Using large quality incentives may not significantly drive improvement among primary care providers, but payment reform may help decrease variation in quality performance among physicians, according to a study published in Health Affairs.
The study examined the primary care provider compensation model of Minneapolis-based Fairview Health Services, one of the Pioneer accountable care organizations in Minnesota. Fairview based 40 percent of physicians' compensation on clinic-level quality metrics as part of the ACO.
Researchers used publicly reported performance data from 2010 to 2012 to assess which primary care providers improved the most under Fairview's payment model and the degree to which the improvement narrowed the gap in patient outcomes for primary care providers who treated high- and low-income patients.
They found the quality metric improvement at Fairview was not dramatically different from or greater than the improvement of other comparable medical groups in the state.
Instead, the largest predictor of quality improvement appeared to be the primary care providers' baseline quality performance on three quality metrics studied — optimal diabetes care, optimal vascular disease care and cancer screening.
Providers whose baseline performance was in the lowest third improved, on average, three times more than providers whose baseline performance reached the middle third, and almost six times more than those in the top third.
Ultimately, researchers found there was a decrease in the variation of quality performance across all primary care providers at Fairview, as well as a narrowing of the gap in quality between providers who treated the highest-income patients and those who treated the lowest-income patients.
"Since providers with lower initial quality disproportionately treated lower-income patient panels, their increases in quality resulted in a narrowing in performance across providers treating higher- and lower-income panels," wrote the study authors. "The findings also highlight the fact that larger incentives do not necessarily translate into larger quality improvement."
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