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Physician Incentives Not Correlated with High Quality Care in New Analysis

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A new article from Weill Cornell Medical College researcher Dr. Tara Bishop published in the American Journal of Managed Care, suggests that financial incentives and public reporting on quality measures alone may have little impact on physicians to improve quality of care.

Dr. Bishop, an assistant professor of public health in the Division of Outcomes and Effectiveness and an assistant professor of medicine, used data from the 2006 and 2007 National Ambulatory Medical Care Survey, a nationally representative survey administered by the Centers for Disease Control and Prevention's National Center for Health Statistics that contains information about outpatient visits. Dr. Bishop compared care provided by physicians whose pay was at least partially based upon quality measures or patient satisfaction, and physicians who publicly report quality data to those who neither are eligible for incentives or report data.

Dr. Bishop, an assistant professor of public health in the Division of Outcomes and Effectiveness Research, the Nanette Laitman Clinical Scholar in Public Health/Clinical Evaluation and an assistant professor of medicine at Weill Cornell

Dr. Bishop's research, conducted with co-investigators Dr. Alex D. Federman, an associate professor of General Internal Medicine from the Mount Sinai School of Medicine and Dr. Joseph S. Ross, an assistant professor in the section of General Internal Medicine at the Yale University School of Medicine, is the first that examines the relationship between financial incentives and public reporting on quality at the national level.

The researchers found that there was no difference between care provided by physicians who receive financial incentives and those who don't, and no difference between those who publicly report and those who don't.

But in that same article, they also suggest that it's not time yet for post-mortems on physician quality improvement incentives.

"We are now learning that these incentive programs may not be as effective as we thought they would be when they were first devised," said Dr. Bishop, also the Nanette Laitman Clinical Scholar in Public Health/Clinical Evaluation. "We need to conduct more research to understand exactly how quality incentive programs should be structured and implemented to have an effect on quality."

Other research on financial incentives and public reporting, mostly at single institutions or by single insurers, have had mixed results. Similarly, this latest research seems to raise more questions than answers.

"I almost feel like we have to go back to square one and think a lot more carefully about how to structure incentives," Dr. Bishop said. "Is there a certain amount of money to change behavior? Does it take more than money to have an effect?"

Dr. Bishop, whose interest focuses on how we practice outpatient medicine on a national and local level, plans to examine how payment models from other service industries, such as law, affect cost and use. She also plans to analyze the reporting on consumer information websites, such as healthgrades.com and vitals.com, to see if they influence physician behavior.

"This latest research is just the beginning," Dr. Bishop said. "We need to continue to examine this."

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