While quality of provider care shouldn't be based on financial incentives given to doctors, a new study examining the concept of monetarily rewarding certain patient screenings shows that such a trend does exist and could have detrimental implications in other areas of care.
British researchers worked with doctors from Kaiser Permanente to study the effects of financial incentives for two specific screenings--diabetic retinopathy and cervical cancer--given to roughly 2.5 million patients of Kaiser Permanente Northern California. Financial rewards were given for the former screening from 1999 to 2003 and, not surprisingly, the rate for diabetic retinopathy screenings increased from 84.9 percent to 88.1 percent in that time frame. Once the payments stopped, the screening rates declined--to 80.5 percent by 2007.
Cervical cancer screening rates experienced similar trends, rising slightly--from 77.4 to 78 percent--between 1999 and 2000, when monetary rewards existed. The screening rate dipped to 74.3 percent between 2001 and 2005 with the removal of financial incentives, but rose again when the incentives were put back into place.
"If the findings of this study are confirmed across a wider range of indicators, clinicians need to be aware that if financial incentives are removed, their focus may change and they may need to think proactively about how to maintain previous levels of patient care," the study's authors wrote.
A "stepwise reduction of payments" was recommended by the authors for policy makers who are intent on ultimately doing away with financial incentives. "They may also need to introduce a system of monitoring achievement in areas where indicators have been removed," the authors continued, "and perhaps decide a priori the level of decline in achievement that could trigger a review and possible reintroduction."
To learn more:
- here's the study in the British Medical Journal
- read this Los Angeles Times Booster Shots blog post