The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates

Objectives. The purpose of this study was to examine the effects on immunization coverage of 3 incentives for physicians-a cash bonus for practice-wide increases, enhanced fee for service, and feedback. Methods. Incentives were applied at 4-month intervals over 1 year among 60 inner-city office-based pediatricians. At each interval, charts of 50 randomly selected children between 3 and 35 months of age were reviewed per physician. Results. The percentage of children who were up to date for diphtheria, tetanus, and pertussis and Haemophilus influenzae type b; polio and measles-mumps-rubella immunization in the study's bonus group improved by 25.3 percentage points (P<.01) No significant changes occurred in the other groups. However, percentage of immunizations received outside the participating practice also increased significantly in the bonus group (P<.01) Levels of missed opportunities to Immunize were high in all groups and did not change over time. Physicians' knowledge edge of contraindications was low. Conclusions. Bonuses sharply and rapidly increased immunization coverage;in medical records. However, much of the increase was-the result of better documentation. A bonus is a powerful incentive, but more structure or education may be necessary to achieve the desired results.