Payment Incentives Can Boost Care, but Long-Term Strategies Needed
Financial incentives can encourage physicians to provide higher quality care to their patients, but the additional money might not be enough to significantly improve care over the long term, according to a study published Wednesday in the Journal of the American Medical Association, the Los Angeles Times' "Science Now" reports.
For the study, researchers followed physicians at 12 Department of Veterans Affairs outpatient clinics and focused on how well they followed recommended care guidelines for patients with high blood pressure, a common chronic condition that requires physicians to establish a clear monitoring and communication plan with patients. The physicians were placed into four groups.
Physicians in three groups received the additional payments based on certain criteria, while the fourth -- which served as the control group -- did not receive the payments.
Of the three groups that received incentive payments:
- Physicians in one group were incentivized individually if they improved how they treated their patients with high blood pressure;
- Physicians in a second group received the additional payment if their entire practice improved; and
- Physicians in the third group were eligible for both the individual and group incentives.
According to "Science Now," the researchers asserted that the financial incentives were not offered to "coerce" the physicians to be more attentive to their patients, adding that the additional money was meant to help the physicians overcome "clinical inertia" and "increase their interest in" managing their patients' care (Kaplan, "Science Now," Los Angeles Times, 9/11).
The study found that the individual incentives -- $2,672 per doctor on average -- helped spur a significant change in the physicians' performance. Meanwhile, group payments -- $1,648 on average -- and combined group and individual payments -- $4,270 on average -- did not lead to significant changes in performance (Evans, Modern Healthcare, 9/11).
More specifically, the study found that physicians who were eligible for individual payments increased the proportion of patients receiving enhanced care from 75% to 84%, while those who were eligible for practice-wide incentives increased it from 80% to 85% and those eligible for combined group and individual incentives rose from 79% to 88%. The study also found that extra payments to physician groups were not associated with improved outcomes.
When the payments ended, the enhanced care declined, according to the researchers ("Science Now," Los Angeles Times, 9/11).
Study co-author Laura Petersen -- a professor at the Baylor College of Medicine and director of the Houston VA Health Services and Development Center of Excellence -- noted that financial incentives might not be enough to significantly improve care in the long term, adding that "payment-system interventions are only one piece of the solution to improve management of chronic diseases." She also called for "[m]ore resource-intensive, tailored, patient-level self-management strategies" in order to "truly affect patient outcomes" (Modern Healthcare, 9/11).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.