Survey: Physicians Skeptical About Pay-for-Performance Quality, Accuracy

A survey of physicians found that more than three in four support pay-for-performance programs if quality measures are accurate, but most physicians do not believe payers or the government will "try hard" for accuracy, according to research by University of Chicago researchers in the current issue of Health Affairs. 

The report's author -- Lawrence Casalino, an assistant professor of health studies at the University of Chicago -- said he was surprised by the number of physicians that support financial incentives to improve care. However, he said that if pay-for-performance and public reporting models are not designed properly, physicians are concerned that doctors might not provide treatment for sick, poor or noncompliant patients, and that they might neglect unmeasured areas of quality. "There's a real fear of unintended consequences," he said. The survey also found that 32% of physicians support public reporting of individual physicians' quality scores, while 45% support public reporting of medical group scores, even if the scores are accurate. Of the 1,168 randomly selected general internists contacted, 48% completed the questionnaire. 

Physician support for pay-for-performance could be quickly undermined if these concerns are not addressed, Casalino said. He said that possible solutions are:

• Allow risk adjustments for patients' race, ethnicity, socioeconomic status and the severity of their sicknesses;

• Reward practices that care for high numbers of at-risk patients; and

• Allow practices to exclude a certain number of patients with a particular condition, which is what Great Britain currently practices in its pay-for-performance program.

Casalino added that the strong support for pay-for-performance also is a positive sign for health IT adoption in physician practices, although the survey did not directly ask about health IT.