Physician descriptions of the influence of pay for performance on medical decision-making.

Objectives: To explore physician descriptions of the influence of pay for performance (P4P) programs on their medical decision-making for the delivery of health care through three antecedents of behavior intention-attitude toward program compliance, perceived behavioral control, and subjective norms. Study design/setting: This study utilized a qualitative descriptive research methodology to capture physician descriptions through semi-structured interviews and a focus group. Primary data was collected from actively practicing physicians in the United States with P4P experience. Principal findings: The findings imply that multiple factors influence physicians' attitudes toward program compliance summarized by four primary themes: (a) program compliance and beliefs of physicians in delivering patient care, (b) design, control, and performance motivation, (c) physician performance measurements and the opinions of others, and (d) patient care and compensation program considerations. Conclusions: The findings suggest that physician involvement in the design, implementation, communication, and on-going evaluation of P4P models influence physician behavior. The findings also suggest that physicians are motivated by the delivery of what they believe is good patient care more than by P4P financial incentives. Finally, the most influential voices for physician P4P compliance includes their physician peers and administrators. Outside of the larger societal benefit of P4P compliance, individual family, friends, policymakers, payors, and others have little to no influence on physician decision-making.