- The Washington Times - Tuesday, October 11, 2005

Doctors who participated in a pay-for-performance program improved their quality of care at a faster rate than doctors on a regular payment system, according to a report released today.

But physicians in the plan who already were meeting clinical standards primarily maintained their current patient-care quality to get the extra money without actually improving, according to the report.

“This study shows we still have some questions that need to be asked on what we can expect from pay-for-performance programs,” said Dr. Anne-Marie Audet, quality improvement vice president at the Commonwealth Fund.

The New York health research organization funded the report, which was released in today’s issue of the Journal of the American Medical Association (JAMA).

The report is considered to be the first comparison of pay-for-performance payment systems and regular reimbursement plans for doctors.

Recent surveys estimated that 100 pay-for-performance plans, which link doctors’ pay with meeting certain standards in patient care, are being used nationwide. The plans are administered by health insurers, medical groups and some government agencies.

The JAMA study tracked about 200 physician groups, which were part of a pay-for-performance program or a regular payment system provided by Cypress, Calif., health insurer PacifiCare Health Systems Inc.

Doctors were measured on the clinical quality of providing cervical-cancer screenings, mammographies and hemoglobin-A testing from October 2001 through April 2004.

The study found that clinical quality improved mostly at a higher rate for doctors who were paid bonuses for meeting certain quality standards.

Cervical-cancer screenings improved 5.3 percent for doctors who were part of the bonus incentive program. Doctors in a regular payment plan improved 1.7 percent in their cancer screenings at the same time.

Pay-for-performance doctors improved quality for mammographies by 1.9 percent, while other doctors increased quality by 0.2 percent. Hemoglobin-A testing improved at the same rate for both groups, 2.1 percent, according to the report.

PacifiCare’s Chief Medical Officer Dr. Sam Ho called the results a “clear signal” to expand the company’s current incentive program, which is used only in California, to other states including Oregon, Washington, Arizona, Texas and Colorado.

Physician groups that showed the most improvement were initially those with the lowest-quality ratings, according to the report.

“I didn’t expect those groups to respond that way, given their target was so far away and there was little chance of them getting the money without doing something radical,” said Meredith Rosenthal, one of the study’s authors and an assistant professor at Harvard’s School of Public Health.

But the bonus incentives did not push doctors who already were meeting clinical standards to raise the quality of patient care, Ms. Rosenthal said.

Doctors who already were performing at or above the standards captured about 75 percent of bonus payments despite their limited improvement over time, according to the report.

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