Original Research

Journal of General Internal Medicine

, Volume 27, Issue 5, pp 548-554

First online:

Do Physician Organizations Located in Lower Socioeconomic Status Areas Score Lower on Pay-for-Performance Measures?

  • Alyna T. ChienAffiliated withDivision of General Pediatrics, Children’s Hospital Boston; Department of Pediatrics, Harvard Medical School Email author 
  • , Kristen WroblewskiAffiliated withDepartment of Health Studies, The University of Chicago
  • , Cheryl DambergAffiliated withRAND Corporation
  • , Thomas R. WilliamsAffiliated withIntegrated Healthcare Association
  • , Dolores YanagiharaAffiliated withIntegrated Healthcare Association
  • , Yelena YakuninaAffiliated withIntegrated Healthcare Association
  • , Lawrence P. CasalinoAffiliated withDivision of Outcomes and Effectiveness Research, Department of Public Health, Weill Cornell Medical College

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Physician organizations (POs)—independent practice associations and medical groups—located in lower socioeconomic status (SES) areas may score poorly in pay-for-performance (P4P) programs.


To examine the association between PO location and P4P performance.


Cross-sectional study; Integrated Healthcare Association’s (IHA’s) P4P Program, the largest non-governmental, multi-payer program for POs in the U.S.


160 POs participating in 2009.


We measured PO SES using established methods that involved geo-coding 11,718 practice sites within 160 POs to their respective census tracts and weighting tract-specific SES according to the number of primary care physicians at each site. P4P performance was defined by IHA’s program and was a composite mainly representing clinical quality, but also including measures of patient experience, information technology and registry use.


The area-based PO SES measure ranged from −11 to +11 (mean 0, SD 5), and the IHA P4P performance score ranged from 23 to 86 (mean 69, SD 15). In bivariate analysis, there was a significant positive relationship between PO SES and P4P performance (p < 0.001). In multivariate analysis, a one standard deviation increase in PO SES was associated with a 44% increase (relative risk 1.44, 95%CI, 1.22-1.71) in the likelihood of a PO being ranked in the top two quintiles of performance (p < 0.001).


Physician organizations’ performance scores in a major P4P program vary by the SES of the areas in which their practice sites are located. P4P programs that do not account for this are likely to pay higher bonuses to POs in higher SES areas, thus increasing the resource gap between these POs and POs in lower SES areas, which may increase disparities in the care they provide.


physician organizations independent practice associations medical groups pay-for-performance quality disparities