Influence of financial productivity incentives on the use of preventive care

PURPOSE: We examined whether physician factors, particularly financial prod uctivity incentives, affect the provision of preventive care. SUBJECTS AND METHODS: We surveyed and reviewed the charts of 4,473 patients who saw 1 of 169 internists from 11 academically affiliated primary care p ractices in Boston. We abstracted cancer risk factors, comorbid conditions, and the dates of the last Papanicolaou (Pap) smear, mammogram, cholesterol screening, and influenza vaccination. We obtained physician information in cluding the method of financial compensation through a mailed physician sur vey. We used multivariable logistic regression to examine the association b etween physician factors and four outcomes based on Health Plan Employer Da ta and Information Set (HEDIS) measures: (1) Pap smear within the prior 3 y ears among women 20 to 75 years old; (2) mammogram in the prior 2 years amo ng women 52 to 69 years old; (3) cholesterol screening within the prior 5 y ears among patients 40 to 64 years old; and (4) influenza vaccination among patients 65 years old and older. All analyses accounted for clustering by provider and site and were converted into adjusted rates. RESULTS: After adjustment for practice site, clinical, and physician factor s, patients cared for by physicians with financial productivity incentives were significantly less likely than those cared for by physicians without t his incentive to receive Pap smears (rate difference, 12%; 95% confidence i nterval [CI]: 5% to 18%) and cholesterol screening (rate difference, 4%; 95 % CI: 0% to 8%). Financial incentives were not significantly associated wit h rates of mammography (rate difference, -3%; 95% CI: -15% to 10%) or influ enza vaccination (rate difference, -13%; 95% CI: -28% to 2%). CONCLUSIONS: Our findings suggest that some financial productivity incentiv es may discourage the performance of certain forms of preventive care, Spec ifically Pap smears and cholesterol screening. More studies are needed to e xamine the effects of financial incentives on the quality of care, and to e xamine whether quality improvement interventions or incentives based on qua lity improve the performance of preventive care. (C)2001 by Excerpta Medica , Inc.