Programs contains four sections:

  • National
  • International
  • State
  • Local/Private (Limited literature at this time)


There are currently over 160 independent P4P programs in the United States and most clinicians qualify for participation in one or more programs. Programs may be mandatory but are typically voluntary. The P4P bonus can range from 1.5% to 40% of a clinician's fee-for-service billings, with most programs ranging between 1.5% and 10%. The bonus is typically new money but some P4P programs withhold a percentage of a clinician's fee for service billings to finance the program. P4P is increasingly popular throughout the developed world with national or provincial programs in Britain, Canada, Australia, New Zealand, and several others.

Authors' Opinion

Navigating the CMS national program can be complex. Ongoing challenges include providing clinicians with timely reimbursement, performance feedback, and responsiveness to new clinical evidence or a change in the health care environment. Nevertheless, CMS likely has the most comprehensive and valid program in the United Sates. Additionally, we recommend that insurers be required to select from among the CMS measures, as these measures have gone through rigorous transparent development by content experts. Internationally, P4P is expanding quickly.  Most countries have government-regulated programs, and this simplicity allows physicians to better understand the program and work to meet specific measures. Within the US, we anticipate a greater role for state-specific programs.