The Impact of Financial Incentives on Physician Productivity in Medical Groups

Conrad, Douglas A.; Sales, Anne E.; Liang, Su‐Ying; Chaudhuri, Anoshua; Maynard, Charles; Pieper, Lisa E.; Weinstein, Laurel; Gans, David N; Piland, Neill F.

doi:10.1034/j.1600-0560.2002.57.x

Cited by 71 publications

(62 citation statements)

References 18 publications

(27 reference statements)

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“…Interestingly, the empirical literature has found mixed results when it comes to what factors are endogenous in these sorts of problems. For instance, Conrad et al (2002) argue that physician direct patient-care hours, group size monitoring and organizational-level financial risk variables are potentially endogenous. However, they could not reject the null hypothesis that financial incentive and the organizational design features were exogenous in their study and conclude that the OLS procedure is appropriate.…”

Section: Theoretical Underpinnings and Econometric Issuesmentioning

confidence: 99%

Physician's production of primary care in Ontario, Canada

2009

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This paper examines the factors affecting the number of patient visits per week reported by family physicians in Ontario. The way that a physician is paid is potentially endogenous to the number of patients seen per week, thus an instrumental variable method of estimation is employed to account for the endogeneity bias. Once account is taken of the endogeneity of remuneration as well as relevant physician and practice characteristics, the estimated elasticity of output with respect to hours worked is 0.74; 0.68 in group practices and 0.82 in solo practices. Physicians paid on a non-fee-for-service (NFFS) conduct 15-31% fewer patient visits per week in comparison to those paid under an FFS scheme. Certain patient populations in practices affect patient visits in important ways, as do a number of physician and practice characteristics.

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Section: Theoretical Underpinnings and Econometric Issuesmentioning

confidence: 99%

Physician's production of primary care in Ontario, Canada

2009

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“…Incentives have been used widely in ambulatory medical care to increase visit productivity. 1 Productivity rates are often benchmarked to Medical Group Management Association standards for physicians via use of individual production-based compensation formulae. In recent years, there has been growing interest in applying this methodology to increase performance of physicians in achievement of specific quality targets, most often in preventive care and chronic disease management.…”

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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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“…19,20 Given the increasing range of services provided by physicians, some more recent studies have moved away from counts of discrete services to [1][2][3]9,11,[13][14][15][16][17] Number of full-time employees (e.g., non-physician providers such as registered nurses or medical assistants) Facilities or office space 2,9,11,13,15,16 Office rental; medical records; computing Medical equipment 2,9,11,13,16 Radiological equipment Supplies 11,13,16 In-office ancillary services (e.g., laboratory) Malpractice insurance 13 NA Practice administration 13,16 Billing; insurance company contracting and monitoring; accounting and payroll; marketing and promotion; legal and consulting; housekeeping, maintenance, and security 13,21,22,38 Derived from the Resource-Based Relative Value Scale (RBRVS), RVUs provide a measure of output that account for both the mix (based on relative resource intensity) and the number of services provided by physicians. RVUs also fall short, however, as a conceptual metric for the output from a physician or their practice.…”

Section: What Are the Outputs From Physician Work?mentioning

confidence: 99%