| P4P For Medical Groups Stimulates Changes In Practice
A large group of California physicians given financial
incentives to improve the quality of medical care have begun to embrace
an array of changes important to advancing quality, according to a
RANDCorporation study.
Measures adopted by medical groups include speeding up
adoption of information technology such as electronic medical records,
more closely tracking the improvement of physician performance and
sharpening institutional focus on quality, according to findings
published in the March/April edition of the journal Health Affairs.
The project was supported by a grant from the California HealthCare Foundation.
"Physician groups are responding to pay-for-performance
programs by making practice changes and altering how they compensate
physicians to reward quality, but health plans and purchasers say that
those investments are not yet translating into substantial gains in
quality," said Cheryl Damberg, the study’s lead author and a
senior policy researcher at RAND, a nonprofit research organization.
"The true benefits of these programs may take more time
to be realized and it is likely that investments in other quality
efforts will be needed in addition to performance-based pay," Damberg
said.
The RAND Health study found that medical groups are
providing some payments to individual physicians based on quality
measures and physicians in the program are receiving more feedback
about whether they are attaining quality goals.
P4P programs in healthcare have grown rapidly in recent
years as a way to improve the quality of care delivered by doctors,
hospitals and other healthcare providers. Despite the rapid adoption of
these programs, there is little research about how well they work and
what types of strategies work best.
RAND researchers are evaluating a statewide
pay-for-performance program launched by the California Integrated
Healthcare Association in 2003. The initiative includes seven major
California health plans and 225 physician groups.
The groups employ 35,000 physicians who care for 6.2
million people enrolled in commercial health maintenance organizations
and point-of-service plans.
Under the program, physician groups receive financial
bonuses if they meet certain performance guidelines such as increasing
the number of patients with diabetes who receive recommended blood
tests. Other performance measures include improving patient experience
with getting care and adopting health information technology
capabilities.
Between 2003 and 2007, the participating health plans paid $203 million in incentives to participating physician groups.
The RAND study reports findings gathered from surveys of
35 medical groups, the seven health plans and representatives from two
employers that are involved in the P4P experiment.
Most of the medical groups surveyed suggested that the
program’s financial incentives – generally about $1,500 to
$2,000 annually per physician – were too small to stimulate
significant change among most doctors. They suggested the incentives
needed to be two to five times higher to achieve quality improvements.
Health plans thought increasing the incentives was a low
priority because of the relatively small qualityimprovements attained
thus far and questions about whether other types of investments might
produce greater quality gains, according to the study.
Although there is some concern that P4P might cause
physicians to drop patients who decline to follow recommendations, few
reports of such events were received. More than two-thirds of the
medical groups reported that the P4P program resulted in more positives
than negatives.
Most physician organizations said they collected more
bonus payments than they had spent to comply with the program, although
six said it was barely enough to cover their costs. Twenty of the
medical groups surveyed said the program had affected the behavior of
their individual physicians, prompting them to embrace quality efforts
such as performing more intensive outreach to patients.
Address: RAND Corporation, 1776 Main St., Santa Monica, CA 90401; (310) 393-0411, www.rand.org.
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