No verdict on pay-for-performance U.S. health plans

CHICAGO Tue Mar 10, 2009 9:59am EDT

A surgery nurse is seen beside the heart beat monitor February 29, 2008. REUTERS/Fabrizio Bensch

A surgery nurse is seen beside the heart beat monitor February 29, 2008.

Credit: Reuters/Fabrizio Bensch

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CHICAGO (Reuters) - Dangling a financial carrot in front of doctors as a way to improve health quality has changed the way some doctors practice medicine, but has yet to significantly improve quality and may be interfering with doctor-patient relationships, researchers said on Tuesday.

Pay-for-performance plans, in which doctors, hospitals and other providers receive more money if they meet certain goals, are seen as a way of boosting health quality.

Despite the rapid adoption of these programs, there is little research about how well they work or what types of strategies work best.

Researchers at the RAND Corporation, a nonprofit research group, studied a pay-for-performance program started in 2003 involving seven major California health plans and 225 physician groups who care for a total of 6.2 million people.

Although the programs appear to be speeding the adoption of information technology such as electronic medical records, these changes have failed to improve quality, they found.

"Physician groups are responding to pay-for-performance programs by making practice changes and altering how they compensate physicians to reward quality, but health plans and purchasers say that those investments are not yet translating into substantial gains in quality," said Cheryl Damberg, a senior policy researcher at RAND, whose study appears in the journal Health Affairs.

"The true benefits of these programs may take more time to be realized and it is likely that investments in other quality efforts will be needed in addition to performance-based pay."

Most of the medical groups surveyed in the study reported that the program's financial incentives -- generally about $1,500 to $2,000 annually per physician -- were too small to stimulate significant change among most doctors.

They suggested the incentives needed to be two to five times higher in order to achieve quality improvements.

A separate study on pay-for-performance schemes in the Annals of Family Medicine, found that doctors resented the intrusion of such plans on the doctor-patient relationship.

Ruth McDonald and Martin Roland of the University of Manchester in England conducted in-depth interviews with doctors in Britain and California, where pay-for-performance programs are being implemented.

In Britain, physicians said the emphasis on computer systems and data collection crowded out communication with patients. In the United States, physicians said they resented the structure of the audit and payment systems, which sometimes distorted the process of care.

The authors said these problems might be diminished if doctors felt they had more autonomy in implementing the programs.

(Editing by Chris Wilson)

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