Medicine
They've been repeated so often that many health care quality gurus take them for granted: 1) paying physicians for performance will improve quality of care; 2) increasing patient satisfaction will reduce care costs and improve outcomes.
Not necessarily, two recent studies suggest.
A Cochrane for Clinicians piece on financial incentives for improving the quality of care in the April 1st issue of American Family Physician concludes that despite their increasing popularity, there is actually "limited evidence" that pay-for-performance models are successful in primary care practice. When positive effects were seen in the studies examined in the Cochrane review, they were disappointingly modest. Further, writes commentator Elizabeth Salisbury-Afshar, MD, MPH, "In addition to costs, potential harms must be considered. For example, if financial incentives are provided only for certain health indicators, physicians may spend more time focusing on meeting those indicators while paying less attention to other important components of care." This commentary elicited several online comments from readers, ranging from a defense of the "tried and true" fee-for-service model to requests for better tools and systems to allow physicians to improve care quality without making unsustainable demands on their time.
In a similar vein, a study published in the Archives of Internal Medicine found that although higher patient satisfaction was associated with lower rates of emergency department use, it also was linked to several less desirable outcomes, including higher odds of any inpatient admission, greater total and prescription drug costs, and higher mortality. Is it possible, questions Dr. Brenda Sirovich an accompanying editorial, that patient satisfaction is driven by receiving more care, but not better care? She goes on to observe:
Practicing physicians have learned ... that they will be rewarded for excess and penalized if they risk not doing enough. More aggressive practice, therefore, improves not only patients' perceived outcomes, but also those of physicians (reimbursement, performance ratings, protection against lawsuits), and the positive feedback loop of health care utilization is fueled at two ends. ... A positive feedback system is not in fact positive (ie, favorable)—it represents an unstable system, one that cannot control its own growth, or demise. We, as a profession and as a society, can take responsibility for controlling this unrestrained system only if we commit to overcoming the widespread misconception that more care is necessarily better care, and to realigning the incentives that help nurture this belief.
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The above post was first published on the AFP Community Blog.
- Financial Incentives, Maybe; Corporate Profit, No!
If we truly wish to move toward a healthcare system which delivers high quality in a reliable manner, one of the great flaws of our current system is that incentives are not always lined up to achieve that goal. Indeed, we could make a strong argument...
- Can Mindful Communication Protect Physicians From Burnout?
Are mindful clinicians happier clinicians, and do they communicate better with patients? A pair of studies published in 2013 in Annals of Family Medicine aimed to answer one or the other of these questions. Mindfulness, defined as "purposeful...
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According to a national survey, a typical family physician spends nearly half of his or her working hours outside of the examination room doing follow-up care or documentation. I think most of my colleagues would agree that entering notes into the...
- Mindful Communication, Physician Burnout, And Patient Satisfaction
Are mindful clinicians happier clinicians, and do they communicate better with patients? A pair of studies published this month in Annals of Family Medicine aimed to answer one or the other of these questions. Mindfulness, defined as "purposeful...
- Medical Homes And The Meaning Of "p.c." - Part 1 Of 2
In this week's issue of Annals of Internal Medicine, Dr. Adam Goldstein writes about a disabled elderly man who died from a metastatic colorectal cancer that may have been prevented had one of his physicians referred him for a screening test at one...
Medicine
Counterintuitive findings on quality incentives and patient satisfaction
They've been repeated so often that many health care quality gurus take them for granted: 1) paying physicians for performance will improve quality of care; 2) increasing patient satisfaction will reduce care costs and improve outcomes.
Not necessarily, two recent studies suggest.
A Cochrane for Clinicians piece on financial incentives for improving the quality of care in the April 1st issue of American Family Physician concludes that despite their increasing popularity, there is actually "limited evidence" that pay-for-performance models are successful in primary care practice. When positive effects were seen in the studies examined in the Cochrane review, they were disappointingly modest. Further, writes commentator Elizabeth Salisbury-Afshar, MD, MPH, "In addition to costs, potential harms must be considered. For example, if financial incentives are provided only for certain health indicators, physicians may spend more time focusing on meeting those indicators while paying less attention to other important components of care." This commentary elicited several online comments from readers, ranging from a defense of the "tried and true" fee-for-service model to requests for better tools and systems to allow physicians to improve care quality without making unsustainable demands on their time.
In a similar vein, a study published in the Archives of Internal Medicine found that although higher patient satisfaction was associated with lower rates of emergency department use, it also was linked to several less desirable outcomes, including higher odds of any inpatient admission, greater total and prescription drug costs, and higher mortality. Is it possible, questions Dr. Brenda Sirovich an accompanying editorial, that patient satisfaction is driven by receiving more care, but not better care? She goes on to observe:
Practicing physicians have learned ... that they will be rewarded for excess and penalized if they risk not doing enough. More aggressive practice, therefore, improves not only patients' perceived outcomes, but also those of physicians (reimbursement, performance ratings, protection against lawsuits), and the positive feedback loop of health care utilization is fueled at two ends. ... A positive feedback system is not in fact positive (ie, favorable)—it represents an unstable system, one that cannot control its own growth, or demise. We, as a profession and as a society, can take responsibility for controlling this unrestrained system only if we commit to overcoming the widespread misconception that more care is necessarily better care, and to realigning the incentives that help nurture this belief.
**
The above post was first published on the AFP Community Blog.
- Financial Incentives, Maybe; Corporate Profit, No!
If we truly wish to move toward a healthcare system which delivers high quality in a reliable manner, one of the great flaws of our current system is that incentives are not always lined up to achieve that goal. Indeed, we could make a strong argument...
- Can Mindful Communication Protect Physicians From Burnout?
Are mindful clinicians happier clinicians, and do they communicate better with patients? A pair of studies published in 2013 in Annals of Family Medicine aimed to answer one or the other of these questions. Mindfulness, defined as "purposeful...
- Do Medical Scribes Improve Doctor Or Patient Experiences?
According to a national survey, a typical family physician spends nearly half of his or her working hours outside of the examination room doing follow-up care or documentation. I think most of my colleagues would agree that entering notes into the...
- Mindful Communication, Physician Burnout, And Patient Satisfaction
Are mindful clinicians happier clinicians, and do they communicate better with patients? A pair of studies published this month in Annals of Family Medicine aimed to answer one or the other of these questions. Mindfulness, defined as "purposeful...
- Medical Homes And The Meaning Of "p.c." - Part 1 Of 2
In this week's issue of Annals of Internal Medicine, Dr. Adam Goldstein writes about a disabled elderly man who died from a metastatic colorectal cancer that may have been prevented had one of his physicians referred him for a screening test at one...