Pay-for-performance (P4P) programs are being implemented across the country in attempts to use financial incentives to improve health care quality. To date, much of the design and implementation work on P4P has been or is being conducted by Medicare, and focuses on care provided in the hospital setting. In July 2007, P4P will be extended to physicians who deliver ambulatory services in the office and other outpatient settings under the Physician Quality Reporting Initiative (PQRI). This study will explore the design and implementation of P4P systems and how rural physicians might be affected by P4P systems.

This study will utilize qualitative research methods, including literature reviews and expert interviews, to explore key research questions related to the design and implementation of P4P systems by CMS and private health care delivery systems. Design and implementation issues to be addressed will include quality measures and measurement, linking quality measurement to payments, dissemination of information, and the implications of P4P for rural physicians. Study products will include a Final Report and Policy Analysis Brief of study findings. To ensure that study products are highly relevant to policymakers and the rural health care community, the study will be informed by a team of experts, including rural and urban physicians involved in P4P, Federal policymakers, specialty association stakeholders, and other scholars in the field. Research findings will be widely disseminated to policymakers and the rural health community.

Publications

• The Medicare Physician Quality Reporting Initiative: Implications for Rural Physicians (Final Report)
  NORC Walsh Center for Rural Health Analysis
  Date: 08/2010
  This report discusses the impact of rurality on office-based physicians' participation in the 2007 Physician Quality Reporting Initiative (PQRI). PQRI offers a financial incentive to physicians and other eligible professionals who successfully report quality measures related to services provided under the Medicare Physician Fee Schedule.
• The Medicare Physician Quality Reporting Initiative: Implications for Rural Physicians (Policy Brief)
  Policy Brief
  NORC Walsh Center for Rural Health Analysis
  Date: 08/2010
  Rural practices may be at a disadvantage with respect to participating in the Physician Quality Reporting Initiative, not necessarily because of their geographic location, but because they tend to be smaller and have fewer resources and a less developed quality measurement infrastructure.