Pay for Performance, Public Reporting, and Racial Disparities in Health Care

Pay-for-performance and public reporting programs may have a neutral, narrowing, or widening effect on racial disparities in health care. The authors begin this article by suggesting that certain characteristics of these programs may affect disparities. They then present results from a systematic review of the literature on the effects of performance incentive programs on racial disparities in health care. The review revealed that only one empirical study provided data on this issue: It showed that a major public reporting program increased disparities in coronary artery bypass graft rates. The authors then present the results of interviews with leaders of 15 major performance incentive programs in the United States. The interviews indicated that current programs are not designed to reduce disparities and often lack characteristics that may be important in reducing disparities. The article concludes with program leaders' recommendations on how performance incentive programs could be designed to reduce disparities.

[1]  Sheila Roman,et al.  Public reporting and pay for performance in hospital quality improvement. , 2007, The New England journal of medicine.

[2]  Jon B Christianson,et al.  Penetrating the “Black Box”: Financial Incentives for Enhancing the Quality of Physician Services , 2004, Medical care research and review : MCRR.

[3]  N. Black,et al.  The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. , 1998, Journal of epidemiology and community health.

[4]  Thomas H. Lee,et al.  Paying physicians for high-quality care. , 2004, The New England journal of medicine.

[5]  K. Vranizan,et al.  The role of black and Hispanic physicians in providing health care for underserved populations. , 1996, The New England journal of medicine.

[6]  Stephen D. Persell,et al.  Ambulatory hypercholesterolemia management in patients with atherosclerosis. Gender and race differences in processes and outcomes. , 2005, Journal of general internal medicine.

[7]  Eric T. Bradlow,et al.  Relationship between Medicare's hospital compare performance measures and mortality rates. , 2006, JAMA.

[8]  L. Sandy,et al.  Pay for performance in commercial HMOs. , 2007, The New England journal of medicine.

[9]  R Adams Dudley,et al.  Pay-for-performance research: how to learn what clinicians and policy makers need to know. , 2005, JAMA.

[10]  Nancy M Albert,et al.  Association between performance measures and clinical outcomes for patients hospitalized with heart failure. , 2007, JAMA.

[11]  W. Manning,et al.  The Unreliability of Individual Physician “Report Cards” for Assessing the Costs and Quality of Care of a Chronic Disease , 2000 .

[12]  M. Rosenthal,et al.  Early experience with pay-for-performance: from concept to practice. , 2005, JAMA.

[13]  Francois S de Brantes,et al.  A middle ground on public accountability. , 2004, The New England journal of medicine.

[14]  D. Asch,et al.  Racial Profiling: The Unintended Consequences of Coronary Artery Bypass Graft Report Cards , 2005, Circulation.

[15]  S. Altman,et al.  America's Health Care Safety Net: Intact but Endangered , 2000 .

[16]  D. Scanlon,et al.  The role of performance measures for improving quality in managed care organizations. , 2001, Health services research.

[17]  N. Kressin.  Separate but not equal: the consequences of segregated health care. , 2005, Circulation.

[18]  M. Chin,et al.  Reducing racial and ethnic disparities in health care: an integral part of quality improvement scholarship , 2006, Quality and Safety in Health Care.

[19]  M. Chin,et al.  Interventions to Reduce Racial and Ethnic Disparities in Health Care , 2007, Medical care research and review : MCRR.

[20]  Laura Petersen,et al.  Does Pay-for-Performance Improve the Quality of Health Care? , 2006, Annals of Internal Medicine.

[21]  M. Peek,et al.  Interventions to Enhance Breast Cancer Screening, Diagnosis, and Treatment among Racial and Ethnic Minority Women , 2007, Medical care research and review : MCRR.

[22]  N. Lurie,et al.  Disparities and quality improvement: federal policy levers. , 2005, Health affairs.

[23]  D. Conrad,et al.  Paying physicians for quality: evidence and themes from the field. , 2006, Joint Commission journal on quality and patient safety.

[24]  James C. Robinson,et al.  Theory and practice in the design of physician payment incentives. , 2001, The Milbank quarterly.

[25]  Arleen F. Brown,et al.  The Association Between Clinical Care Strategies and the Attenuation of Racial/Ethnic Disparities in Diabetes Care: The Translating Research Into Action for Diabetes (TRIAD) Study , 2006, Medical care.

[26]  Paul G Shekelle,et al.  Public reporting on quality in the United States and the United Kingdom. , 2003, Health affairs.

