Financial incentives encourage improved family physician care
MedWire News: Incentive payments to family physicians may account for some improvements to patient management following the introduction of new primary care enrolment models in Canada, say researchers.
They found that diabetes management and preventive screening for breast, cervical, and colorectal cancer improved after physicians had enrolled in Family Health Networks (FHN) and Family Health Groups (FHGs).
The team studied the impact of FHNs, a capitation-based model, and FHGs, a blended fee-for-service model, before and after they were introduced in the Canadian province of Ontario within the last 10 years.
FHNs include a base payment per patient for the provision of comprehensive care plus incentives, premiums, and bonuses for preventive care and some chronic disease management, while FHGs offer enhanced fee-for-service payments and new billing codes.
Both provide the same service enhancement fees for patients meeting benchmark targets for cervical, breast, and colorectal cancer screening, although there are additional reminder fee payments in FHNs.
Annual diabetes management incentive payments were added to FHGs in 2006, and FHN models received the same payment. Heart failure management incentives were introduced into both models in 2008, although there are no incentive payments for the management of other chronic diseases.
R Liisa Jaakkimainen (University of Toronto) and colleagues compared performance before and after physicians joined these new primary care groups between 2004 and 2007, using Ontario administrative claims data.
The 3466 physicians had belonged to a FHN or FHG for at least 2 years, and patients were selected if they were rostered to the study physician during this period and had been in contact with the physician in the 2 years before this.
The two models did not consistently vary in their performance for preventive screening of breast, cervical, and colorectal cancer and chronic disease management for diabetes, heart failure, and asthma.
Performance for Pap smears and mammograms approached current benchmarks, although this had been true before introduction of the new models.
Colorectal cancer screening significantly improved for patients after joining either new primary care model, and increased in rural regions in FHNs compared with FHGs.
However, annual eye examinations decreased for younger patients with diabetes after joining a FHG or FHN, and there were no changes in performance measures for heart failure management or asthma care.
Overall, the researchers conclude in the journal BMC Family Medicine that "to some degree" the improvements they observed may be attributed to incentive payments offered within FHGs and FHNs.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Anita Wilkinson