Linking Doctors' Pay To Performance Has Little Effect On Diabetes Outcomes

Armen Hareyan's picture
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Linking doctors' pay to how well they follow treatment guidelines can improve quality of care but not health outcomes, according to a study of 1,666 poor, uninsured patients with diabetes.

Medicare and large health insurers have been experimenting with pay-for-performance (PFP) plans that pay doctors more based on how well they follow accepted treatment guidelines.

The researchers looked at changes in how doctors practiced at the ACCESS Community Health Network in Chicago after it started paying for performance. Under the new system, physicians received a base salary plus bonus payments for specific tests and procedures they ordered.

The study focused on how well doctors did in testing for hemoglobin A1c, a measure of blood glucose control in people with diabetes.

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"We were trying to find out if the way we paid doctors improved people's health overall," said lead author Katie Coleman, a research associate at Group Health Cooperative's MacColl Institute for Healthcare Innovation in Seattle. "We found that the process of care improved, meaning that the doctors ordered the recommended number of tests. We did not find any major changes in patient outcomes."

The study appears in the November issue of the Journal of Health Care for the Poor and Underserved.

Although the patients seen at ACCESS have less heath insurance and are generally poorer than those included in other studies, the results were the same. Coleman says that this is further proof that, while pay for performance affects how doctors work, it does little to address patients' behavior.

"Patients spend less than 1 percent of their time with their doctors, managing their own health care the rest of the time," said Coleman. "If you do a purely medical intervention, it really isn't surprising that we don't see major improvements in people's health. PFP fills in half of the equation. Now we need to find ways to work on the other half --involving patients."

Larry Deeb, M.D., president of Medicine & Science at the American Diabetes Association, agrees that there are two important parts of good health care outcomes. One is what the physician does and the other depends on the patient.

"You have to encourage physicians to be creative in treating patients," he said, "but remain careful not to punish the physician for what the patient does or does not do."

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