Physician financial incentives: use of quality incentives inches up, but productivity still dominates.

Issue brief (Center for Studying Health System Change) 02/2007;
Source: PubMed

ABSTRACT 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.

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    ABSTRACT: Objectives: To estimate: (1) the percentage of physicians whose compensation is variable; (2) the frequency at which performance incentives for productivity, care quality, patient satisfaction, and resource use were used to determine compensation; and (3) how much incentives differ for physicians who serve greater percentages of patients who are Medicaid-insured, racial/ethnic minorities, or who face language barriers, versus those who do not. Study Design: Cross-sectional study of 3234 nationally representative physicians responding to the 2008 Center for Studying Health System Change's Health Tracking Physician Survey (HTPS). Methods: We examined the degree to which practices' percentage of Medicaid revenues and physicians' panel characteristics were associated with physicians' financial incentives using x2 statistics and multivariate logistic regression (adjusting for physician specialty, practice type, and capitation levels, and area-based factors). Results: Compensation was variable for 69% of respondents, was most frequently tied to productivity (68%), and less often to care quality (19%), patient satisfaction (21%), or resource use (14%). Physicians were significantly less likely to report variable compensation if the percentage Medicaid revenues was 50% or more (adjusted odds ratio [OR] 0.73, 95% confidence interval [CI], 0.57-0.95) or if physician panels were at least 50% Hispanic (adjusted OR 0.74, 95% CI, 0.56-0.99). However, physicians were significantly more likely to report use of all 4 performance incentives if percentage of Medicaid revenues was 6% to 24%. Conclusions: Physicians report different types of financial incentives designed to alter care quality and quantity; incentive types differ by the degree that practices derive revenues from Medicaid or serve Hispanic patients. Further investigation is needed to understand how to align financial incentives with disparity-reduction efforts.
    The American journal of managed care 02/2014; 20(2):121-9. · 2.17 Impact Factor
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    ABSTRACT: This study examines the use of non-financial performance measures in physician compensation contracts. Based on agency theory, we develop hypotheses predicting that such measures are more likely to be used in settings in which the measures are more informative, when alternative control mechanisms are complements rather than substitutes to non-financial performance measures, and when external pressures for quality of care and cost-containment are greater. We test these hypotheses based on a national survey of physicians administered four times over the 1996 to 2005 period. Our tests lead to the conclusion that non-financial performance measures play a significant role in physician compensation, acting to balance other incentives based purely on individual productivity. We also provide evidence that physician ownership of the practice, more prevalent in small practices, serves as a substitute for non-financial performance measures, thereby reducing their role.
    SSRN Electronic Journal 08/2008; DOI:10.2139/ssrn.1196489
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    ABSTRACT: PURPOSEThe cost of cancer care continues to increase at an unprecedented rate. Concerns have been raised about financial incentives associated with the chemotherapy concession in oncology practices and their impact on treatment recommendations. METHODS The objective of this study was to measure the physician-reported effects of prescribing chemotherapy or growth factors or making referrals to other cancer specialists, hospice, or hospital admissions on medical oncologists' income. US medical oncologists involved in the care of a population-based cohort of patients with lung or colorectal cancer from the Cancer Care Outcomes Research and Surveillance (CanCORS) study were surveyed regarding their perceptions of the impact of prescribing practices or referrals on their income.ResultsAlthough most oncologists reported that their incomes would be unaffected, compared with salaried oncologists, physicians in fee-for-service practice, and those paid a salary with productivity incentives were more likely to report that their income would increase from administering chemotherapy (odds ratios [ORs], 7.05 and 7.52, respectively; both P < .001) or administering growth factors (ORs, 5.60 and 6.03, respectively; both P < .001). CONCLUSIONA substantial proportion of oncologists who are not paid a fixed salary report that their incomes increase when they administer chemotherapy and growth factors. Further research is needed to understand the impact of these financial incentives on both the quality and cost of care.
    Journal of Clinical Oncology 12/2012; 31(5). DOI:10.1200/JCO.2012.43.6063 · 17.88 Impact Factor