A PERFORMANCE-BASED INCENTIVE PROGRAM FOR INFLUENZA IMMUNIZATION IN THE ELDERLY

Our objective was to implement and evaluate performance-based reimburs ement for influenza immunization of the elderly in physician offices. We performed a community-based quasi-experiment with historic and conc urrent comparisons, using primary care physician offices in Monroe Cou nty, New York. Participants in the intervention group included 53 prim ary care physicians admitting to one hospital, and the comparison grou p included 82 primary care physicians admitting to other hospitals. Al l physicians participated in a Medicare-sponsored demonstration to inc rease influenza immunization rates, and, during the 1990-1991 immuniza tion season, used a target-based poster to track immunization rates. P hysicians in the intervention group were enrolled in a performance-bas ed financial incentive program that rewarded immunization rates above 70%. A survey concerning influenza immunization practices and opinions was sent to all physicians. The average physician-specific immunizati on rate in the incentive group was 73.1% versus 55.7% in the compariso n practices (P < .001). Eligibility for incentives, practice size, sex of physician, medical specialty, reminder postcards, and practice pop ulations including medically indigent patients were associated with im munization level. Controlling for the above variables, we completed a regression analysis showing that eligibility for the incentive was sti ll significant (P = .003). The survey responses were not predictive of performance or significantly different between the two groups, except for the negative influence of sending postcards. This study in a comm unity setting suggests that linking reimbursement to performance may b e a successful strategy to increase influenza immunization levels for the elderly.