Pay-for-performance metrics must be more impactful and physician-controlled

Pay-for-Performance Metrics Must Be More Impactful and Physician-Controlled

Background: This editorial builds on a study by Brulin and Teoh, released ahead of the March/April 2025 issue of Annals of Family Medicine, which found that performance-based reimbursement is associated with lower perceived quality of care by increasing illegitimate tasks and moral distress for primary care physicians.

Editorial Stance: Quality metrics and pay-for-performance initiatives are far more expensive than many patients, clinicians, or administrators realize. The authors call for more rigorous review through cluster randomized controlled trials both before and after implementation—and recommend against  implementing metrics with little impact or those that detract from care. They recommend refocusing incentives on targets that are impactful, time-limited, low-cost, and physician-controlled. 

Why It Matters: While no single metric is perfect, some can support better care if applied thoughtfully and tested in real-world settings. All Quality Metrics Are Wrong; Some Quality Metrics Could Become Useful

Michael E. Johansen, MD, MS, et al 

Grant Family Medicine, OhioHealth, Columbus, Ohio