[27]  Deborah Schrag,et al.  Primary care physicians who treat blacks and whites. , 2004, The New England journal of medicine.

[28]  M. Chin,et al.  Cultural Leverage , 2007, Medical care research and review : MCRR.

[29]  Micah T. Prochaska,et al.  Reducing Health Disparities in Depressive Disorders Outcomes between Non-Hispanic Whites and Ethnic Minorities , 2007, Medical care research and review : MCRR.

[30]  M. Rosenthal,et al.  What Is the Empirical Basis for Paying for Quality in Health Care? , 2006, Medical care research and review : MCRR.

[31]  J. Unützer,et al.  Improving Depression Care for Older, Minority Patients in Primary Care , 2005, Medical care.

[32]  R. Mannion,et al.  Enhancing performance in health care: a theoretical perspective on agency and the role of information. , 2000, Health economics.

[33]  Thomas Curtin,et al.  Shortages of medical personnel at community health centers: implications for planned expansion. , 2006, JAMA.

[34]  P. Mcnamara.  Foreword: Payment Matters? The Next Chapter , 2006, Medical care research and review : MCRR.

[35]  D. Ross-Degnan,et al.  Effect of quality improvement on racial disparities in diabetes care. , 2006, Archives of internal medicine.

[36]  Thomas R. Williams.  Practical design and implementation considerations in pay-for-performance programs. , 2006, The American journal of managed care.

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

[38]  B. Landon.  Commentary on “Penetrating the ‘Black Box’: Financial Incentives for Enhancing the Quality of Physician Services,” by Douglas A. Conrad and Jon B. Christianson , 2004, Medical care research and review : MCRR.

[39]  Elbert S. Huang,et al.  Diabetes Health Disparities , 2007 .

[40]  Julie M Hook,et al.  Incentive Implementation in Physician Practices: A Qualitative Study of Practice Executive Perspectives on Pay for Performance , 2006, Medical care research and review : MCRR.

[41]  Paul G Shekelle,et al.  Public disclosure of performance data: learning from the US experience , 2000, Quality in health care : QHC.

[42]  Judith Cukor,et al.  Problems with quality monitoring for Medicaid managed care: Perceptions of institutional and private providers in New York City , 2000, Journal of Urban Health.

[43]  P. Oliver.  Rewards and Punishments as Selective Incentives for Collective Action: Theoretical Investigations , 1980, American Journal of Sociology.

[44]  D. Asch,et al.  The unintended consequences of publicly reporting quality information. , 2005, JAMA.

[45]  H. Aaron.  Primary care physicians who treat blacks and whites. , 2004, The New England journal of medicine.

[46]  A. Sehgal.  Impact of quality improvement efforts on race and sex disparities in hemodialysis. , 2003, JAMA.

[47]  D. Sclar,et al.  Trends in the rate of depressive illness and use of antidepressant pharmacotherapy by ethnicity/race: an assessment of office-based visits in the United States, 1992-1997. , 2000, Clinical therapeutics.

[48]  L. Casalino,et al.  Will pay-for-performance and quality reporting affect health care disparities? , 2007, Health affairs.

[49]  K. Fiscella,et al.  Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. , 2000, JAMA.

[50]  Sharon-Lise T Normand,et al.  Pay for performance in commercial HMOs. , 2006, The New England journal of medicine.

[51]  A. Zaslavsky,et al.  Racial disparities in the quality of care for enrollees in medicare managed care. , 2002, JAMA.

[52]  D. Nerenz.  Health care organizations' use of race/ethnicity data to address quality disparities. , 2005, Health affairs.

[53]  Stephen D. Persell,et al.  Ambulatory hypercholesterolemia management in patients with atherosclerosis , 2005, Journal of General Internal Medicine.

[54]  A. Frølich,et al.  Strategies To Support Quality-based Purchasing : A Review of the Evidence , 2004 .

[55]  M. Peek,et al.  Diabetes Health Disparities , 2007, Medical care research and review : MCRR.

[56]  K. Grumbach,et al.  Who is Caring for the Underserved? A Comparison of Primary Care Physicians and Nonphysician Clinicians in California and Washington , 2003, The Annals of Family Medicine.

[57]  A. Zaslavsky,et al.  Relationship between quality of care and racial disparities in Medicare health plans. , 2006, JAMA.

[58]  S. Watson.  Race, Ethnicity and Quality Of Care: Inequalities and Incentives , 2001, American Journal of Law & Medicine.

[59]  Yujing Shen,et al.  Selection incentives in a performance-based contracting system. , 2003, Health services research.