Embed Size (px)
DESCRIPTION
3 Research Questions 1. What is the prevalence and magnitude of P4P incentives? 2. Are these incentives financially important to physician groups? 3. Do P4P incentives lead to increased use of QI initiatives? 4. How do physician group leaders view P4P?
Citation preview
1
The Relationship between Pay-The Relationship between Pay-for-Performance Incentives and for-Performance Incentives and Quality Improvement: A Survey Quality Improvement: A Survey
of Massachusetts Physician of Massachusetts Physician Group LeadersGroup Leaders
Ateev Mehrotra, Steven Pearson, Kathryn Ateev Mehrotra, Steven Pearson, Kathryn Coltin, Ken Kleinman, Janice Singer, Coltin, Ken Kleinman, Janice Singer,
Barbra Rabson, Eric SchneiderBarbra Rabson, Eric Schneider
RAND Pittsburgh, University of Pittsburgh, Brigham and Women’s RAND Pittsburgh, University of Pittsburgh, Brigham and Women’s Hospital, Harvard Medical School, Harvard School of Public Health, Hospital, Harvard Medical School, Harvard School of Public Health,
and Massachusetts Health Quality Partnersand Massachusetts Health Quality Partners
Supported by the Robert Wood Johnson Foundation Rewarding Results Supported by the Robert Wood Johnson Foundation Rewarding Results Initiative and an National Research Service Award (#6 T32 HP11001-17) Initiative and an National Research Service Award (#6 T32 HP11001-17)
2
Previous ResearchPrevious Research
Few published studies on P4P Few published studies on P4P incentives have shown limited or no incentives have shown limited or no impact impact 11
Potential reasonsPotential reasons Providers reject conceptProviders reject concept Magnitude not significantMagnitude not significant Insufficient timeInsufficient time
1. Rosenthal and Frank. Med Care Research Review, Rosenthal et al. JAMA. 2005 Oct 12, 294:1788-93.
3
Research QuestionsResearch Questions1.1. What is the prevalence and What is the prevalence and
magnitude of P4P incentives?magnitude of P4P incentives?2.2. Are these incentives financially Are these incentives financially
important to physician groups?important to physician groups?3.3. Do P4P incentives lead to Do P4P incentives lead to
increased use of QI initiatives?increased use of QI initiatives?4.4. How do physician group leaders How do physician group leaders
view P4P?view P4P?
4
Study SampleStudy Sample 100 groups on Massachusetts 100 groups on Massachusetts
2005 physician group report card2005 physician group report card Interviewed leaders of 79 groups Interviewed leaders of 79 groups
between May and September 2005between May and September 2005 Semi-structured phone interviews Semi-structured phone interviews
lasting 30-60 minlasting 30-60 min
5
Physician Group Physician Group Characteristics Characteristics
(n=79) (n=79)Number of Primary Care Number of Primary Care
ProvidersProviders%%
<= 10 MD<= 10 MD 1313 11-25 MD11-25 MD 2828 26-100 MD26-100 MD 4141 > 100 MD> 100 MD 1818Significant Capitation Significant Capitation (>25% of commercial revenue)(>25% of commercial revenue)
1313
6
Research QuestionsResearch Questions1.1. What is the prevalence and What is the prevalence and
magnitude of P4P incentives?magnitude of P4P incentives?2.2. Are these incentives financially Are these incentives financially
important to physician groups?important to physician groups?3.3. Do P4P incentives lead to Do P4P incentives lead to
increased use of QI initiatives?increased use of QI initiatives?4.4. How do physician group leaders How do physician group leaders
view P4P?view P4P?
7
Prevalence and Magnitude Prevalence and Magnitude of of
P4P in MassachusettsP4P in Massachusetts
* Limited to 37 groups
Groups with P4P Groups with P4P incentives in health incentives in health plan contractsplan contracts
89%89%
Overall revenue tied Overall revenue tied to P4Pto P4P
2.2%2.2%(0.3 – 8.0)*(0.3 – 8.0)*
8
Focus of Current P4P Focus of Current P4P Incentives Among Groups Incentives Among Groups
with Any P4P (n=71)with Any P4P (n=71) MeasuresMeasures Groups reporting Groups reporting
any P4P tied to any P4P tied to measuremeasure
%%HEDIS measures HEDIS measures 100100Utilization measuresUtilization measures 6464Use of EMR or other ITUse of EMR or other IT 5151Patient Satisfaction Survey Patient Satisfaction Survey MeasuresMeasures
3535
9
Research QuestionsResearch Questions1.1. What is the prevalence and What is the prevalence and
magnitude of P4P incentives?magnitude of P4P incentives?2.2. Are these incentives financially Are these incentives financially
important to physician groups?important to physician groups?3.3. Do P4P incentives lead to Do P4P incentives lead to
increased use of QI initiatives?increased use of QI initiatives?4.4. How do physician group leaders How do physician group leaders
view P4P?view P4P?
