Effect of Financial Bonus Size, Loss Aversion, and Increased Social Pressure on Physician Pay-for-Performance

Key Points Question Does increasing bonus size or adding the behavioral economic principles of social pressure or loss aversion improve pay-for-performance effectiveness among physicians? Findings In this randomized clinical trial of 54 physicians and cohort study including 66 physicians and 8188 patients, increased bonus size was associated with improved quality relative to a comparison group, although adding increased social pressure and opportunities for loss aversion did not improve quality. Meaning Increasing pay-for-performance bonus sizes may be associated with improved effectiveness, whereas adding the behavioral economic principles of social pressure and loss aversion may not be.