Linking Doctors’ Pay to Performance Has Little Effect on Diabetes Outcomes

According to a study of 1,667 poor, uninsured patients with diabetes, linking doctors’ pay to how well they follow treatment guidelines can improve quality of care but not health outcomes. 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.

“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.”

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.”

Nov, 2007:Journal of Health Care for the Poor and Underserved

================================

FACT:
Most Elderly Don’t Get Good Medical Care:  The quality of care received by vulnerable elderly Medicare, Medicaid patients is barely acceptable, a team of U.S. researchers report. Researchers at the University of California, Los Angeles, used quality of care measurements to look at 43 specific types of care received by more than 100,000 community-dwelling people, average age 81,  between 1999 and 2000. The study found that vulnerable elderly patients — those at risk of death or functional decline — received only 65 percent of tests and other diagnostic evaluations and treatments recommended for a number of illnesses and conditions, including diabetes and heart disease. "Thirty-five percent of the medical care interventions they should have received were not provided, indicating significant room for improvement. Only 42 percent of patients with diabetes were tested to assess their blood sugar control or received an eye examination during the one-year period covered by the study. October issue of the journal Medical Care.