10
Evaluation of Financial Evaluation of Financial Importance Stratified by Importance Stratified by
Revenue at RiskRevenue at Risk
* Limited to 37 non-IPA groups with P4PMantel-Haenzel chi-squared test for trend significant with p value of 0.01
% of Overall Revenue tied to
P4P
N* P4P are “very important” or “moderately important” to group’s financial success
%<1% 19 11
1-3% 9 22
>3% 9 56
11
Research QuestionsResearch Questions1.1. What is the prevalence and What is the prevalence and
magnitude of P4P incentives?magnitude of P4P incentives?2.2. Are these incentives financially Are these incentives financially
important to physician groups?important to physician groups?3.3. Do P4P incentives lead to Do P4P incentives lead to
increased use of QI initiatives?increased use of QI initiatives?4.4. How do physician group leaders How do physician group leaders
view P4P?view P4P?
12
Use of QI InitiativesUse of QI Initiatives
0 20 40 60 80 100
Hypertension Control
LDL control
Hyperlipidemia Screening
Chlamydia Screening
Adequacy of Well Child Visits
Asthma Controller Medication Use
Mammogram Screening
HbA1c Measurement
13
Relationship between P4P Relationship between P4P & QI Initiatives& QI Initiatives
0 20 40 60 80 100
Hypertension Control
LDL control
Hyperlipidemia Screening
Chlamydia Screening
Adequacy of Well Child Visits
Asthma Controller Medication Use
Mammogram Screening
HbA1c Measurement
P4P Incentive
QI Initiative
14
Variables Associated with Variables Associated with Increased Use of QI Increased Use of QI
InitiativesInitiativesOdds Ratio(95% CI)
PValue
Pay-for-performance incentive 1.6 (1.0-2.4)
0.04
Employed Physician Group 3.2 (1.5 – 7.1)
0.004
Larger group (>39 physicians) 2.2 (1.0 - 4.9)
0.06
15
Research QuestionsResearch Questions1.1. What is the prevalence and What is the prevalence and
magnitude of P4P incentives?magnitude of P4P incentives?2.2. Are these incentives financially Are these incentives financially
important to physician groups?important to physician groups?3.3. Do P4P incentives lead to Do P4P incentives lead to
increase use of QI initiatives?increase use of QI initiatives?4.4. How do physician group leaders How do physician group leaders
view P4P?view P4P?
16
Views of P4PViews of P4P% of
Physician Group
LeadersPhysician groups should be paid based performance on HEDIS measures
77
P4P will lead to quality improvements over next 3 years
79
17
LimitationsLimitations Findings do not address any Findings do not address any
problems with how current P4P problems with how current P4P incentives are structuredincentives are structured
Does not address actual Does not address actual performance on quality measuresperformance on quality measures
Cannot comment on potential Cannot comment on potential adverse impacts of P4P incentivesadverse impacts of P4P incentives
18
Key FindingsKey Findings Vast majority of groups face P4PVast majority of groups face P4P Leaders support concept of P4P tied Leaders support concept of P4P tied
to HEDIS measures to HEDIS measures Current magnitude of P4P may be Current magnitude of P4P may be
insufficientinsufficient P4P incentives are associated with P4P incentives are associated with
increased use of QI initiativesincreased use of QI initiatives
19
Policy ImplicationsPolicy Implications Support among physician leaders for Support among physician leaders for
incentives based on qualityincentives based on quality Help us understand the necessary Help us understand the necessary
financial magnitude of incentivesfinancial magnitude of incentives Demonstrate potential for pay-for-Demonstrate potential for pay-for-
performance incentives to increase performance incentives to increase attention paid to quality attention paid to quality improvementimprovement
21
Independent Variables in Independent Variables in ModelModel
P4P Incentive on that measureP4P Incentive on that measure Percentage of Employed Physicians Percentage of Employed Physicians
(majority vs. less than majority) (majority vs. less than majority) Use of EMR (majority use EMR vs. less Use of EMR (majority use EMR vs. less
than majority)than majority) Size of group (>39 PCP vs. <=39 PCP)Size of group (>39 PCP vs. <=39 PCP) Types of MD (Mostly specialty vs. Equal Types of MD (Mostly specialty vs. Equal
mix or mostly primary care)mix or mostly primary care) Significant capitation Significant capitation Part of a NetworkPart of a Network
22
Assessing Prevalence of Assessing Prevalence of QI Initiatives QI Initiatives
Focus on 8 HEDIS measuresFocus on 8 HEDIS measures Open-ended question Open-ended question Follow-up questions to Follow-up questions to
determine whether met criteria determine whether met criteria for 12 pre-specified categories for 12 pre-specified categories of QI initiativesof QI initiatives
Not all reported QI initiatives Not all reported QI initiatives codedcoded
23
Measures Discussed in Measures Discussed in InterviewInterview
HEDIS measuresHEDIS measures Patient Patient
satisfaction survey satisfaction survey resultsresults
Utilization Utilization measuresmeasures
Use of EMR or Use of EMR or other ITother IT
Asthma Controller Asthma Controller Medication UseMedication Use
Adequacy of Well Child Adequacy of Well Child VisitsVisits
Chlamydia ScreeningChlamydia Screening Mammogram ScreeningMammogram Screening HbA1c ScreeningHbA1c Screening Hyperlipidemia Hyperlipidemia
Screening in patients Screening in patients with CADwith CAD
LDL control among LDL control among patients with CADpatients with CAD
Hypertension ControlHypertension Control
24
Ideally What % of Overall Ideally What % of Overall Revenue Should be Tied to Revenue Should be Tied to
P4P Incentives?P4P Incentives?
% of Physician Group Leaders
Ideal Percentage 5% or Greater 91
