Financial Incentives for Quality in Breast Cancer Care

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As incentive to improve healthcare quality, many managed care and payer organizations use pay-for-performance programs, which reward physicians monetarily for adhering to high care standards and improving patient outcomes. Several studies have examined the effect these programs have on primary care but few have examined their impact on cancer care. Reasons for this may include the lack of agreement on outcomes measures and the existence of multiple practice guidelines.

Researchers from the University of California Los Angeles conducted an observational study of a population-based group of patients with breast cancer to determine the extent to which pay-for-performance programs influence breast cancer care. They asked 477 patient- identified medical oncologists, radiation oncologists, and surgeons from Los Angeles County to complete a survey regarding their reimbursement relationships. Investigators received 348 responses.

According to the study, 20% of physicians surveyed said they received payments based on patient satisfaction scores and 15% responded that they received incentive payments based on their use of practice guidelines. Virtually none of the respondents indicated that payments were tied to true quality indicators.

Physicians in staff-model or large group-model health plans were more likely to be subject to pay-for-performance incentives. Those who participated in pay-for-performance programs were more likely receiving capitated payments rather than fee-for-service reimbursement. The study concluded that in relation to breast cancer care, quality-of-care measures are not yet a driving force behind financial incentives.

Tisnado DM, Rose-Ash DE, Malin JL, et al. Financial incentives for quality in breast cancer care.

2008;14:467-466.

Am J Manag Care.