In more than a decade of the healthcare industry talking about moving from volume to value, the pace of embedding quality metrics into provider compensation models has been more evolutionary than revolutionary.

Getting quality right in a comp plan is one of the most consequential design decisions a medical group can make. Too little, and it's window dressing. Too much, and you risk alienating the clinicians you need to retain.

Our April 14, 2026, MGMA Stat poll found that almost four in 10 (39%) medical practice leaders believe the quality elements of their provider compensation models effectively drives behavior change, while 25% did not and another 36% said they do not use quality in their comp models. The poll had 199 applicable responses.

What you told us

Leaders who felt quality-based compensation was successfully driving behavior pointed to a wide mix of measures that directly align with day-to-day clinical practice, documentation discipline, and patient outcomes.

• The most effective measures tended to be those that were concrete, specialty-relevant, and operationally visible, such as chart and note closure timeliness, unsigned charts, documentation completion, claims acceptance, and hospital remits, which reinforced accountability and workflow reliability.
• Clinical outcome and preventive care metrics — blood pressure control, A1c, adenoma detection rates, cancer screening, well‑child visits and immunizations, AWVs, closing care gaps, and controlled hypertension — were frequently cited as changing clinician focus and consistency of care.
• Patient-facing measures like patient experience, referrals, name recognition, and provider-to-provider communication helped reinforce relationship-building behaviors.
• Organizations also highlighted the effectiveness of hospital-based performance metrics, readmissions, MIPS, MGMA benchmarks, and productivity-linked measures (including wRVUs and patients per day), especially when quality performance was used as a “gateway” requirement for earning productivity incentives.

Across responses, what worked best were measures clinicians perceived as fair, meaningful to their specialty, and clearly tied to both financial outcomes and patient safety and experience.

Practice leaders who did not believe quality incentives were effectively driving behavior pointed to a combination of low financial impact, weak trust in measurement, and limited provider buy‑in. Inadequate weighting of quality in compensation and persistent provider mindset and attitude barriers emerged as the dominant reasons quality-based pay failed to change behavior:

• Many felt clinicians already deliver high-quality care based on professional pride, making the quality dollars at risk too small to influence behavior meaningfully.
• Others emphasized that metrics were poorly defined, unreliable, frequently re-benchmarked, or not seen as truly reflective of quality — often viewed instead as “box-checking” exercises or outcomes driven largely by support staff rather than physicians themselves.
• Data trust issues, attribution challenges, and skepticism about whether measures captured real clinical value further eroded engagement.

Organizations without a quality component in compensation most often cited culture and ownership structure — particularly physician-owned “eat what you kill/treat” models — as the primary barrier, with strong resistance to tying pay to quality rather than productivity. Nearly as common were data challenges, including inconsistent or subjective measures, lack of consensus on what constitutes meaningful quality, and concern that quality is hard to measure reliably. Many also pointed to administrative burden and model complexity.

In several cases, leaders said quality expectations exist culturally but are intentionally not linked to compensation, while a few noted it simply hasn’t been a priority yet or was paused after COVID-19 due to provider burnout.

How we got here

Quality has had gradual but unmistakable momentum. Our MGMA Stat polling found only one in four medical groups (26%) tied quality performance to physician compensation in 2016. That share climbed to 36% by mid-2018, reached 38% in early 2019, and then essentially froze during the disruption of the COVID-19 pandemic.

As post-pandemic volume and staffing stabilization occurred, quality re-entered the conversation: 47% of groups reported incorporating quality into physician comp plans in a May 2023 MGMA poll. By April 2024, the industry reached a symbolic milestone: an even 50/50 split between groups that include quality metrics and those that do not.

The trend extends beyond polling. MGMA DataDive Provider Compensation benchmarking data show that purely salary-based and purely productivity-based compensation methods — once the simplest and most common approaches — accounted for roughly 44% of all reported comp methods in 2020. By 2024, that share had shrunk to less than 25%. In their place, comp models incorporating some element of quality metrics grew from about 26% of all methods in 2020 to more than 38% in 2024, according to the 2025 MGMA Provider Compensation data report.

The mean compensation allocation data also help tell the story:

• Among primary care physicians, quality and patient experience represent about 4.6% of total compensation allocation based on 2024 data, up from 2.9% based on 2023 data.
• Surgical and nonsurgical specialists also show modest increases, with quality allocations hovering around 2.3% to 2.6%.

These percentages may seem small in isolation, but they represent real dollars and, more importantly, real signals about organizational priorities.

