title: Influence of financial productivity incentives on the use of preventive care.
abstract: OBJECTIVE
  We examined whether physician factors, particularly financial productivity incentives, affect the provision of preventive care.
  
  
  METHODS
  We surveyed and reviewed the charts of 4,473 patients who saw 1 of 169 internists from 11 academically affiliated primary care practices in Boston. We abstracted cancer risk factors, comorbid conditions, and the dates of the last Papanicolaou (Pap) smear, mammogram, cholesterol screening, and influenza vaccination. We obtained physician information including the method of financial compensation through a mailed physician survey. We used multivariable logistic regression to examine the association between physician factors and four outcomes based on Health Plan Employer Data and Information Set (HEDIS) measures: (1) Pap smear within the prior 3 years among women 20 to 75 years old; (2) mammogram in the prior 2 years among women 52 to 69 years old; (3) cholesterol screening within the prior 5 years among patients 40 to 64 years old; and (4) influenza vaccination among patients 65 years old and older. All analyses accounted for clus-tering by provider and site and were converted into adjusted rates.
  
  
  RESULTS
  After adjustment for practice site, clinical, and physician factors, patients cared for by physicians with financial productivity incentives were significantly less likely than those cared for by physicians without this incentive to receive Pap smears (rate difference, 12%; 95% confidence interval [CI]: 5% to 18%) and cholesterol screening (rate difference, 4%; 95% CI: 0% to 8%). Financial incentives were not significantly associated with rates of mammography (rate difference, -3%; 95% CI: -15% to 10%) or influenza vaccination (rate difference, -13%; 95% CI: -28% to 2%).
  
  
  CONCLUSIONS
  Our findings suggest that some financial productivity incentives may discourage the performance of certain forms of preventive care, specifically Pap smears and cholesterol screening. More studies are needed to examine the effects of financial incentives on the quality of care, and to examine whether quality improvement interventions or incentives based on quality improve the performance of preventive care.
authors.affiliation: Division of General Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: C C
authors.initials: CC
authors.lastname: Wee
authors.forename: R S
authors.initials: RS
authors.lastname: Phillips
authors.forename: H R
authors.initials: HR
authors.lastname: Burstin
authors.forename: E F
authors.initials: EF
authors.lastname: Cook
authors.forename: A L
authors.initials: AL
authors.lastname: Puopolo
authors.forename: T A
authors.initials: TA
authors.lastname: Brennan
authors.forename: J S
authors.initials: JS
authors.lastname: Haas
mesh_terms: D000328:Adult; D000368:Aged; D001900:Boston; D002784:Cholesterol / Q000097:blood; D004526:Efficiency; D005260:Female; D006801:Humans; D007252:Influenza Vaccines / Q000008:administration & dosage; D007388:Internal Medicine / Q000191:economics*; D016015:Logistic Models; D008297:Male; D008327:Mammography / Q000191:economics / Q000706:statistics & numerical data; D008403:Mass Screening / Q000191:economics / Q000706:statistics & numerical data; D008875:Middle Aged; D015999:Multivariate Analysis; D065006:Papanicolaou Test; D010818:Practice Patterns, Physicians' / Q000191:economics*; D011314:Preventive Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D011322:Primary Prevention / Q000191:economics*; D012052:Reimbursement, Incentive; D014626:Vaginal Smears / Q000191:economics / Q000706:statistics & numerical data
chemical_list: D007252:Influenza Vaccines; D002784:Cholesterol