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Taking the Measure of Quality Healthcare

March 12, 2010

DPBRN logoMore American insurers have turned in recent years to a new reimbursement model for hospitals and physicians called Pay for Performance (P4P). It links the amount of the provider’s reimbursement to the quality of care provided to treat a patient. In essence, if providers meet the insurer’s measurable standards for quality of care, they will be fully rewarded. If they fail to meet the quality measures, their pay out will be reduced. While insurers and providers continue to debate the merits of P4P in the healthcare arena, many foresee a day when the model will be extended to reimbursement for dental services. But is the current state of the P4P science compatible with dentistry?
In the January/February issue of the Journal for Healthcare Quality, NIDCR grantees take a fresh look at this question based on past experience with P4P in primary and dental care. They conclude that large-scale implementation of P4P in dentistry may not be a realistic option right now. The researchers noted that public insurance for dental services in the United States is limited, with insurance payments representing just 61.4 percent of dentists’ revenues compared to 86 percent of physicians’ income. They also found that existing government healthcare reimbursement programs tend to be oriented to hospitals and large provider groups. Dentists tend to operate their own individual practices and thus provide their services in outpatient settings.

“Dental providers might accept P4P if they contribute to program design and see a link between P4P and quality,” the researchers added. “Unfortunately, at the present time quality in dental care is not clearly defined and is difficult to measure. Without measurement, performance improvement cannot take place. Absent a culture of quality measurement and improvement, development of more best practices, clinical practice guidelines, and evidence-based quality indicators, dentistry will continue to lag behind medicine in the adoption of P4P.”


  • Pay-for-performance in dentistry: what we know.  Voinea-Griffin A, Rindal DB, Fellows JL, Barasch A, Gilbert GH, Safford MM; DPBRN Collaborative Group.  J Healthc Qual. 2010 Jan-Feb;32(1):51-8.

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This page last updated: February 26, 2014