|P4P Programs Help Improve Care – Most Of The Time, Study Finds
Everyone enjoys a pay raise for a job well done –
physicians are no exception – but in some instances, financial
incentives for healthcare performance may actually backfire.
That’s the conclusion of a UCLA study, showing
that patient-care performance ratings for 25 medical groups across
California improved significantly following the launch of a statewide
patient-care performance in 2004. Incentives focusing on doctor
productivity were a different matter.
Hector P. Rodriguez, assistant professor in UCLA’s
School of Public Health and his colleagues found evidence that certain
kinds of financial incentives for the purpose of improving patient
care, in combination with public reporting of medical group performance
ratings, have a positive effect on patient care experiences. They also
found that some types of incentives may have a negative overall impact
on how patients experienced their care.
Rodriguez looked at how medical group performance
ratings changed over time and found that ratings in specific measures,
representing three broad categories – physician communication,
care coordination and office-staff interactions – improved
substantially during the period after the start of the Integrated
Healthcare Association’s (IHA) patient-care performance program.
Incentives for addressing the quality of
patient-clinician interaction and the overall experience of patient
care tended to result in improved performance in those areas,
especially when the additional funds were used broadly by medical
groups to positively reinforce a patient-centered work culture.
The greatest improvements were seen within those groups
that placed less emphasis on physician productivity and greater
emphasis on clinical quality and patient experience. Within groups
where financial incentives were paid directly to physicians, Rodriguez
found that placing too much emphasis on physician productivity actually
had a negative impact on the experiences patients had when visiting
their primary care physician.
Medical groups were free to use the additional funds in
various ways, with some groups paying incentives directly to physicians
and others using the incentives more broadly, focusing on
organizational priorities. The groups also participated in a public
reporting program in which ratings in two of the three broad categories
were released annually to the public in the form of a "healthcare
report card" comparing the performance of the medical groups and
insurers to one another.
Rodriguez’s research team based its findings on
information collected from 124,021 patients of 1,444 primary care
physicians at 25 California medical groups between 2003 and 2006. It
conducted interviews with group medical directors to determine how
financial incentives were used. All 25 groups, which represent six
insurers, were awarded financial incentives for achievements in the
broad categories of clinical care processes, patient care experiences
and office-based information systems, in accordance with IHA’s
Rodriguez’s report was published in the Journal of General Internal Medicine
Ted von Glahn, of the Pacific Business Group on Health,
in San Francisco was the principal investigator on the study. The
research was funded by the Commonwealth Fund. The researchers report no
conflict of interest.
Address: UCLA School of Public Health, 650 Charles E.
Young Drive S., Room 16-035, Center for Health Sciences, Los Angeles,
CA 90095-1772; www.ph.ucla.edu.