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Physicians May Not Know of Pay-for-Performance Incentives

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Lack of Awareness May Be Hampering Quality Initiatives

Initiatives to improve health care increasingly link physician payment to quality of care. But studies so far have shown mixed findings about whether or not these "pay-for-performance" programs actually improve care.

Dr. Tara Bishop

These incentives may not be working because physicians do not always know about them. To evaluate this possibility, Weill Cornell researchers Dr. Kira Ryskina and Dr. Tara Bishop used data from a national survey of physicians to perform the first assessment of physician awareness of pay-for-performance on a national scale. Results of their study were published online Aug. 5 in JAMA Internal Medicine, a Journal of the American Medical Association, and is scheduled for the Oct. 14 print publication.

For their study, Drs. Ryskina and Bishop used data from the 2007-2008 National Ambulatory Medical Care Survey, which is a national survey of office-based physicians.

"Of the physicians who completed the survey, a fifth received some compensation for quality," said lead author Dr. Ryskina, an internal medicine resident at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. "An almost similar percentage of physicians did not know whether their compensation was linked to quality or patient satisfaction."

"Nearly one in five physicians did not know whether pay-for-performance was part of their compensation," said senior author Dr. Bishop, the Nanette Laitman Clinical Scholar in Public Health/Clinical Evaluation, assistant professor of public health and medicine in the Division of Outcomes and Effectiveness Research at Weill Cornell Medical College and assistant attending physician at NewYork-Presbyterian Hospital. "These findings suggest that one reason why pay-for-performance has not been overwhelmingly effective is that physicians are not aware."

If payers want pay-for-performance programs to be more effective, the authors said, they may need to do more to ensure that physicians understand what the incentives are and how they might affect their compensation. In addition, leadership in organizations like physician practices and clinics may also need to ensure that their physicians are aware of pay-for-performance and other incentive programs.

"There have been rapid changes in physician incentive compensation programs in recent years," Dr. Bishop added. "Future research should try to assess if physician awareness of these programs has improved."

Dr. Bishop's work on this study is supported by a National Institute on Aging Career Development Award (K23AG043499) and in part by funds provided to her as the Nanette Laitman Clinical Scholar in Public Health/Clinical Evaluation at Weill Cornell Medical College.

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