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.
The study concluded that although programs designed to reduce unintended disparities are more costly and time-consuming, overall they will see more success and less backlash from physicians and patients (Casalino/Elster, Health Affairs, 4/10). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.