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Viewpoint |

Harnessing the Right Combination of Extrinsic and Intrinsic Motivation to Change Physician Behavior

Timothy J. Judson, MD, MPH1; Kevin G. Volpp, MD, PhD2,3; Allan S. Detsky, MD, PhD4,5
[+] Author Affiliations
1Department of Medicine, University of California, San Francisco
2LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia
3Center for Health Equity and Promotion, Cresencz VA Medical Center, Philadelphia, Pennsylvania
4Institute of Health Policy Management and Evaluation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
5Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
JAMA. 2015;314(21):2233-2234. doi:10.1001/jama.2015.15015.
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This Viewpoint discusses the challenges of identifying the proper balance of extrinsic and intrinsic motivators for changing physicians’ behavior as a means of improving health care productivity.

During the last 50 years, technological progress in health care has been achieved primarily through spectacular discoveries in medications and imaging. More recently, policy makers have focused on changing the behavior of physicians as a way to improve efficiency in the production of health. One approach has been to shift incentives from the quantity of services to a mixture of quantity and quality, known as “value based reimbursement.” The Department of Health and Human Services aims to have 50% of all Medicare payments tied to quality or value by the end of 2018.1 As health care financing evolves toward reimbursement schemes in which physicians assume risk, there are important questions to consider regarding the balance of extrinsic motivators (eg, financial reimbursement or other forms of recognition such as awards) and intrinsic motivators (eg, personal satisfaction derived from doing good work, or internal desire to achieve a particular objective). This Viewpoint discusses the complexities involved in determining the right mix of physician motivators to achieve the “value goal” in health care.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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