The Experience of Pay for Performance in English Family Practice: A Qualitative Study

Campbell, Stephen; McDonald, Ruth; Lester, Helen

doi:10.1370/afm.844

Cited by 135 publications

(196 citation statements)

References 25 publications

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“…A recent analysis of a large pay-forperformance program with family practitioners in the British National Health Service reported improved quality of care for 2 of 3 chronic conditions followed by the slowing of improvement and a reduction in continuity of care 7 as well as unintended changes in staff and practitioner-patient dynamics. 8 Overall, the aggregate evidence available is difficult to interpret because of the wide variety of interventions, target behaviors, and health care environments represented.…”

Section: Discussionmentioning

confidence: 99%

Effect of Financial Incentives on Improvement in Medical Quality Indicators for Primary Care

Gavagan¹,

Du²,

Saver³

et al. 2010

The Journal of the American Board of Family Medicine

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Purpose: The efficacy of rewarding physicians financially for preventive services is unproven. The objective of this study was to evaluate the effect of a physician pay-for-performance program similar to the Medicare Physician Quality Reporting Initiative program on quality of preventive care in a network of community health centers.Methods: A retrospective review of administrative data was done to evaluate a natural quasi-experiment in a network of publicly funded primary care clinics. Physicians in 6 of 11 clinics were given a financial incentive twice the size of the current Centers for Medicare and Medicaid Services' incentive for achieving group targets in preventive care that included cervical cancer screening, mammography, and pediatric immunization. They also received productivity incentives. Six years of performance indicators were compared between incentivized and nonincentivized clinics. We also surveyed the incentivized clinicians about their perception of the incentive program.Results: Although some performance indicators improved for all measures and all clinics, there were no clinically significant differences between clinics that had incentives and those that did not. A linear trend test approached conventional significance levels for Papanicolaou smears (P ‫؍‬ .08) but was of very modest magnitude compared with observed nonlinear variations; there was no suggestion of a linear trend for mammography or pediatric immunizations. The survey revealed that most physicians felt the incentives were not very effective in improving quality of care.Conclusion: We found no evidence for a clinically significant effect of financial incentives on performance of preventive care in these community health centers. Based on our findings and others, we believe there is great need for more research with strong research designs to determine the effects, both

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Section: Discussionmentioning

confidence: 99%

Effect of Financial Incentives on Improvement in Medical Quality Indicators for Primary Care

Gavagan¹,

Du²,

Saver³

et al. 2010

The Journal of the American Board of Family Medicine

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“…148 Incentives also reinforce the office team structure. 149 Oversight is essential to the ultimate success of a patient centered medical home system of care. The United Kingdom established the National Institute for Health and Clinical Excellence to manage incentives and define objectives of their health system.…”

Section: Reimbursement Modelsmentioning

confidence: 99%

The Medical Home: Growing Evidence to Support a New Approach to Primary Care

Rosenthal¹

2008

The Journal of the American Board of Family Medicine

446

341

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Introduction:A medical home is a patient-centered, multifaceted source of personal primary health care. It is based on a relationship between the patient and physician, formed to improve the patient's health across a continuum of referrals and services. Primary care organizations, including the American Board of Family Medicine, have promoted the concept as an answer to government agencies seeking political solutions that make quality health care affordable and accessible to all Americans.Methods: Standard literature databases, including PubMed, and Internet sites of numerous professional associations, government agencies, business groups, and private health organizations identified over 200 references, reports, and books evaluating the medical home and patient-centered primary care.Findings: Evaluations of several patient-centered medical home models corroborate earlier findings of improved outcomes and satisfaction. The peer-reviewed literature documents improved quality, reduced errors, and increased satisfaction when patients identify with a primary care medical home. Patient autonomy and choice also contributes to satisfaction. Although industry has funded case management models demonstrating value superior to traditional fee-for-service reimbursement adoption of the medical home as a basis for medical care in the United States, delivery will require effort on the part of providers and incentives to support activities outside of the traditional face-to-face office visit.Conclusions: Evidence from multiple settings and several countries supports the ability of medical homes to advance societal health. A combination of fee-for-service, case management fees, and quality outcome incentives effectively drive higher standards in patient experience and outcomes. Community/ provider boards may be required to safeguard the public interest.

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“…16 Such a process is important to prevent resentment among physicians who are unable to meet benchmarks for payment, despite hard work. 19 Conversely, other studies have found that many physicians who receive payments in a pay-for-performance system do not necessarily consciously make improvement to enhance financial performance. 20 Only 54% of eligible physicians participated in the present gainsharing program.…”

Section: Discussionmentioning

confidence: 97%

Quality and financial outcomes from gainsharing for inpatient admissions: A three‐year experience

Leitman

Levin

Lipp

et al. 2010

Journal of Hospital Medicine

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BACKGROUND:Gainsharing is a way to provide incentives to physicians to decrease hospital costs without compromising quality.METHODS:A pay‐for‐performance program was instituted over a three‐year period from July 2006 to June 2009. Baseline length of stay (LOS) and case costs were developed during the year prior to the inception of the program. Best practice norms (BPNs) were established at the top 25th percentile of physicians for each all patient refined (APR)‐diagnosis related group (DRG). Hospital costs were analyzed in several areas, including operating room charge (OR), supplies and implants, nursing and per‐diem room costs. Payments were based upon case level performance compared to BPN's and the physician's historic performance. Eligible cases included commercial insurance only for the first 2 years but Medicare cases were included after October 2008 resulting from a Centers for Medicare and Medicaid Services (CMS)‐approved demonstration project. Payments to physicians required meeting quality thresholds, including chart completion, and compliance with core measures.RESULTS:A total of 184 (54%) physicians enrolled into the program. There was a $25.1 million reduction in hospital costs during the 3 years ($16 million from participating and $9.1 million from non‐participating physicians, P < 0.01). Most cost reductions were attributed to reduced LOS and reductions in medical supply costs. Total physician payouts were over $2 million (average $1,866 per quarter). Delinquent medical records decreased from an average of 43% in the second quarter 2006 to 30% (P < 0.0001) in the second quarter 2009. Quality measures improved during the study period but not by a statistical significance.CONCLUSIONS:Gainsharing provided an incentive for physicians to reduce hospital costs while maintaining hospital quality. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine.

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The Experience of Pay for Performance in English Family Practice: A Qualitative Study

Cited by 135 publications

References 25 publications

Effect of Financial Incentives on Improvement in Medical Quality Indicators for Primary Care

Effect of Financial Incentives on Improvement in Medical Quality Indicators for Primary Care

The Medical Home: Growing Evidence to Support a New Approach to Primary Care

Quality and financial outcomes from gainsharing for inpatient admissions: A three‐year experience

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