Journal of General Internal Medicine

, Volume 27, Issue 5, pp 548–554 | Cite as

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

  • Alyna T. Chien
  • Kristen Wroblewski
  • Cheryl Damberg
  • Thomas R. Williams
  • Dolores Yanagihara
  • Yelena Yakunina
  • Lawrence P. Casalino
Original Research



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 



Special thanks to Talia Walker and Caitlin Rideout for their assistance.


This project was supported by a grant from the Robert Wood Johnson Foundation.

Prior presentations

The National Pay for Performance Summit, March 24, 2011; AcademyHealth Annual Research Meeting, June 12, 2011

Conflicts of Interest

Dr. Chien does not have any conflicts of interest.

Ms. Wroblewski does not have any conflicts of interest.

Dr. Damberg does not have any conflicts of interest.

Dr. Williams does not have any conflicts of interest. His employer, Integrated Healthcare Association, a non-profit, has the following conflicts of interest: Consultancies: Keenan Advisory Board; Grants received: Sanofi-Aventis, 11/2008.

Ms. Yanagihara does not have any conflicts of interest. Her employer, Integrated Healthcare Association, a non-profit, has the following conflicts of interest: Consultancies: Keenan Advisory Board; Grants received: Sanofi-Aventis, 11/2008.

Ms. Yakunina does not have any conflicts of interest. Her former employer, Integrated Healthcare Association, a non-profit, has the following conflicts of interest: Consultancies: Keenan Advisory Board; Grants received: Sanofi-Aventis, 11/2008.

Dr. Casalino does not have any conflicts of interest.


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Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Alyna T. Chien
    • 1
  • Kristen Wroblewski
    • 2
  • Cheryl Damberg
    • 3
  • Thomas R. Williams
    • 4
  • Dolores Yanagihara
    • 4
  • Yelena Yakunina
    • 4
  • Lawrence P. Casalino
    • 5
  1. 1.Division of General Pediatrics, Children’s Hospital Boston; Department of PediatricsHarvard Medical SchoolBostonUSA
  2. 2.Department of Health StudiesThe University of ChicagoChicagoUSA
  3. 3.RAND CorporationSanta MonicaUSA
  4. 4.Integrated Healthcare AssociationOaklandUSA
  5. 5.Division of Outcomes and Effectiveness Research, Department of Public HealthWeill Cornell Medical CollegeNew YorkUSA

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