Results from a national survey designed to gauge physician support for pay-for-performance programs and public reporting of quality scores found that general internists support the use of financial incentives to improve patient care, but they oppose public reporting and are concerned about unintended consequences.
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National Survey Results
Internists Weigh In on Pay-For-Performance, Public Reporting
By News Staff
The survey, "General Internists’ Views on Pay-For-Performance and Public Reporting of Quality Scores: A National Survey," appears in the March/April issue of Health Affairs. An abstract of the survey is available free online. Nonsubscribers may order the full article at a cost of $12.95.
Researchers from the University of Chicago conducted the survey in 2005. "We found a sizable reservoir of potential physician support, in principle, for financial incentives to improve care," said the study's lead author, Lawrence Casalino, M.D., Ph.D., assistant professor of health studies at the University of Chicago, in a March 6 press release. "But we also found a good deal of mistrust and concern about how such incentives would be assessed and applied and how the applications might alter access to care for high-risk or disadvantaged patients."
Survey responses from 556 physicians showed that many lacked confidence in the development of fair and accurate quality indicators and feared that flawed quality assessments would prompt physicians to screen out high-risk patients.
One survey respondent wrote, "I have 10-15 patients whom I would have to fire. The poor, unmotivated, obese and noncompliant would all have to find new physicians."
Specifically, survey results showed that
Researchers from the University of Chicago conducted the survey in 2005. "We found a sizable reservoir of potential physician support, in principle, for financial incentives to improve care," said the study's lead author, Lawrence Casalino, M.D., Ph.D., assistant professor of health studies at the University of Chicago, in a March 6 press release. "But we also found a good deal of mistrust and concern about how such incentives would be assessed and applied and how the applications might alter access to care for high-risk or disadvantaged patients."
Survey responses from 556 physicians showed that many lacked confidence in the development of fair and accurate quality indicators and feared that flawed quality assessments would prompt physicians to screen out high-risk patients.
One survey respondent wrote, "I have 10-15 patients whom I would have to fire. The poor, unmotivated, obese and noncompliant would all have to find new physicians."
Specifically, survey results showed that
- nearly 75 percent of respondents wanted physicians to receive financial incentives for accurate quality measures;
- slightly more than 30 percent of those surveyed supported public reporting of individual physicians' quality scores, but that percentage rose to 45 percent for the reporting of medical groups' quality performance;
- only 30 percent of respondents considered then-current quality measures to be accurate;
- 85 percent of responding physicians said quality measures were not adequately adjusted for patients' socioeconomic status;
- 38 percent of those surveyed said health plans would try hard to make measures accurate, and 35 percent thought the government would do so;
- more than 60 percent of physicians surveyed said measuring quality would divert physicians' attention from important types of care for which quality is not measured; and
- 82 percent of respondents said measuring quality could lead physicians to shun high-risk patients.
Study authors concluded that although pay-for-performance programs are proliferating, "their features are not yet locked into place. Giving serious consideration to physician views might help policy-makers design programs to have as positive an effect as possible on the quality of heath care."
The national survey was supported by grants from the CDC and the Chicago Center of Excellence in Health Promotion Economics.
The national survey was supported by grants from the CDC and the Chicago Center of Excellence in Health Promotion Economics.
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