Financial incentives for physicians mean better care for patients

Apr 21 2007

Financial incentives for physicians mean better care for patients, according to a six-year study of a large preferred provider organization in Hawaii.

Researchers led by Amanda Gilmore, M.P.H., set out to determine if patients who saw physicians participating in a quality-based incentive program were more likely to receive recommended care compared to patients who saw physicians who did not participate.

The team evaluated 11 indicators of health care quality that included breast cancer screening, colorectal cancer screening, childhood immunizations and use of long-term control drugs for asthma.

The study found a consistent association between a PPO patient being seen by a physician enrolled in the incentive program and that patient receiving recommended care. Studies of physician incentive programs in health maintenance organizations, or HMOs, have found similar results.

“It was interesting that the favorable results did not demonstrate themselves until two or three years into the program,” said Gilmore, a senior health services researcher with Health Benchmarks, Inc., of Woodland Hills, Calif.

The study appears in the latest online issue of Health Services Research .

The PPO that was evaluated is run by Hawaii Medical Service Association (Blue Cross Blue Shield of Hawaii), an insurer that covers roughly half of all Hawaiians. More than 65 percent of HMSA members are in its PPO.

Physicians in the incentive program, which was voluntary, were given a financial reward based on how they compared to other participating practitioners in the use of the quality indicators. The amounts ranged from 1 percent to 7.5 percent of the physician's base professional fees and the average payment increased from $2,428 to $4,785 over the study period.

The study is a good one and its strength is that it includes so many health care providers and involves a big patient population, lending greater validity to its results, said Paul Rowan, Ph.D., assistant professor at the University of Texas School of Public Health in Houston.

Two of Gilmore's co-authors are employees of Hawaii Medical Service Association, the study discloses. The association reviewed the manuscript before submission for publication and contributed information about the program and administrative data for analysis, but had no influence over study design, analysis or manuscript write-up.

Health Services Research is the official journal of AcademyHealth and is published by Blackwell Publishing on behalf of the Health Research and Educational Trust. Contact Jennifer Shaw, HSR Business Manager, at (312) 422-2646 or [email protected] . HSR is available online at http://www.blackwell-synergy.com/loi/hesr .

Gilmore AS, et al. Patient outcomes and evidence-based medicine in a PPO setting: a six-year evaluation of a physician pay-for-performance program. Health Serv Res online, 2007.