(ZS Associates: Evanston, IL) -- While incentives can be an effective motivator in health care, a new study from global consulting firm ZS Associates suggests that more than 75 percent of incentives are so small or poorly communicated that they go unnoticed by providers. As a result, more than $20 billion in health care incentives may be wasted annually.

Performance incentives (and penalties) are a widely accepted tool to achieve health care quality and cost goals. They are a key element in the Patient Protection and Affordable Care Act (PPACA) and also a central part of the design and rationale behind accountable care organizations (ACOs), where participants earn incentives for achieving key performance goals.

In its 2012 “Incentives for Health Professionals” (IHP) report, ZS surveyed more than 4,500 health care providers and payers on the use of pay-for-performance incentives to guide provider behavior and achieve goals, such as increased patient drug compliance, decreased hospital readmission rates, efficient care coordination, and improved quality. ZS concluded most incentives, though well intentioned, neither affect behavior nor help meet health-care quality and cost goals. The goals of some ACOs may also be in jeopardy.

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