Paying doctors based on how well their patients did and paying them more to treat high-risk patients produces better outcomes than traditional fee-for-service compensation.
Paying doctors based on how well their patients did and paying them more to treat high-risk patients because of multiple problems or socioeconomic factors produced better outcomes than traditional fee-for-service compensation, a new study finds.
The study, conducted by researchers at the University of California, San Francisco and the New York City Department of Health and Mental Hygiene, sought to see whether pay-for-performance in small practices where most U.S. residents receive care, produced better results. Researchers used randomized group of small primary care clinics in New York that had all been given identical electronic health record software that included decision support and patient registry functions with quality improvement specialists offering technical assistance.
The clinics working under pay-for-performance incentives were paid more for each patient whose care met specified performance criteria, such as providing preventive health care and reducing long-term health risks, such as heart attack and stroke. The program rewarded physicians successful in preventive health care to reduce long-term risks of heart attack and stroke — for instance, in blood pressure control and aspirin prescription for those who need it.
To avoid concern that pay-for-performance programs discourage doctors from treating difficult patients, the doctors were given higher payments for patients with co-morbidities, who had Medicaid insurance, or who were uninsured.
“Pay-for-performance programs shift the focus from basic care delivery to high quality care delivery,” says first author Naomi Bardach, assistant professor in the UCSF Department of Pediatrics. “So they are designed to incentivize people to improve care.”
The study, published in the Sept. 11 issue of JAMA, compared a randomized cluster of clinics that operated under the pay-for-performance incentives to a similar group of clinics compensated in a traditional fee-for-service arrangement from April 2009 through March 2010. The incentivized clinics showed improvements of 9.7% to 9% of patients meeting pre-established goals compared to 4.3% to 1.2% for the fee-for-service clinics.
Bardach notes that such improvements are meaningful because the rates of such things as blood pressure control were so low to begin with that only 10% to 16% of patients with diabetes had normal blood pressure control. As such, an improvement of even 5% of patients is relatively large.
“This is a high-risk population for heart attack and stroke and so getting their blood pressure under control will make a difference,” she says.
Bardach says further research is needed to determine whether or not this trend can continue over time.
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