Welcome to the Pay for Performance Research Site

Please note this version of p4presearch.org is currently under construction                                

This website is designed to help clinicians and educators navigate the complex landscape of pay for performance (P4P). It contains over 400 references with summaries and links where available. It also provides links to local, state, and national resources as well as Powerpoint and online Breeze video presentations on select topics.

The site is organized by topics of interest, along the toolbar on the top of your screen, so that users may go directly to a particular item as needed. The website is regularly updated with new topics and references from both Medline referenced sources and the popular press. Eventually it will provide a step-by-step P4P learning module to enhance clinicians understanding of this controversial issue.

This website, like P4P, is a dynamic process. As such, we appreciate your comments, suggestions, and additional references. 


P4P definition - What is P4P?

P4P has many definitions. As a result, P4P can mean different things to different people. At its core, P4P is a system of reimbursement that pays clinicians bonuses based on predetermined performance measures.


The goals of P4P are twofold:

  • P4P aims to improve the quality of care by incenting clinicians to focus on particular processes of care or to strive towards particular patient outcomes.
  • It is hoped that P4P will provide substantial cost savings, indirectly by keeping patients healthier or directly by incentivizing clinicians to provide more cost effective care.


P4P is one of three increasingly common forms of performance based incentives which are often used simultaneously. They include:

  • P4P using positive incentives such as a financial bonus versus negative incentives such as financial withholds or non-payment.
  • Public Reporting or Report Cards the performance results of clinics or individual clinicians.
  • Ranking or Tiering clinics or individual clinicians based on their performance and using the ranking to determine differential patient copays or network affiliations.


P4P programs for clinicians are currently offered by:

  • Insurers including Medicare and Medicaid at the state and national levels
  • Health systems and HMOs
  • Community-based organizations (typically public reporting only)


Like all forms of physician reimbursement, P4P has benefits and burdens which are reflected in an exponentially growing medical, economic, political, legal, and bioethical literature.


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