Abstract
Background: The use of financial incentives to providers to increase quality and/or lower costs has increased as pay-for-performance has proliferated. While some quality metrics targeted in pay-for-performance schemes include HPV vaccination, little to no information exists on the extent to which financial incentives are used to promote HPV vaccination.
Objective: This study is one of the first to report the extent to which financial incentives for clinics and clinical staff are used to promote HPV vaccination. We also report the likelihood of eligibility to receive financial incentives by clinical staff role.
Data: In 2022, we conducted a national survey of clinical staff working in primary care clinics that provided HPV vaccination to children (N=2,527). WebMD Market Research recruited participants through their Medscape Network. Respondents were 1) certified to practice in the US; 2) practiced as a physician, physician assistant (PA), nurse practitioner, advanced practice nurse (APN) including nurse practitioner, registered nurse (RN), licensed practical/vocational nurse (LPN/LVN), medical assistant (MA), or certified nursing assistant (CNA); 3) worked in pediatrics, family medicine, or general medicine specialties; and 4) had a role in HPV vaccination for children ages 9 through 12 years. We set quotas for roughly equal numbers of pediatricians, family physicians and other physicians, PAs and APNs, RNs, and MAs/CNAs. The response rate was 57% (AAPOR response rate 3). The University of North Carolina Institutional Review Board approved the study protocol.
Methods: The primary outcome was a mutually exclusive categorical variable that captured the type of quality metrics for which financial incentives had been used in the past year: HPV vaccine, other pediatric vaccinations, other quality metrics, or none. The secondary outcome was an indicator variable for whether the respondent was, or would be, eligible for a financial incentive. We estimated a multinomial logistic regression model for the primary outcome and a logistic regression model for the secondary outcome. Models adjusted for characteristics of the clinic (rurality, specialty, number of clinics in the system, ownership structure, number of prescribers, % of children using Vaccine for Children, and number of patients ages 9-12) and of the respondent (training, gender, race/ethnicity, and years in practice).
Results: Only 8% (N=193) of respondents had financial incentives for HPV vaccine in their clinics. Clinics that were part of a healthcare system were more likely to have used financial incentives for HPV vaccine: relative to clinics not in a system, clinics in a system of 5 or more clinics had an odds ratio (OR) = 2.06 (95% confidence interval [CI] 1.40, 3.03). Clinics that saw more children were more likely to have used financial incentives for HPV vaccine: relative to respondents seeing 0-9 children per week, respondents seeing 50 or more children per week had an OR = 2.64 (95% CI 1.47, 4.72). Physicians were more than twice as likely than other roles to be eligible for financial incentives (e.g., physician assistant OR = 0.40 [95% CI 0.28, 0.59]).
Conclusions: There is opportunity to extend the use of financial incentives in primary care to promote HPV vaccination.