A trial of disclosing physicians' financial incentives to patients.

BACKGROUND Concern regarding financial conflict of interest for physicians has led to calls for disclosure of financial incentives to patients. However, limited data on the outcomes of disclosure exist to guide policy. METHODS This randomized trial was conducted among 8000 adult patients at 2 multispecialty group practices based in the Boston, Mass, and Los Angeles, Calif, areas. Intervention patients were mailed a compensation disclosure letter written by the chief medical officer of their physician group, and all patients were surveyed approximately 3 months later. RESULTS Disclosure patients were significantly more able to identify correctly the compensation model of their primary care physician, in Boston (adjusted odds ratio, 2.30; 95% confidence interval, 1.92-2.75) and in Los Angeles (adjusted odds ratio, 1.37; 95% confidence interval, 1.03-1.82). Disclosure patients also had more confidence in their ability to judge the possible influence of incentives on their health care: in Boston, 32.5% vs 17.8% (P<.001); and in Los Angeles, 31.8% vs 26.4% (P = .20). The disclosure intervention did not change trust in primary care physicians overall. However, of patients who remembered receiving the disclosure, 21.4% in Boston and 24.4% in Los Angeles responded that the disclosure had increased trust either greatly or somewhat, while in both cities less than 5% of patients responded that the information decreased trust. Patients' loyalty to their physician group was higher among disclosure patients in Boston (73.4% vs 70.2%; P = .03) and Los Angeles (74.1% vs 66.9%; P = .08). CONCLUSIONS Among diverse patient populations, a single mailed disclosure letter from physician groups was associated with improved knowledge of physicians' compensation models. Patients' trust in their physicians was unharmed, and their loyalty to their physician group was strengthened. For physician groups with similar compensation programs, disclosure to patients should be considered an effective method to enhance the patient-physician relationship.

[1]  A. Zaslavsky,et al.  Physician incentives and disclosure of payment methods to patients , 2001, Journal of General Internal Medicine.

[2]  P. Ubel.  Money talks, patients walk? , 2001, Journal of General Internal Medicine.

[3]  W. Levinson,et al.  The effect of physician disclosure of financial incentives on trust. , 2005, Archives of internal medicine.

[4]  James C. Robinson,et al.  The alignment and blending of payment incentives within physician organizations. , 2004, Health services research.

[5]  D. Sulmasy,et al.  Ethics in Practice: Managed Care and the Changing Health Care Environment , 2004, Annals of Internal Medicine.

[6]  Bruce Landon,et al.  Paying for quality: providers' incentives for quality improvement. , 2004, Health affairs.

[7]  M. Rosenthal,et al.  Transmission of financial incentives to physicians by intermediary organizations in California. , 2002, Health affairs.

[8]  Rajesh Balkrishnan,et al.  How disclosing HMO physician incentives affects trust. , 2002, Health affairs.

[9]  S. Pearson,et al.  Patient attitudes toward physician financial incentives. , 2001, Archives of internal medicine.

[10]  T. Gallagher,et al.  Patients' attitudes toward cost control bonuses for managed care physicians. , 2001, Health affairs.

[11]  T. Miller,et al.  Disclosing doctors' incentives: will consumers understand and value the information? , 2000, Health affairs.

[12]  M. Hall,et al.  Disclosure of physician incentives: do practices satisfy purposes? , 2000, Health affairs.

[13]  T. Lake,et al.  Health Plans' Selection and Payment of Health Care Providers, 1999 , 2000 .

[14]  G. Larkin,et al.  Ethical issues of managed care. , 1999, Emergency medicine clinics of North America.

[15]  T. Miller,et al.  Disclosing physician financial incentives. , 1999, JAMA.

[16]  K. Vranizan,et al.  Primary care physicians' experience of financial incentives in managed-care systems. , 1998, The New England journal of medicine.

[17]  E. Emanuel,et al.  Ethical guidelines for physician compensation based on capitation. , 1998, The New England journal of medicine.

[18]  R. Berenson,et al.  Ethical Practice in Managed Care: A Dose of Realism , 1998, Annals of Internal Medicine.

[19]  C. Jaén.  Primary-care physicians. , 1997, Tobacco control.

[20]  P. Ubel,et al.  Managed care organizations should not disclose their physicians' financial incentives. , 1997, The American journal of managed care.

[21]  B. Gray.  Trust and trustworthy care in the managed care era. , 1997, Health affairs.

[22]  T. Bodenheimer.  The HMO backlash--righteous or reactionary? , 1996, The New England journal of medicine.

[23]  D. Berwick.  Quality of health care. Part 5: Payment by capitation and the quality of care. , 1996, The New England journal of medicine.

[24]  D. Mechanic,et al.  The impact of managed care on patients' trust in medical care and their physicians. , 1996, JAMA.

[25]  D. Himmelstein,et al.  Extreme risk-the new corporate proposition for physicians , 1996 .

[26]  E. Larson.  The soul of an HMO. , 1996, Time.

[27]  R. Berenson,et al.  A national survey of the arrangements managed-care plans make with physicians. , 1995, The New England journal of medicine.

[28]  M. Rodwin,et al.  Conflicts in managed care. , 1995, The New England journal of medicine.

[29]  Charles W. Plows,et al.  Ethical Issues in Managed Care: Council on Ethical and Judicial Affairs, American Medical Association , 1995 .

[30]  E. Emanuel,et al.  Preserving the physician-patient relationship in the era of managed care. , 1995, JAMA.

[31]  M. Angell,et al.  The Doctor as Double Agent , 1993, Kennedy Institute of Ethics journal.

[32]  D. Sulmasy.  Physicians, Cost Control, and Ethics , 1992, Annals of Internal Medicine.

[33]  S. Zeger,et al.  Longitudinal data analysis using generalized linear models , 1986 .