PERFORMANCE-BASED PHYSICIAN REIMBURSEMENT AND INFLUENZA IMMUNIZATION RATES IN THE ELDERLY

Objective: To investigate the effect of performance-based financial in centives on the influenza immunization rate in primary care physicians ' offices. Design: Randomized controlled trial during the 1991 influen za immunization season. Setting: Rochester, New York, and surrounding Monroe County during the Medicare Influenza Vaccine Demonstration Proj ect. Participants: A total of 54 solo or group practices that had part icipated in the 1990 Medicare Demonstration Project. Interventions: Al l physicians in participating practices agreed to enumerate their ambu latory patients aged 65 or older who had been seen during the 1990 or 1991 calendar years, and to track the immunization rate on a weekly ba sis using a specially designed poster from September 1991 to January 1 , 1992. Additionally, physicians agreed to be randomized, by practice group, to the control group or to the incentive group, which could rec eive an additional $.80 per shot or $1.60 per shot if an immunization rate of 70% or 85%, respectively, was attained. Measurements: The main outcome measures are the 1991 immunization rate and the improvement i n immunization rate from the 1990 to 1991 influenza seasons for each g roup practice. Results: For practices in the incentive group, the mean immunization rate was 68.6% (SD 16.6%) compared with 62.7% (SD 18.0%) in the control group practices (P = .22). The median practice-specifi c improvement in immunization rate was +10.3% in the incentive group c ompared with +3.5% in the control group (P = .03). Conclusions: Despit e high background immunization rates, this modest financial incentive was responsible for similar to 7% increase in immunization rate among the ambulatory elderly.