Doctors and Nurses

Pay-for-performance and public reporting programs aimed at improving quality among physicians unintentionally could increase social disparities if they are not carefully designed, according to a study in Health Affairs.

The researchers found that both pay-for-performance and public quality reporting programs might adversely affect physicians' income in minority communities, particularly low-income communities. The authors also found that public reporting might benefit affluent or more educated patients, who have greater access to reporting tools than low-income or uneducated patients.

The authors outlined six program design elements for reducing such disparities:

• Provide incentives for both absolute quality scores and improvement over time;
• Use risk adjustment or stratified analyses;
• Reward overall quality and reduction in disparities;
• Measure quality using a variety of methods to avoid having physicians focus on some practices while dropping others;
• Use pay-for-performance and public reporting programs only when statistically reliable and valid measurements are available; and
• Measure effects on disparities of the pay-for-performance or public reporting program.