Financial incentive program for providers reduces pediatric ED visits

Michael G Burke, MD

A physician incentive program (PIP) that provides primary care providers (PCPs) with bonuses tied to specific goals to decrease pediatric emergency department (ED) use significantly decreases such visits, according to a retrospective analysis involving 1376 PCPs who participated in the PIP. The PCPs included pediatricians, other physicians, and various types of nurse practitioners from a single health maintenance organization; 86.1% of participants had a medical degree and 41.6% of participants specialized in pediatrics.

Investigators ranked participants in the PIP intervention according to their ED utilization rate and provided 3 potential incentives: PCPs in the quartile with the lowest rate of ED use received a $10,000 bonus each quarter for maintaining that low rate; PCPs who provided office hours a minimum of 4 hours a week during evenings or weekends received a $5,000 bonus for each quarter they maintained this availability; and any PCP who decreased his or her patients’ ED utilization rate by at least 5% compared with the same quarter of the previous year received a bonus that varied with the savings associated with the decreased number of ED visits.

During the 3-year study period, the PIP group was associated with a significantly lower average ED visit rate than the non-PIP group, even after adjustment for degree, specialty, education program, and board status. Further, compared with non-PIP practitioners, PIP providers who received any incentive payment had significantly fewer ED visits per 1000 member-months as did PIP providers who received at least 1 incentive payment for meeting after-hours criteria (Li J, et al. Pediatr Emerg Care. 2019;35[5]:363-368).

Thoughts from Dr Burke

Here’s an example of aligning incentives to benefit providers, payors, and, potentially, patients. If these incentives decrease patient barriers to being seen in their medical home versus waiting in a busy ED, patients and their families may be happier and healthier.