Bonuses for docs do little to improve diabetes care

Small financial incentives aimed at getting physicians to make sure their diabetic patients receive recommended routine exams may not lead to changes in doctors' behavior, according to a new study from Canada.

The findings echo much of what has been shown in other so-called pay-for-performance arrangements, said Meredith Rosenthal, a health policy researcher at the Harvard School of Public Health in Boston who wasn't involved in the study.

Those systems offer money to physicians who achieve certain goals that are known to improve patients' health, reduce errors or save money.

Rosenthal said financial incentives can affect medical care if they are accompanied by efforts to help doctors meet the goals. "I think there's a limited amount one can do just changing the fee structure around these things," she told Reuters Health.

Researchers and policymakers have been looking to pay-for-performance as one strategy to improve health outcomes.

"There's a big gap between what we're doing in practice and what the evidence tells us we should be doing," said Dr. Tara Kiran, the lead author of the study from St. Michael's Hospital and the University of Toronto.

The Relationship Between Financial Incentives and Quality of Diabetes Care in Ontario, Canada RESULTS One-quarter of Ontarians with diabetes had an incentive code billed by their physician. The proportion receiving the optimal number of all three monitoring tests (HbA1c, cholesterol, and eye tests) rose gradually from 16% in 2000 to 27% in 2008. Individuals who were younger, lived in rural areas, were not enrolled in a primary care model, or had a mental illness were less likely to receive all three recommended tests. Patients with higher numbers of incentive code billings in 2006–2008 were more likely to receive recommended testing but also were more likely to have received the highest level of recommended testing prior to introduction of the incentive code. Following the same patients over time, improvement in recommended testing was no greater after billing of the first incentive code than before.

CONCLUSIONS The diabetes incentive code led to minimal improvement in quality of diabetes care at the population and patient level. Our findings suggest that physicians who provide the highest quality care prior to incentives may be those most likely to claim incentive payments.

Tara Kiran, MD, MSC
J. Charles Victor, MSC, PSTAT
Alexander Kopp, BA,
Baiju R. Shah, MD, PHD and
Richard H. Glazier, MD, MPH

Centre for Research on Inner City Health, Keenan Research Centre in the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Ontario, CanadaDepartment of Family and Community Medicine, St. Michael’s Hospital, Toronto, Ontario, CanadaDepartment of Family and Community Medicine, University of Toronto, Toronto, Ontario, CanadaInstitute for Clinical Evaluative Sciences, Toronto, Ontario, CanadaDalla Lana School of Public Health, Toronto, Ontario, CanadaDepartment of Medicine, University of Toronto, Toronto, Ontario, CanadaCorresponding author: Tara Kiran, [email protected].