MANAGED CARE April 2007. ©MediMedia USA
Although 3 out of 4 primary care physicians support the use of financial rewards as an incentive for better medical care, the majority would rather not make quality assessments readily available to the public, according to a recent survey by the University of Chicago Medical Center. Physicians in the survey view public reporting as potentially punitive, and they worry that such programs may harm poor and noncompliant patients.
"We found a sizeable reservoir of potential physician support, in principle, for financial incentives to improve care," says the author, Lawrence Casalino, MD, PhD, an assistant professor of health studies, "but we also found a good deal of mistrust and concern about how such incentives would be assessed and applied and about how the applications might alter access to care for high-risk or disadvantaged patients."
Respondents also expressed a pervasive lack of confidence in how well quality of care can be assessed. Eighty-five percent questioned the accuracy of current tools for risk adjustment. But in fact, more than half rejected public reporting on quality of medical groups and individual doctors even if it is accurate.
Casalino reports that 82 percent worried that flawed quality assessments would encourage physicians to avoid high-risk patients. One physician respondent said that the "poor, unmotivated, obese, and noncompliant would all have to find new physicians."
Only 38 percent agreed strongly or somewhat strongly that "health plans will try hard to make quality measures as accurate as possible." And only 35 percent agreed strongly or somewhat strongly that the government would try hard.
Physicians should be given financial incentives for quality
Financial incentives for quality are unprofessional
Measures of the quality of individual physicians' performance should be made public
Measures of the quality of individual medical groups' performance should be made public
Source: Casalino LP, et al. General internists' views on pay-for-performance and public reporting of quality scores: A national survey. Health Affairs. 2007;26(2):492–499.