Two recent studies highlight the profound influence of financial incentives on medical decision-making. The first study, published in JAMA, investigated how a new Medicare billing code for abdominal hernia repair affected surgeon behavior. It found that after introducing a higher payment for larger hernias, the proportion of patients diagnosed with smaller hernias dropped significantly. The second study, also featured in JAMA Network Open, examined whether financial incentives could encourage urologists to adopt active surveillance for low-risk prostate cancer patients. Despite the potential benefits, the incentive failed to produce significant changes in practice patterns. These findings underscore the complex interplay between financial rewards and clinical decisions.

The introduction of a revised Medicare billing code for abdominal hernia repair has revealed intriguing shifts in surgical practices. University of Michigan researchers noted that before the change, hernia size did not affect reimbursement rates. However, once the new code linked payment to hernia dimensions, the percentage of patients diagnosed with smaller hernias plummeted from 60% to 49% within a single year. This dramatic shift raises questions about the accuracy of previous diagnoses. Researchers cautiously suggested that the financial incentive might have led surgeons to overestimate hernia sizes, possibly influenced by what they termed "perceptive bias." This phenomenon suggests that monetary rewards can subtly alter professional judgment, leading to potentially inflated measurements or even dishonest reporting.

Meanwhile, another study explored the impact of financial incentives on urological practices concerning low-risk prostate cancer. The research, conducted among members of Michigan’s Blue Cross and Blue Shield plan, aimed to determine if offering financial rewards would increase the adoption of active surveillance—a less invasive approach compared to traditional treatments like biopsies and surgery. Over three years and involving more than 15,000 patients, the study found no significant increase in the use of active surveillance despite the incentive. This outcome is particularly striking given the wide variation in active surveillance rates across different urology groups, ranging from 30% to 73%. Even in practices where active surveillance was least common, there was no notable shift towards this method. The researchers pointed out that nonclinical factors, including financial considerations, heavily influence treatment choices. For instance, primary treatments can generate substantially higher immediate earnings for physicians compared to active surveillance, which may explain the reluctance to change established practices.

These studies reveal that while simple financial incentives can swiftly alter documentation practices, they may fall short when it comes to changing deeply ingrained clinical behaviors. The researchers concluded that aligning prostate cancer care quality with payment might require ensuring equal reimbursement for different management strategies. Ultimately, the effectiveness of financial incentives in healthcare hinges on aligning them closely with both patient outcomes and physician motivations. As one famous movie line aptly puts it, “Show me the money,” highlighting the enduring power of tangible financial rewards in driving change.