The proportion of physicians in group practice whose compensation is based in part on quality measures increased from 17.6 percent in 2000-01 to 20.2 percent in 2004-05, according to a new national study from the Center for Studying Health System Change (HSC). Despite this small but statistically significant increase, quality-related physician compensation is much less common than financial incentives tied to physicians' individual productivity, which has consistently affected 70 percent of physicians in non-solo practice since 1996-97. Examining the trend in quality-related physician compensation since 1996-97 suggests that quality incentives are most prevalent among primary care physicians and in large practices that receive a substantial share of revenue from capitated payments, or fixed per patient, per month payments.
[Show abstract][Hide abstract] ABSTRACT: Despite the proliferation of clinical practice guidelines (CPGs), physicians have been slow to adopt them.
Describe changes in the reported effect of CPGs on physicians' clinical practice over the past decade, and identify the practice characteristics associated with those changes.
Longitudinal and cross-sectional analyses of rounds 1-4 of the Community Tracking Study Physician Survey, a nationally representative survey, conducted periodically between 1996 and 2005.
The cross-sectional outcome was the reported effect of CPGs on the physician's practice (very large, large, moderate, small, very small, and no effect). The longitudinal outcome was the change in reported effect of CPGs between two consecutive rounds for panel respondents. Independent variables included changes in physicians' practice characteristics (size, ownership, capitation, availability of information technology (IT) to access guidelines, whether quality measures and profiling affect compensation, and revenue sources).
The proportion of primary care physicians reporting that CPGs had a very large or large effect on their practice increased significantly from 1997 to 2005, from 16.4% to 38.7% (P < .0001). The corresponding change for specialists was 18.9% to 28.2% (P < .0001). In longitudinal multivariate analyses, practice characteristics associated with an increase in effect of CPGs included acquiring IT to access guidelines, an increase in the impact that quality measures and profiling have on compensation, and an increase in the proportion of practice revenue under capitation or derived from Medicaid.
Promotion of wider adoption of health IT, and financial incentives linked to validated quality measures, may facilitate further growth in the impact of CPGs.
Journal of General Internal Medicine 07/2007; 22(6):742-8. DOI:10.1007/s11606-007-0155-y · 3.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Pay-for-performance (P4P) initiatives have been discussed since the early 1990s, but support for the concept has grown recently, fueled by experience with quality of care measures, endorsements by key players and research that underlines the need for quality improvements and reform to the physician payment system. This synthesis examines the evidence on P4P. Key findings include: About one-third of U.S. physicians already face quality-based incentives under their managed care contracts. These measures most often relate to clinical targets, efficiency, patient satisfaction and use of information technology, but apply to a limited set of specific diseases and preventive care services. While 80 percent of plans pay for meeting benchmarks, 20 percent pay for improvements in performance. Overall, incentive payments are small, averaging at most 5 percent of total payments. While large-scale, "real-life" research consistently shows improvement in quality indicators when P4P is in place, it is hard to disentangle the impact of P4P from that of other simultaneous quality initiatives. Evidence of P4P impact from small controlled studies has not been positive. Doctors are generally supportive of P4P but concerned about how well it can be implemented.
The Synthesis project. Research synthesis report 12/2007;
[Show abstract][Hide abstract] ABSTRACT: This paper provides a descriptive analysis of the remuneration of doctors in 14 OECD countries for which reasonably comparable data were available in OECD Health Data 2007 (Austria, Canada, the Czech Republic, Denmark, Finland, France, Germany, Hungary, Iceland, Luxembourg, Netherlands, Switzerland, the United Kingdom and the United States). Data are presented for general practitioners (GPs) and medical specialists separately, comparing remuneration levels across countries both on the basis of a common currency (US dollar, adjusted for purchasing power parity) and in relation to the average wage of all workers in each country.
Ce document de travail présente une analyse descriptive de la rémunération des médecins dans 14 pays de l’OCDE pour lesquels on trouve des données raisonnablement comparables dans Eco-santé OCDE 2007 (Allemagne, Autriche, Canada, Danemark, États-Unis, Finlande, France, Hongrie, Islande, Luxembourg, Pays-Bas, République tchèque, Royaume-Uni et Suisse). Les données sont présentées séparément pour les généralistes (omnipraticiens) et les spécialistes. La comparaison des niveaux de rémunération entre pays est faite sur la base d’une monnaie commune (le dollar américain, ajusté pour la parité des pouvoirs d’achat), ainsi qu’en rapport avec le salaire moyen de l’ensemble des travailleurs dans chacun des pays.
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