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P4P Could Widen Medical Disparities

Poor people and ethnic minorities may not benefit as much from pay for performance (P4P) as originally thought, according to a study issued by the Rand Corp.

In fact, rewarding primary care physicians through P4P for providing better care may widen medical disparities that this population experiences.

Using a model that simulated a typical P4P program, primary care physicians in Massachusetts whose practices served the highest proportion of vulnerable populations would receive about $7,100 less annually than other practices, a result of existing gaps in the quality of health care received by patients in these groups.

That difference could be even larger if greater amounts of money are put at stake in future P4P programs.

Typically, there are relatively fewer physicians and other medical providers in communities with large medically vulnerable populations.

If these providers receive lower payments than other providers, new resources may be diverted elsewhere, making it difficult to reverse existing disparities.

“Paying for performance may have the unintended effect of diverting medical resources away from the communities that need these resources the most,” says Mark Friedberg, MD, the study’s lead author and an associate natural scientist at Rand.

Researchers say that P4P programs need to be structured to account for the payment shortfalls that could worsen medical disparities.

One approach could be to provide targeted grants to physicians who provide care to vulnerable populations, which could offset lower payments while preserving the incentive to improve care for these populations.

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