Physician pay-for-performance programs are gaining popularity across the country as ways to promote better healthcare quality. But a new study from the University of California, Los Angeles, has found that not all programs operate with the same goals and that the ultimate success of the programs depends on how the rewards are actually used.
The UCLA study found that patient care performance ratings for 25 medical groups across California showed meaningful improvement overall following the launch of a statewide pay for performance program in 2004, according to the study appearing in the December issue of the Journal of General Internal Medicine.
Study author Hector Rodriguez, assistant professor in the department of health services at the UCLA School of Public Health, and his colleagues, determined that financial incentives used for the purpose of improving patient care—in combination with public reporting of medical group performance ratings—had a positive impact on patient care experiences. However, these incentives could cause a negative impact, as well.
In the process of finding out how medical group performance ratings changed over time, the researchers observed that the ratings of specific measures representing three broad categories—physician communication, care coordination, and office staff interactions—improved during the period right after the start of a pay for performance program. For the study, researchers looked at information collected from 124,021 patients of 1,444 primary care physicians between 2003 and 2006.
When the incentives were aimed at addressing the quality of patient clinician interactions, the overall experience of patient care tended to result in improved performance in those three categories. This was true—especially when additional funds were used by medical groups to positively reinforce a patient centered work culture, according to the study.
However, the researchers found that the greatest improvements were found among those groups that placed less emphasis on physician productivity—and greater emphasis on clinical quality and patient experience. When financial incentives were paid directly to physicians—rather than being used more broadly- they found that putting too much emphasis on physician productivity actually had a negative impact on the experiences patients had when visiting their primary care provider.
Keeping in mind the current healthcare debate on Capitol Hill, Rodriguez said that quality improvement and reimbursement reform efforts "should integrate patient reported experiences of care as a central metric for evaluating reform effects."