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Elizabeth Cooney is a health reporter for the Worcester Telegram & Gazette.
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Monday, May 7, 2007

Mass. doctors favorable toward pay for performance

Leaders of Massachusetts primary care physician groups look favorably on pay-for-performance incentives, and practices that have the programs also adopt quality improvement plans, a survey by Harvard researchers shows.

Skepticism has greeted these programs because of concerns that they undermine professionalism, Dr. Eric C. Schneider of the Harvard School of Public Health said in an interview. He is a co-author of the Robert Wood Johnson Foundation-funded study in this month’s American Journal of Managed Care.

In pay-for-performance programs, a portion of insurers' payments to doctors is based on how well they meet national standards for care, such as managing diabetes or encouraging mammograms. Schneider and his co-authors wondered what physicians thought about performance pay as a way to improve quality.

"The financial situation for primary care physicians is pretty challenging right now and these incentives are coming at a time when they’ve been given other incentives that relate directly to having them reduce access to care, such as imaging, formularies for medications, and some other things," Schneider said. "I do think the clinical view is those are related not directly to quality but more to cost control, so these other incentives directed at improving quality align well with their mission."

Another reason pay-for-performance initiatives might be well received is that they pay bonuses rather than take away compensation, Schneider said.

The researchers surveyed leaders of 100 primary care group practices in Massachusetts in 2005. Pay-for-performance accounted for an average of 2.2 percent of a practice’s total revenue, the article said, which one-third of the practice leaders thought was financially important. Eighty-nine percent of the leaders said their groups had pay-for-performance incentives in at least one of their health plan contracts.

These incentives were associated with a higher likelihood that a group had quality improvement initiatives in place, the paper said.

Dr. Kenneth Peelle, president of the Massachusetts Medical Society, said that since the survey was done, health plans have increased the amount of pay tied to performance. Blue Cross Blue Shield of Massachusetts, for example, said last year its performance bonus would be 10 to 13 percent.

"The problem we see is each of the health plans seems to come up with a different payment plan," said Peelle. "We look to government to put out some overall guidelines for this to work together."

Posted by Elizabeth Cooney at 05:00 PM
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