The federal push behind the shift

This shift is not occurring in a vacuum. CMS set an ambitious goal to have 100% of traditional Medicare beneficiaries in accountable care relationships by 2030. As of January 2026, about 14.3 million were in such arrangements — a 4.4% jump from the prior year. Anders Gilberg, MGMA senior vice president of government affairs, has noted that CMS has historically struggled to meet its sweeping timelines, though the directional pressure is undeniable. A January 2025 MGMA poll found that 44% of practice leaders expected government payer value-based programs to drive the biggest changes in the coming year, with another 24% pointing to commercial insurance.

APPs: The next frontier for quality-linked comp

While much of the conversation has centered on physician compensation, advanced practice providers (APPs) represent a crucial piece of the puzzle. APPs now constitute a much larger share of the ambulatory workforce, and their comp models are evolving accordingly. MGMA data show that APPs carry a significantly higher proportion of straight base salary — roughly 84% — compared to physicians, but quality and patient experience still account for a meaningful allocation share.

As nurse practitioners and physician assistants take on larger, sometimes nearly independent panels, particularly in primary care settings where APP productivity and wRVUs are rising sharply, tying a portion of APP pay to quality outcomes aligns their incentives with the same organizational goals that drive physician behavior.

The five-year compensation growth for APPs has outpaced many physician specialties — primary care PA compensation rose nearly 30% over five years, according to 2025 MGMA data. As organizations invest more heavily in these roles, building quality expectations into APP compensation from the outset creates a more cohesive culture of accountability across the care team.

Finding the balance

So what does a well-designed quality component look like? VMG Health's physician compensation design team advises that organizations new to quality-linked pay should start by adding a modest incentive on top of existing compensation — rather than carving it out of base pay or productivity rates — so clinicians don't feel they are taking a pay cut to fund the program. Over time, the share tied to quality can increase as physicians grow more familiar with and trusting of the performance reporting, though VMG notes that the quality allocation generally tops out in the 10% to 20% range even for organizations well along the volume-to-value continuum.

How the dollars are structured matters too: some groups use a flat amount across all specialties, while others tie the opportunity to a percentage of median or individual compensation to account for specialty-level pay variation. Regardless of allocation method, the right design principles matter more than the exact percentage:

• Choose metrics providers can influence: The most common complaint about quality-linked comp is that clinicians feel evaluated on outcomes they cannot control. Select measures tied to clinical behaviors — screening rates, care gap closure, documentation quality, follow-up compliance — rather than broad population health outcomes driven by social determinants beyond a clinician's reach.
• Tailor metrics to the specialty: Primary care lends itself naturally to measures around preventive care, chronic disease management, and patient experience. Surgical specialties may be better served by complication rates, surgical site infections, or appropriate utilization. A one-size-fits-all scorecard will motivate few.
• Start small and build: Organizations new to quality-linked compensation should resist overhauling their model in a single cycle. Introducing a modest quality component — even 5% of total comp — as an add-on bonus rather than a reallocation of existing pay creates a positive-sum dynamic that builds trust.
• Get physician buy-in early: Our polling consistently highlights the value of physician compensation committees and strategic planning conversations that give clinicians a voice in the metrics governing their pay. Comp plans imposed from above tend to generate resentment, not behavior change.
• Invest in the data infrastructure: Quality-linked compensation is only as credible as the data behind it. If clinicians don't trust the reporting — or if dashboards lag months behind the measurement period — the motivational effect collapses. Real-time or near-real-time visibility into quality performance is quickly becoming the norm.
• Revisit annually: Healthcare delivery evolves, payer contracts shift, and clinical evidence changes best practices. A quality component that made sense two years ago may be measuring the wrong things today. Regular reviews, as MGMA consulting experts have consistently recommended, are essential to maintaining relevance and alignment with organizational strategy.

The road ahead

Half of medical groups now incorporate quality into physician compensation, and the share is poised to grow as value-based payer contracts become more prevalent and CMS continues its push toward universal accountable care. Among the other half, many acknowledge they will need to eventually — several respondents to MGMA's 2024 poll noted they are already tracking quality measures but have hesitated to tie them to pay due to workforce instability or cultural resistance.

That hesitation is understandable. But the evidence increasingly suggests that the question is not whether to add quality to comp models, but how to do it in a way that respects clinician autonomy, reflects clinical reality, and genuinely drives the behaviors your organization needs. The practices that get this design right will not only meet the demands of an evolving payment landscape — they will build the kind of high-performance culture that attracts and retains the best physicians and APPs in an intensely competitive market.

Join the conversation

• MGMA Stat polls are conducted weekly to give medical practice leaders a pulse on the latest trends in healthcare management. To participate, sign up for MGMA Stat at mgma.com/mgma-stat.
• Has your organization made strides in adding quality into physician or APP compensation models? Share your story in the MGMA Member Community or email us at connection@mgma.com.