Pay-for-performance (P4P) programs offer health care providers financial incentives to achieve predefined quality targets. Practice executives sit at a key nexus point for deter- mining how P4P programs are implemented in physician practices. Using a qualitative interview design, this article examines the role practice executives play in the implemen- tation of P4P programs and how their perspectives and decisions can influence the suc- cess of these programs. The authors identified five key findings related to practice execu- tives’ views on P4P: quality incentives are better than utilization incentives, quality incentives are bonus rewards, quality incentives are agents for change, providers do not feel they have control over attaining quality targets, and the ways in which quality is measured are problematic. The authors discuss five different ways in which practice exec- utives distribute rewards to physicians. These findings may help payers more effectively design and implement financial rewards for quality.
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