Physician practices in Accountable Care Organizations are more likely to collect and use physician performance information, yet base only a small proportion of compensation on performance data

Abstract

Importance It is critical to develop a better understanding of the strategies provider organizations use to improve the performance of frontline clinicians and whether ACO participation is associated with differential adoption of these tools. Objectives Characterize the strategies that physician practices use to improve clinician performance and determine their association with ACOs and other payment reforms. Data Sources The National Survey of Healthcare Organizations and the National Survey of ACOs fielded 2017‐2018 (response rates = 47 percent and 48 percent). Study Design Descriptive analysis for practices participating and not participating in ACOs among 2190 physician practice respondents. Linear regressions to examine characteristics associated with counts of performance domains for which a practice used data for feedback, quality improvement, or physician compensation as dependent variables. Logistic and fractional regression to examine characteristics associated with use of peer comparison and shares of primary care and specialist compensation accounted for by performance bonuses, respectively. Principal Findings ACO‐affiliated practices feed back clinician‐level information and use it for quality improvement and compensation on more performance domains than non‐ACO‐affiliated practices. Performance measures contribute little to physician compensation irrespective of ACO participation. Conclusion ACO‐affiliated practices are using more performance improvement strategies than other practices, but base only a small fraction of compensation on quality or cost.

Association of Primary Care Physician Compensation Incentives and Quality of Care in the United States, 2012-2016

“…8,9,32 From 2012-2016, less than 5% to 10%, on average, of primary care physicians' compensation was based on quality, patient experience, and resource utilization. [33][34][35] Thus, our findings could be consistent with the ineffectiveness of small incentives.…”

Physician Compensation Arrangements and Financial Performance Incentives in US Health Systems

“…The findings of frequent but modest incentive compensation for health system PCPs and specialists for clinical quality, patient experience, access, and other areas correspond with prior findings in various settings, both before and after adoption of the Affordable Care Act, with and without participation in accountable care organizations . It is challenging to translate risk-bearing payment arrangements and many measures of quality, utilization, or value to the individual physician level for payment purposes owing to limitations in panel sizes and reliability concerns with measuring individual physician performance .…”

“…The findings of frequent but modest incentive compensation for health system PCPs and specialists for clinical quality, patient experience, access, and other areas correspond with prior findings in various settings, both before and after adoption of the Affordable Care Act, with and without participation in accountable care organizations. 22,24,29,30 It is challenging to translate riskbearing payment arrangements and many measures of quality, utilization, or value to the individual physician level for payment purposes owing to limitations in panel sizes and reliability concerns with measuring individual physician performance. [31][32][33][34][35] The increasing intricacy of individual APM finical incentives, including risk-bearing arrangements, coupled with the cumulative complexity of incentives across payers, has been cited as a rationale for practices and POs to serve as a buffer between payers' incentives and physicians.…”

How Feedback Is Given Matters: A Cross-Sectional Survey of Patient Satisfaction Feedback Delivery and Physician Well-being

“…2 Although physicians perceive some benefits to receiving feedback, its impact on subsequent performance is limited and varies by contextual factors, including baseline performance, availability of coaching support, credibility of feedback, and feedback delivery characteristics, such as frequency, comparison to peers, and "channel"dthe source through which the feedback is delivered, such as e-mailed reports or individual performance review. 3,4 Assessment of patient satisfaction is deeply embedded in the current health care system, as achievement in this area is increasingly linked to reimbursement from payers, 2 used to evaluate individual physician performance, 3 and felt to be justified from clinical and business perspectives. 5 Evidence suggests that patients reporting high satisfaction with their physician experience improved patient outcomes and are less likely to pursue malpractice claims.…”