In studying a sample of 252 health maintenance organizations drawn from 41 U.S. metropolitan areas, Harvard School of Public Health researchers found that 52.1% of health plans representing 81.3% of people enrolled in HMOs used pay-for-performance programs in 2005. Physician pay-for-performance programs, which almost always included measures of clinical care quality, were more common than hospital pay-for-performance programs. About one-third of physician-oriented incentive programs rewarded only the top-rated physicians or groups and not those who improved the most, according to the study published in the Nov. 2 issue of The New England Journal of Medicine.
The authors believe the findings can serve as a useful resource for the Centers for Medicare and Medicaid Services as it goes about designing pay-for-performance programs for Medicare. For example, currently Medicare doesn’t require recipients to choose a primary care physician. The survey showed that HMOs that don’t require many of their members to select a primary care physician were less likely to use pay for performance. That finding may reflect that, when there are many physicians involved with a patient’s care, it may be difficult to attribute performance to a single physician or group. CMS may need to consider the challenges of implementing pay for performance in the absence of a primary care physician requirement. The researchers also found that HMOs tend to pay medical groups rather than individual physicians for performance. Medicare, for the most part, does not contract with groups; it may need to do so to take full advantage of pay for performance, write the authors.
