Reform Update: JAMA Study Suggests Money Alone May Not Be Enough To Improve Performance, Reduce Costs

One goal of health reform, among many, is to break the industry's dependence on incentives for hospitals and doctors to do a high volume of business. Incentives for volume invite wasteful spending, of course, and also can be harmful if patients receive unnecessary care as a result.

The Patient Protection and Affordable Care Act is testing new incentives that attempt to reward hospitals and doctors for controlling costs without compromising quality. But getting them right is tricky, and that challenge is on display in new research published in Journal of the American Medical Association.

The study, which included a dozen Veterans Affairs primary-care clinics, sought to identify whether financial incentives were more successful if they reward individual physicians, their practices or both.

The incentives (for blood pressure control quality measures) turned out to be of little consequence, and only payments made directly to doctors made a real difference, the study found.