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Pay-for-performance programs may worsen medical disparities, study finds
Date:5/3/2010

Rewarding primary care physicians for providing better care to patients could end up widening medical disparities experienced by poorer people and those belonging to racial and ethnic minorities, according to a new RAND Corporation study.

Researchers found that under a typical pay-for-performance program medical practices that serve vulnerable populations would likely receive lower payments than other practices, a result of existing gaps in the quality of health care received by patients in these groups.

The finding suggests that pay-for-performance programs could divert resources away from medically needy communities, further eroding the quality of medical care rather than driving improved quality.

"Paying for performance may have the unintended effect of diverting medical resources away from the communities that need these resources the most," said Dr. Mark Friedberg, the study's lead author and an associate natural scientist at RAND, a nonprofit research organization. "If you don't watch where the money goes, pay-for-performance programs have the potential to make disparities worse."

The study is the first to simulate the impact of pay-for-performance on physician practices that serve medically vulnerable communities. The findings are published in the May edition of the journal Health Affairs that is devoted to issues in primary care.

Pay-for-performance programs are an increasingly popular strategy for improving the quality of medical care. For example, recently passed federal health reform legislation encourages the Medicare program to expand the new strategy. Under such programs, physician groups may receive a bonus if they meet certain performance goals, such as frequently providing recommended blood tests to patients with diabetes

Simulating the impact of a typical pay-for-performance program on primary care physicians in Massachusetts, researchers found that average-sized physician practice
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Contact: Warren Robak
robak@rand.org
310-451-6913
RAND Corporation
Source:Eurekalert

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