Do Physician Organizations Located in Lower Socioeconomic Status Areas Score Lower on Pay-for-Performance Measures?
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
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.
- H.R. 3590 --111th Congress. Patient Protection and Affordable Care Act. United States of America; 2009.
- Shortell SM, Casalino LP. Health care reform requires accountable care systems. JAMA. 2008;300(1):95–97. CrossRef
- Rosenthal MB, Landon BE, Normand SL, Frank RG, Epstein AM. Pay for performance in commercial HMOs. N Engl J Med. 2006;355(18):1895–1902. CrossRef
- Chernew ME, Mechanic RE, Landon BE, Safran DG. Private-payer innovation in Massachusetts: the ‘Alternative Quality Contract’. Health Aff (Millwood). 2011;30(1):51–61. CrossRef
- Chien AT, Chin MH, Davis AM, Casalino LP. Pay for performance, public reporting, and racial disparities in health care: how are programs being designed? Med Care Res Rev. 2007;64(5 Suppl):283S–304S. CrossRef
- Franks P, Fiscella K. Effect of patient socioeconomic status on physician profiles for prevention, disease management, and diagnostic testing costs. Med Care. 2002;40(8):717–724. CrossRef
- Reschovsky JD, O’Malley AS. Do primary care physicians treating minority patients report problems delivering high-quality care? Health Aff (Millwood). 2008;27(3):w222–w231. CrossRef
- Subramanian SV, Chen JT, Rehkopf DH, Waterman PD, Krieger N. Comparing individual- and area-based socioeconomic measures for the surveillance of health disparities: A multilevel analysis of Massachusetts births, 1989–1991. Am J Epidemiol. 2006;164(9):823–834. CrossRef
- Blustein J, Borden WB, Valentine M. Hospital performance, the local economy, and the local workforce: findings from a US National Longitudinal Study. PLoS Med. 2010;7(6):e1000297. PMCID: PMC2893955.
- Bach PB, Pham HH, Schrag D, Tate RC, Hargraves JL. Primary care physicians who treat blacks and whites. N Engl J Med. 2004;351(6):575–584. CrossRef
- Rosenblatt RA, Andrilla CHA, Curtin T, Hart LG. Shortages of medical personnel at community health centers: implications for planned expansion. JAMA. 2006;295(9):1042–1049. CrossRef
- Agency for Healthcare Research and Quality. National Healthcare Disparities Report, 2010. Rockville, MD: U.S. Department of Health and Human Services; 2011.
- Agency for Healthcare Research and Quality. National Healthcare Disparities Report, 2003. Rockville, MD: U.S. Department of Health and Human Services; 2003.
- Hong CS, Atlas SJ, Chang Y, et al. Relationship between patient panel characteristics and primary care physician clinical performance rankings. JAMA. 2010;304(10):1107–1113. CrossRef
- Franks P, Fiscella K, Beckett L, Zwanziger J, Mooney C, Gorthy S. Effects of patient and physician practice socioeconomic status on the health care of privately insured managed care patients. Med Care. 2003;41(7):842–852. CrossRef
- Mehta RH, Liang L, Karve AM, et al. Association of patient case-mix adjustment, hospital process performance rankings, and eligibility for financial incentives. JAMA. 2008;300(16):1897–1903. CrossRef
- Young G, Meterko M, White B, et al. Pay-for-performance in safety net settings: issues, opportunities, and challenges for the future. J Healthc Manag. 2010;55(2):132–141. discussion 141–132.
- Pham HH, Schrag D, Hargraves JL, Bach PB. Delivery of preventive services to older adults by primary care physicians. JAMA. 2005;294(4):473–481. CrossRef
- The Leapfrog Group. The Leapfrog Group fact sheet. http://www.leapfroggroup.org/leapfrog-factsheet. Accessed November 16, 2011.
- Center for Health Care Strategies, Centers for Medicare and Medicaid Services. Descriptions of selected performance incentives programs. http://www.chcs.org/usr_doc/State_Performance_Incentive_Chart_0206.pdf. Accessed November 16, 2011.
- Integrated Healthcare Association. The California Pay for Performance Program. http://www.iha.org/p4p_california.html. Accessed November 16, 2011.
- Andreae MC, Blad K, Cabana MD. Physician compensation programs in academic medical centers. Health Care Manage Rev. 2006;31(3):251–258.
- Ayanian JZ, Weissman JS. Teaching hospitals and quality of care: a review of the literature. Milbank Q. 2002;80(3):569–593. v. CrossRef
- Krieger N, Chen JT, Waterman PD, Rehkopf DH, Subramanian SV. Painting a truer picture of US socioeconomic and racial/ethnic health inequalities: the Public Health Disparities Geocoding Project. Am J Public Health. 2005;95(2):312–323. PMCID: PMC1449172. CrossRef
- Krieger N, Chen JT, Waterman PD, Rehkopf DH, Subramanian SV. Race/ethnicity, gender, and monitoring socioeconomic gradients in health: a comparison of area-based socioeconomic measures--the Public Health Disparities Geocoding Project. Am J Public Health. 2003;93(10):1655–1671. PMCID: PMC1448030. CrossRef
- Erickson SE, Iribarren C, Tolstykh IV, Blanc PD, Eisner MD. Effect of race on asthma management and outcomes in a large, integrated managed care organization. Arch Intern Med. 2007;167(17):1846–1852. CrossRef
- Coberley CR, Puckrein GA, Dobbs AC, McGinnis MA, Coberley SS, Shurney DW. Effectiveness of disease management programs on improving diabetes care for individuals in health-disparate areas. Dis Manag. 2007;10(3):147–155. CrossRef
- Pollack LA, Gotway CA, Bates JH, et al. Use of the spatial scan statistic to identify geographic variations in late stage colorectal cancer in California (United States). Cancer Causes Control. 2006;17(4):449–457. CrossRef
- Information Technology Laboratory, National Institute of Standards and Technology. Federal Information Processing Standards publications. http://www.itl.nist.gov/fipspubs/. Accessed November 16, 2011.
