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The Relationship between Pay-for-Performance Incentives and Quality Improvement: A Survey of Massachusetts Physician Group Leaders. Ateev Mehrotra, Steven Pearson, Kathryn Coltin, Ken Kleinman, Janice Singer, Barbra Rabson, Eric Schneider

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The Relationship between Pay-for-Performance Incentives and Quality Improvement: A Survey of Massachusetts Physician Group Leaders

Ateev Mehrotra, Steven Pearson, Kathryn Coltin, Ken Kleinman, Janice Singer, Barbra Rabson, Eric Schneider

RAND Pittsburgh, University of Pittsburgh, Brigham and Women’s Hospital, Harvard Medical School, Harvard School of Public Health, and Massachusetts Health Quality Partners

Supported by the Robert Wood Johnson Foundation Rewarding Results Initiative and an National Research Service Award (#6 T32 HP11001-17)


Previous research
Previous Research Quality Improvement: A Survey of Massachusetts Physician Group Leaders

  • Few published studies on P4P incentives have shown limited or no impact 1

  • Potential reasons

    • Providers reject concept

    • Magnitude not significant

    • Insufficient time

  • Rosenthal and Frank. Med Care Research Review, Rosenthal et al. JAMA. 2005 Oct 12, 294:1788-93.


Research questions
Research Questions Quality Improvement: A Survey of Massachusetts Physician Group Leaders

  • What is the prevalence and magnitude of P4P incentives?

  • Are these incentives financially important to physician groups?

  • Do P4P incentives lead to increased use of QI initiatives?

  • How do physician group leaders view P4P?


Study sample
Study Sample Quality Improvement: A Survey of Massachusetts Physician Group Leaders

  • 100 groups on Massachusetts 2005 physician group report card

  • Interviewed leaders of 79 groups between May and September 2005

  • Semi-structured phone interviews lasting 30-60 min


Physician group characteristics n 79
Physician Group Characteristics Quality Improvement: A Survey of Massachusetts Physician Group Leaders (n=79)


Research questions1
Research Questions Quality Improvement: A Survey of Massachusetts Physician Group Leaders

  • What is the prevalence and magnitude of P4P incentives?

  • Are these incentives financially important to physician groups?

  • Do P4P incentives lead to increased use of QI initiatives?

  • How do physician group leaders view P4P?


Prevalence and magnitude of p4p in massachusetts
Prevalence and Magnitude of Quality Improvement: A Survey of Massachusetts Physician Group LeadersP4P in Massachusetts

* Limited to 37 groups



Research questions2
Research Questions (n=71)

  • What is the prevalence and magnitude of P4P incentives?

  • Are these incentives financially important to physician groups?

  • Do P4P incentives lead to increased use of QI initiatives?

  • How do physician group leaders view P4P?


Evaluation of financial importance stratified by revenue at risk
Evaluation of Financial Importance Stratified by Revenue at Risk

  • * Limited to 37 non-IPA groups with P4P

  • Mantel-Haenzel chi-squared test for trend significant with p value of 0.01


Research questions3
Research Questions Risk

  • What is the prevalence and magnitude of P4P incentives?

  • Are these incentives financially important to physician groups?

  • Do P4P incentives lead to increased use of QI initiatives?

  • How do physician group leaders view P4P?





Research questions4
Research Questions Risk

  • What is the prevalence and magnitude of P4P incentives?

  • Are these incentives financially important to physician groups?

  • Do P4P incentives lead to increase use of QI initiatives?

  • How do physician group leaders view P4P?



Limitations
Limitations Risk

  • Findings do not address any problems with how current P4P incentives are structured

  • Does not address actual performance on quality measures

  • Cannot comment on potential adverse impacts of P4P incentives


Key findings
Key Findings Risk

  • Vast majority of groups face P4P

  • Leaders support concept of P4P tied to HEDIS measures

  • Current magnitude of P4P may be insufficient

  • P4P incentives are associated with increased use of QI initiatives


Policy implications
Policy Implications Risk

  • Support among physician leaders for incentives based on quality

  • Help us understand the necessary financial magnitude of incentives

  • Demonstrate potential for pay-for-performance incentives to increase attention paid to quality improvement



Independent variables in model
Independent Variables in Model Risk

  • P4P Incentive on that measure

  • Percentage of Employed Physicians (majority vs. less than majority)

  • Use of EMR (majority use EMR vs. less than majority)

  • Size of group (>39 PCP vs. <=39 PCP)

  • Types of MD (Mostly specialty vs. Equal mix or mostly primary care)

  • Significant capitation

  • Part of a Network


Assessing prevalence of qi initiatives
Assessing Prevalence of QI Initiatives Risk

  • Focus on 8 HEDIS measures

    • Open-ended question

    • Follow-up questions to determine whether met criteria for 12 pre-specified categories of QI initiatives

    • Not all reported QI initiatives coded


Measures discussed in interview
Measures Discussed in Interview Risk

  • Asthma Controller Medication Use

  • Adequacy of Well Child Visits

  • Chlamydia Screening

  • Mammogram Screening

  • HbA1c Screening

  • Hyperlipidemia Screening in patients with CAD

  • LDL control among patients with CAD

  • Hypertension Control

  • HEDIS measures

  • Patient satisfaction survey results

  • Utilization measures

  • Use of EMR or other IT



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