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: 4.23). 12/1998; 88(11):1699-701. DOI: 10.2105/AJPH.88.11.1699
Source: PubMed

ABSTRACT 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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    • "). Organizational-level incentives from payers are generally not distributed to individual physicians or are shared equally (Hillman et al. 1998, 1999; Kouides et al. 1998; Amundson et al. 2003; Roski et al. 2003). Some recent studies examined financial rewards based on individual physician's performance (Beaulieu and Horrigan 2005; Doran et al. 2006; Levin-Scherz, DeVita, and Timbie 2006; Gilmore et al. 2007), suggesting that even a small amount of bonuses could improve performances on incentivized measures. "
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    • "They primarily refer to the field of prevention wherein a series of measurable indicators are more likely to be achieved. Nevertheless, the conditions under which quality incentives in healthcare are effective have not been fully identified (Grady et al., 1997; Hillman et al., 1998, 1999; Town et al., 2005; Frolich et al. 2007), thereby justifying the fact that not all countries are committed to this process with the same level of intensity (Chaix-Couturier et al., 2000). In France, the legislator very recently iii manifested his interest in this type of approach, encouraging the evaluation of the legal conditions necessary for its implementation (Bras and Duhamel, 2008). "
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