- Integrated Healthcare Association. The California Pay for Performance Program financial transparency. http://www.iha.org/financial_transparency.html. Accessed November 16, 2011.
- Mehrotra A, Epstein AM, Rosenthal MB. Do integrated medical groups provide higher-quality medical care than individual practice associations? Ann Intern Med. 2006;145(11):826–833.
- Cunningham PJ, Hadley J. Effects of changes in incomes and practice circumstances on physicians’ decisions to treat charity and Medicaid patients. Milbank Q. 2008;86(1):91–123. CrossRef
- Cuzick J. A Wilcoxon-type test for trend. Stat Med. 1985;4(1):87–90. CrossRef
- Zou G. A modified Poisson regression approach to prospective studies with binary data. Am J Epidemiol. 2004;159(7):702–706. CrossRef
- Wilcoxon F. Individual comparisons by ranking methods. Biometrics. 1945;1:80–83. CrossRef
- Openshaw S, Taylor PJ. The modifiable areal unit problem. In: Wrigley N, Bennet RJ, eds. Quantiative geography: a British view. London: Routledge and Regan Paul; 1981.
- Flowerdew R, Manley DJ, Sabel CE. Neighbourhood effects on health: does it matter where you draw the boundaries? Soc Sci Med. 2008;66(6):1241–1255. CrossRef
- Billi JE, Pai CW, Spahlinger DA. The effect of distance to primary care physician on health care utilization and disease burden. Health Care Manage Rev. 2007;32(1):22–29.
- Brooks CH. Associations among distance, patient satisfaction, and utilization of two types of inner-city clinics. Med Care. 1973;11(5):373–383. CrossRef
- Dudley RA, Frolich A, Robinowitz DL, et al. Strategies to support quality-based purchasing: a review of the evidence. Rockville, MD: Agency for Healthcare Research and Quality; 2004:04–0057.
- Friedberg MW, Safran DG, Coltin K, Dresser M, Schneider EC. Paying for performance in primary care: potential impact on practices and disparities. Health Aff (Millwood). 2010;29(5):926–932. CrossRef
- Karve AM, Ou FS, Lytle BL, Peterson ED. Potential unintended financial consequences of pay-for-performance on the quality of care for minority patients. Am Heart J. 2008;155(3):571–576. CrossRef
- Petersen LA, Woodard LD, Urech T, Daw C, Sookanan S. Does pay-for-performance improve the quality of health care? Ann Intern Med. 2006;145(4):265–272.
- Rosenthal MB, Frank RG, Li Z, Epstein AM. Early experience with pay-for-performance: from concept to practice. JAMA. 2005;294(14):1788–1793. CrossRef
- Werner RM, Goldman LE, Dudley RA. Comparison of change in quality of care between safety-net and non-safety-net hospitals. JAMA. 2008;299(18):2180–2187. CrossRef
- Casalino LP, Devers KJ, Lake TK, Reed M, Stoddard JJ. Benefits of and barriers to large medical group practice in the United States. Arch Intern Med. 2003;163(16):1958–1964. CrossRef
- Shortell SM, Casalino LP. Implementing qualifications criteria and technical assistance for accountable care organizations. JAMA. 2010;303(17):1747–1748. CrossRef
- Hing E, Burt CW. Office-based medical practices: methods and estimates from the National Ambulatory Medical Care Survey. Adv Data. 2007;383:1–16.
- Chien AT, Li Z, Rosenthal MB. Improving timely childhood immunizations through pay for performance in Medicaid-managed care. Health Serv Res. 2010;45(6 Pt 2):1934–1947. CrossRef
- Chien AT, Eastman D, Li Z, Rosenthal MB. Impact of a pay for performance program to improve diabetes care in the safety net. Preventive Medicine, forthcoming.
- Mehrotra A, Sorbero ME, Damberg CL. Using the lessons of behavioral economics to design more effective pay-for-performance programs. Am J Manag Care. 2010;16(7):497–503.
- Hayward RA. All-or-nothing treatment targets make bad performance measures. Am J Manag Care. 2007;13(3):126–128.
- Do Physician Organizations Located in Lower Socioeconomic Status Areas Score Lower on Pay-for-Performance Measures?
Journal of General Internal Medicine
Volume 27, Issue 5 , pp 548-554
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- physician organizations
- independent practice associations
- medical groups
- Industry Sectors
- Author Affiliations
- 1. Division of General Pediatrics, Children’s Hospital Boston; Department of Pediatrics, Harvard Medical School, 21 Autumn Street - Room 223, Boston, MA, 02215, USA
- 2. Department of Health Studies, The University of Chicago, Chicago, IL, USA
- 3. RAND Corporation, Santa Monica, CA, USA
- 4. Integrated Healthcare Association, Oakland, CA, USA
- 5. Division of Outcomes and Effectiveness Research, Department of Public Health, Weill Cornell Medical College, New York, NY, USA