Programs that tie physician pay to quality of care are successful. In other words, pay the doctors extra money and they'll give you better health care. Don't and the quality of care is less. The AMA's current issue of Archives of Internal Medicine reports on a study where physician clinics referred Minnesota patients to a tobacco quit line -- or not. Researchers compared clinics that were paid bonuses for making referrals to the tobacco quit line ($5,000 for 50 referrals and $25 for each referrals beyond the first 50) to clinics that did not receive any financial incentives to make referrals.
Guess what? The results showed that those clinics which were in the pay-for-performance program made more than three times as many referrals to the quit smoking line than the non-paid clinics. The clinics which got paid for making referrals made 1,483 such referrals, an average of 11.4 percent of their patients who were smokers. At the clinics where the physicians did not have a chance to earn extra money, only 441 referrals were made, an average of 4.2 percent of their smokers.
Researchers from the University of Minnesota noted that there were some important factors for success besides hard cold cash.
For example, health plans in Minnesota collaborated to make the referral process easy for the clinics. The collaboration between the health plans and the researchers, led by Lawrence An, also allowed clinics to be rewarded regardless of which health plan their patients belonged, so the physicians in the study could make the same recommendation to all patients who were smokers.
The study was funded by Blue Cross and Blue Shield of Minnesota, which also made payments to the clinics -- money that came from a tobacco settlement. Along with a group of other Minnesota health plans, Blue Cross said it plans to continue with the smoking cessation referral program, but with lower financial awards. I don't know about that. Now that they've proven that the money paid to the physicians is what made the big difference in quality of care, they're going to take away the amount of money paid. Do they not think the physicians, all members of the AMA, won't have read about their study and what they paid originally? Or, maybe they think the physicians will change suddenly and let medical ethics win the day. I guess we'll see.
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