New research indicates that primary care physicians who participated in a quality-reporting incentive program saw patients make “greater improvements” in cardiovascular disease preventive care than the patients of fee-for-service providers.
A team led by Naomi Bardach, MD, at the University of California-San Francisco, along with New York City Department of Health researchers, examined the effects of a pay-for-performance quality pilot program in 84 small primary care clinics in New York City.
The clinics used EHRs to send quarterly reports on their preventive care strategies to the New York City Department of Health, receiving extra payments when patients met quality goals, of up to $200 per patient and $100,000 per clinic.
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The study, published in the Journal of the American Medical Association and funded in part by several NIH centers, tracked four quality goals of the incentive program aimed at reducing long-term cardiovascular disease risk: aspirin or antithrombotic medication prescription, blood pressure control, cholesterol control and smoking cessation.
About 4,500 patients were served in the clinics participating in the incentive program, and were compared to 3,000 in traditionally-reimbursed clinics, with at least 10 percent of patients covered by Medicaid or uninsured.
While the outcomes for both the incentivized providers and the fee-for-service providers improved over time, Bardach and her colleagues found providers payed through the incentive plan showed “greater improvements” in rates of appropriate antithrombotic therapy for stroke patients and rates of smoking cessation interventions, and made greater improvements in controlling high blood pressure in patients with hypertension and diabetes.
In all, Bardach and other researchers found the incentive program “led to modest improvements in cardiovascular care processes and outcomes.” The study, Bardach said, “provides evidence that, in the context of increasing uptake of EHRs with robust clinical management tools, small practices may be able to improve their quality performance in response to an incentive.”
Researchers are also calling for more study on the topic, in part because value-based care contracts may be different than the payments used in the pilot program.
“Incentivized clinics performed better on most measures for Medicaid and uninsured patients, but these effects weren’t great enough to prove they weren’t due to chance,” wrote Carol Torgan, from the National Institutes of Health Office of Science Communications.