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Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Using Visual and Narrative Methods to Achieve Fair Process in Clinical Care

Published on: February 16, 2011

Quality-based payment for medical groups and individual physicians.

James C Robinson¹, Stephen M Shortell, Diane R Rittenhouse

¹Berkeley Center for Health Technology, School of Public Health, 247 University Hall, University of California, Berkeley, CA 94720-7360, USA. james.robinson@berkeley.edu

Inquiry : a Journal of Medical Care Organization, Provision and Financing

|August 22, 2009

Summary

Most large medical groups receive pay-for-performance incentives. These groups are more likely to reward physicians based on quality and patient satisfaction, especially when facing external quality-driven incentives.

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Area of Science:

Health Services Research
Medical Economics
Healthcare Management

Background:

External pay-for-performance (P4P) incentives from health plans are increasingly common.
Understanding how these incentives influence medical groups' internal payment structures is crucial for effective healthcare delivery.

Purpose of the Study:

To assess the prevalence of external P4P incentives in large medical groups.
To determine the association between external P4P incentives and internal physician payment methods based on quality and patient satisfaction.

Main Methods:

Analysis of survey data from large medical groups regarding external incentives and physician payment structures.
Statistical analysis, including odds ratios, to evaluate the relationship between incentive types and payment criteria.

Main Results:

Over half (52%) of large medical groups received P4P bonuses based on quality and patient satisfaction (2006-2007).
Groups with external P4P incentives were significantly more likely to pay primary care physicians (OR 4.5) and specialists (OR 2.5) based on quality and satisfaction.
Capitation payment models were associated with salary-based physician pay and less emphasis on productivity compared to fee-for-service models.

Conclusions:

External pay-for-performance incentives are associated with internal physician payment structures that incorporate quality and patient satisfaction metrics.
Healthcare payment models significantly influence how medical groups compensate their physicians, impacting alignment with quality and cost-control goals.