments. The study concluded that, even though therapists receive monetary rewards, the program may not be as effective for patients. The researchers discovered that teen participants didn´t have a higher chance of ending their use of alcohol and drugs due to pay-for-performance.

“However, differences in care processes did not necessarily translate into desired changes in outcomes: patients receiving care from treatment centers and therapists in the P4P arm of the study were not any more likely to remain in remission than patients who were not,” wrote Chien in an editorial that accompanied the article.

Based on the findings, 41 to 51 percent of patients improved in the study and did not use drugs or alcohol at least a month before their last meeting. According to Reuters Health, follow-up data was available for only half to two-thirds of teens and the lack of data could have influenced the results of the study. Researchers also believe that if the study was done with long-term goals, more care could have been provided to patients.

“It’s too short of a time frame,” commented Chien in the Reuters Health. “It could be that if (therapists) received the incentives and therefore those providers provided the recommended care for a longer period of time, and you could follow these kids for a longer period of time, you might see a difference.”

Moving forward, researchers believe that more discussions are needed regarding the structure of pay-for-performance programs as well as the factors that can make financial incentives effective for both patients and therapists.

“We can offer incentives, but they have to be able to be cost-effective,” explained Garner in the Reuters Health article. “The challenge is to find an amount that’s high enough to motivate individuals to change their behavior but low enough to be practical in the real world.”

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