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Study finds pay for performance stimulates changes in medical practice
Date:3/9/2009

iative includes seven major California health plans and 225 physician groups. The groups employ 35,000 physicians who care for 6.2 million people enrolled in commercial health maintenance organizations and point-of-service plans.

Under the program, physician groups receive financial bonuses if they meet certain performance guidelines such as increasing the number of patients with diabetes who receive recommended blood tests. Other performance measures include improving patient experience with getting care and adopting health information technology capabilities. Between 2003 and 2007, the participating health plans paid $203 million in incentives to participating physician groups.

The RAND study reports findings gathered from surveys of 35 medical groups, the seven health plans and representatives from two employers that are involved in the pay-for-performance experiment.

Most of the medical groups surveyed suggested 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.

Health plans thought increasing the incentives was a low priority because of the relatively small quality improvements attained thus far and questions about whether other types of investments might produce greater quality gains, according to the study.

Although there is some concern that pay-for-performance might cause physicians to drop patients who decline to follow recommendations, few reports of such events were received. More than two-thirds of the medical groups reported that the pay-for-performance program resulted in more positives than negatives.

Most physician organizations said they collected more bonus payments than they had spent to comply with the program, although six said it was barely enough to cover their
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Contact: Warren Robak
robak@rand.org
310-451-6913
RAND Corporation
Source:Eurekalert

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