Medical Scientist Training Program, University of Michigan Medical School, Ann Arbor, MI.
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI.
Health Serv Res. 2018 Aug;53 Suppl 1(Suppl Suppl 1):3052-3069. doi: 10.1111/1475-6773.12743. Epub 2017 Jul 26.
To evaluate whether greater experience and success with performance incentives among physician practices are related to increased participation in Medicare's voluntary value-based payment reforms.
DATA SOURCES/STUDY SETTING: Publicly available data from Medicare's Physician Compare (n = 1,278; January 2012 to November 2013) and nationally representative physician practice data from the National Survey of Physician Organizations 3 (NSPO3; n = 907,538; 2013).
We used regression analysis to examine practice-level relationships between prior exposure to performance incentives and participation in key Medicare value-based payment reforms: accountable care organization (ACO) programs, the Physician Quality Reporting System ("Physician Compare"), and the Meaningful Use of Health Information Technology program ("Meaningful Use"). Prior experience and success with financial incentives were measured as (1) the percentage of practices' revenue from financial incentives for quality or efficiency; and (2) practices' exposure to public reporting of quality measures.
DATA COLLECTION/EXTRACTION METHODS: We linked physician participation data from Medicare's Physician Compare to the NSPO3 survey.
There was wide variation in practices' exposure to performance incentives, with 64 percent exposed to financial incentives, 45 percent exposed to public reporting, and 2.2 percent of practice revenue coming from financial incentives. For each percentage-point increase in financial incentives, there was a 0.9 percentage-point increase in the probability of participating in ACOs (standard error [SE], 0.1, p < .001) and a 0.8 percentage-point increase in the probability of participating in Meaningful Use (SE, 0.1, p < .001), controlling for practice characteristics. Financial incentives were not associated with participation in Physician Compare. Among ACO participants, a 1 percentage-point increase in incentives was associated with a 0.7 percentage-point increase in the probability of being "very well" prepared to utilize cost and quality data (SE, 0.1, p < .001).
Physicians organizations' prior experience and success with performance incentives were related to participation in Medicare ACO arrangements and participation in the meaningful use criteria but not to participation in Physician Compare. We conclude that Medicare must complement financial incentives with additional efforts to address the needs of practices with less experience with such incentives to promote value-based payment on a broader scale.
评估医生实践中与绩效激励相关的更多经验和成功是否与参与医疗保险的自愿基于价值的支付改革有关。
数据来源/研究环境：医疗保险的医生比较（n=1278；2012 年 1 月至 2013 年 11 月）和全国医师组织调查 3（NSPO3；n=907538；2013 年）中公开可用的数据。
我们使用回归分析检查了绩效激励之前的暴露程度与参与医疗保险的关键基于价值的支付改革之间的实践水平关系：责任制医疗组织（ACO）计划、医师质量报告系统（“医生比较”）和使用健康信息技术的有意义计划（“有意义的使用”）。先前的财务激励经验和成功被衡量为（1）实践从质量或效率的财务激励中获得的收入百分比；和（2）实践对质量措施公开报告的暴露程度。
数据收集/提取方法：我们将医疗保险的医生比较中的医生参与数据与 NSPO3 调查联系起来。
实践暴露于绩效激励措施的情况差异很大，有 64%的实践受到财务激励的影响，45%的实践受到公开报告的影响，2.2%的实践收入来自财务激励。每增加一个百分点的财务激励，参与 ACO 的概率就会增加 0.9 个百分点（标准误差 [SE]，0.1，p<0.001），参与有意义使用的概率增加 0.8 个百分点（SE，0.1，p<0.001），控制了实践特征。财务激励与参与医生比较无关。在 ACO 参与者中，激励措施增加 1 个百分点与准备使用成本和质量数据的“非常好”的可能性增加 0.7 个百分点（SE，0.1，p<0.001）相关。
医师组织在绩效激励方面的先前经验和成功与参与医疗保险 ACO 安排以及参与有意义的使用标准有关，但与参与医生比较无关。我们的结论是，医疗保险必须通过额外的努力来补充财务激励措施，以解决经验较少的实践需求，以更广泛地促进基于价值的支付。
