More than three in four primary care physicians favor pay-for-performance programs if quality measures are accurate, according to a survey by researchers at the University of Chicago. But most physicians believe that neither health payers nor the government would “try hard to make such measures accurate” and there is little confidence this will change, researchers found.
Researchers also found that only 32 percent of physicians support public reporting of the individual physician's quality scores, while only 45 percent support public reporting of quality scores on the medical group level, even if the measures involved are accurate.
The researchers surveyed 1,168 randomly selected general internists, with 48 percent completing the seven-page questionnaire. The results were published yesterday in the March/April issue of the academic journal Health Affairs.
Study author Dr. Lawrence Casalino, an assistant professor of health studies at the University of Chicago, said he was surprised at the level of physician support for using financial incentives to improve care. But, he added, physicians also believe that unless pay-for-performance and public reporting programs are designed properly, doctors could end up shunning sick, poor or noncompliant patients and neglecting unmeasured but equally important areas of quality.
“There’s a real fear of unintended consequences,” said Casalino, noting that survey respondents wrote in “some pretty sharp comments” at the end of the survey.
For example, one physician wrote: “I have 10 to 15 patients whom I would have to fire. The poor, unmotivated, obese and noncompliant would all have to find new physicians.”
Such concerns need to be addressed, according to Casalino, or physician support for pay for performance could be undermined quickly. Potential remedies, he said, include allowing risk adjustments not just for how sick the patient is, but also for their race, ethnicity and socioeconomic status; rewarding practices that care for large numbers of at-risk patients; and letting practices exclude a certain number of patients with a given condition, as they currently do in Great Britain as part of a large pay-for-performance program.
On a more positive note, the strong support for pay-for-performance programs bodes well for the adoption of health information technology in physician practices, Casalino said, although the survey did not directly question physicians on that issue. “If having information technology or electronic medical records would enable a physician’s office to score higher on quality measures, then it would definitely encourage the uptake of clinical IT,” he said.
From the battlefield to the home front: Managing medical data
Government Health IT presents Col. Claude Hines Jr., program manager for the Defense Health Information Management System, in this recent InSight eSeminar. Col. Hines discusses the health information technology and tactical challenges faced by the military medical community in Iraq, Afghanistan and other areas of conflict. In doing so, he describes the current information technology solutions for transferring clinical data between battlefield care givers to health care personnel at military treatment facilities worldwide.
