Physician Payments Rarely Tied to Care Quality, Study Finds
For the study, researchers surveyed 632 physician practices.
The study found physician pay practices vary widely, including a combination of salary, fees for services and rewards for quality. Doctors who worked for accountable care organizations and those who worked for more traditional practices had wide variance in payment practices.
The researchers also found a modest link between physicians' incomes and the quality of care they provide. This was true even of doctors who worked at ACOs that aimed to improve patient care by driving down costs. Physicians who worked for ACOs had two percentage points more of their incomes linked to care quality than doctors in traditional practices.
Under the Affordable Care Act, ACOs compensate physicians based on the quality of care they deliver to Medicare beneficiaries, the "Wonkblog" reports. However, Mark Friedberg, a senior natural scientist at RAND Corporation, noted physicians at ACOs also treat patients who are not Medicare beneficiaries and have more traditional insurance reimbursement structures. Therefore, a change in one payment model would be unlikely to have a widespread effect on how care is delivered.
Lead study author Andrew Ryan, a health economist at the University of Michigan School of Public Health, said, "I think it points to a potential problem: that these incentives aren't getting translated to individual physicians."
Friedberg said the research confirms a growing body of evidence that shows few physicians are receiving financial incentives from their organizations. He said this is because patients' medical needs are "noisy" and can change drastically from year to year. Friedberg said, "You’re going to be penalizing and rewarding physicians almost entirely due to noise." Instead, his own research suggests physicians receive "soft" incentives not tied to compensation (Johnson, "Wonkblog," Washington Post, 7/20).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.