Physician Financial Incentives and Feedback: Failure to Increase Cancer Screening in Medicaid Managed Care

University of Pennsylvania, Philadelphia, USA.
American Journal of Public Health (Impact Factor: 4.55). 12/1998; 88(11):1699-701. DOI: 10.2105/AJPH.88.11.1699
Source: PubMed


A randomized controlled trial evaluated the impact of feedback and financial incentives on physician compliance with cancer screening guidelines for women 50 years of age and older in a Medicaid health maintenance organization (HMO).
Half of 52 primary care sites received the intervention, which included written feedback and a financial bonus. Mammography, breast exam, colorectal screening, and Pap testing compliance rates were evaluated.
From 1993 to 1995, screening rates doubled overall (from 24% to 50%), with no significant differences between intervention and control group sites.
Financial incentives and feedback did not improve physician compliance with cancer screening guidelines in a Medicaid HMO.

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Available from: Edward J. Lusk, May 27, 2014
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    • "All of these RCTs are based on small scale experiments involving fewer than a hundred physicians or practices. One study (Hillman et al. 1998) involved only 52 physician practices in total. As a result, the effect size might not be statistically identified due to the lack of power. "
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    ABSTRACT: This study exploits a natural experiment in the province of Ontario, Canada, to identify the impact of pay-for-performance (P4P) incentives on the provision of targeted primary care services and whether physicians' responses differ by age, size of patient population, and baseline compliance level. We use administrative data that cover the full population of Ontario and nearly all the services provided by primary care physicians. We employ a difference-in-differences approach that controls for selection on observables and selection on unobservables that may cause estimation bias. We implement a set of robustness checks to control for confounding from other contemporaneous interventions of the primary care reform in Ontario. The results indicate that responses were modest and that physicians responded to the financial incentives for some services but not others. The results provide a cautionary message regarding the effectiveness of employing P4P to increase the quality of health care. Copyright © 2013 John Wiley & Sons, Ltd.
    Health Economics 08/2014; 23(8). DOI:10.1002/hec.2971 · 2.23 Impact Factor
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    • "Many studies have looked at these types of financial incentive schemes. One study considered the impact of such a scheme on hemoglobin testing in California,12 while others have looked at pathway compliance under financial incentives in a Medicaid health maintenance organization.13,14 Further studies analyzed the effects of P4P for diabetes care in a managed care organization in upstate New York;15 and evaluated the impact of using financial incentives for providing smoking cessation advice in a large medical group practice in the United States (US).16 "
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    ABSTRACT: Increasingly, financial incentives are being used in health care as a result of increasing demand for health care coupled with fiscal pressures. Financial incentive schemes are one approach by which the system may incentivize providers of health care to improve productivity and/or adapt to better quality provision. Pay for performance (P4P) is an example of a financial incentive which seeks to link providers' payments to some measure of performance. This paper provides a discussion of the theoretical underpinnings of P4P, gives an overview of the health P4P evidence base, and provide a detailed case study of a particularly large scheme from the English National Health Service. Lessons are then drawn from the evidence base. Overall, we find that the evidence for the effectiveness of P4P for improving quality of care in primary care is mixed. This is to some extent due to the fact that the P4P schemes used in primary care are also mixed. There are many different schemes that incentivize different aspects of care in different ways and in different settings, making evaluation problematic. The Quality and Outcomes Framework in the United Kingdom is the largest example of P4P in primary care. Evidence suggests incentivized quality initially improved following the introduction of the Quality and Outcomes Framework, but this was short-lived. If P4P in primary care is to have a long-term future, the question about scheme effectiveness (perhaps incorporating the identification and assessment of potential risk factors) needs to be answered robustly. This would require that new schemes be designed from the onset to support their evaluation: control and treatment groups, coupled with before and after data.
    Risk Management and Healthcare Policy 07/2014; 7. DOI:10.2147/RMHP.S46423
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    • "In addition, one recent prospective study found that a delay as short as 1 week compromised the influence of a relatively high-magnitude incentive on behavior.57 Yet, many incentive-based interventions involve delays of several weeks or months between target behavior and incentive delivery.66,98,153,154 "
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    ABSTRACT: Behavior plays an important role in health promotion. Exercise, smoking cessation, medication adherence, and other healthy behavior can help prevent, or even treat, some diseases. Consequently, interventions that promote healthy behavior have become increasingly common in health care settings. Many of these interventions award incentives contingent upon preventive health-related behavior. Incentive-based interventions vary considerably along several dimensions, including who is targeted in the intervention, which behavior is targeted, and what type of incentive is used. More research on the quantitative and qualitative features of many of these variables is still needed to inform treatment. However, extensive literature on basic and applied behavior analytic research is currently available to help guide the study and practice of incentive-based treatment in health care. In this integrated review, we discuss how behavior analytic research and theory can help treatment providers design and implement incentive-based interventions that promote healthy behavior.
    Psychology Research and Behavior Management 03/2014; 7:103-114. DOI:10.2147/PRBM.S59792
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