Blog | Monday, September 16, 2013

QD: News Every Day--Small clinics with EHRs can recoup pay-for-performance incentives


Small practices and their patients modestly benefited from pay-for-performance measures, a study showed.

Specifically, among small clinics with a common electronic health records (EHR), a pay-for-performance incentive program compared with usual care resulted in modest improvements in cardiovascular care processes and outcomes. Most evaluations of pay-for-performance have focused on large-group practices, while most people receive care from small practices, the study began. So researchers conducted a cluster-randomized trial of primary care clinics with less than 10 providers in New York City from April 2009 through March 2010. The practices shared the same EHR software that was provided by a city-supported and multi-source funded program.

Clinics were paid for each patient whose care met the performance criteria, but they received higher payments for patients with comorbidities, who had Medicaid insurance or who were uninsured. Quality reports were given quarterly to both the intervention and control groups.

Results appeared online Sept. 11 at the Journal of the American Medical Association.

Intervention clinics had greater adjusted absolute improvement in rates of:
• appropriate antithrombotic prescription (12.0% vs. 6.1%; difference, 6.0%; 95% confidence interval [CI], 2.2% to 9.7%; P=.001 for interaction term),
• blood pressure control (no comorbidities: 9.7% vs. 4.3%; difference, 5.5%; 95% CI, 1.6% to 9.3%, P=.01 for interaction term; with diabetes mellitus: 9.0% vs. 1.2%; difference, 7.8%; 95% CI, 3.2% to 12.4%; P=.007 for interaction term; with diabetes mellitus or ischemic vascular disease: 9.5% vs. 1.7%; difference, 7.8%; 95% CI, 3.0% to 12.6%; P=.01 for interaction term), and
• smoking cessation interventions (12.4% vs. 7.7%; difference, 4.7%; 95% CI, −0.3% to 9.6%]; P=.02 for interaction term).

At the end of the study, intervention clinics received $692,000, ranging from $600 to the maximum of $100,000 (median, $9,900).

The authors noted that 82% of physicians practice in groups of fewer than 10 clinicians, and that it hasn’t been clear to date whether such clinics could recoup pay-for-performance incentives.

They wrote, “Depending on whether the effect sizes found in our study are considered clinically meaningful, the greater improvements in the intervention group compared with the control group on blood pressure control in all patients and smoking cessation in all patients provide supporting evidence that this incentive structure can be effective in the context of EHR-enabled small practices.”