title: The influence of year-end bonuses on colorectal cancer screening.
abstract: OBJECTIVE
  To estimate the effect of physician bonus eligibility on colorectal cancer (CRC) screening, controlling for patient and primary care physician characteristics.
  
  
  METHODS
  Retrospective study using managed care plan claims data from 2000 and 2001.
  
  
  METHODS
  Data on 50-year-old commercially insured patients in a managed care health plan were linked to enrollment and provider files. The data included information on 6749 patients (3058 in 2000 and 3691 in 2001). Multivariate logistic regression models were used to assess the association between CRC screening receipt and physician bonus eligibility.
  
  
  RESULTS
  From 2000 to 2001, CRC screening use increased from 23.4% to 26.4% (P < .01). Results from the multivariate logistic regression analysis revealed that the probability that a patient received a CRC screening was approximately 3 percentage points higher in the bonus year, 2001 (P < .01).
  
  
  CONCLUSIONS
  Bonuses targeted at individual physicians were associated with increased use of CRC screening tests. However, more research is needed to examine the effect of performance-based incentives on resource use and the quality of medical care. Specifically, there is a need to determine whether explicit financial incentives are effective in reducing racial disparities in the quality of patient care. This has particular relevance for CRC screening given that black patients are less likely to be screened, they have higher CRC incidence and mortality rates compared with other racial groups, and screening has been shown to be more cost effective in this population.
authors.affiliation: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention , Atlanta, GA 30041, USA. barmour@cdc.gov
authors.forename: Brian S
authors.initials: BS
authors.lastname: Armour
authors.forename: Carol
authors.initials: C
authors.lastname: Friedman
authors.forename: M Melinda
authors.initials: MM
authors.lastname: Pitts
authors.forename: Jennifer
authors.initials: J
authors.lastname: Wike
authors.forename: Linda
authors.initials: L
authors.lastname: Alley
authors.forename: Jeff
authors.initials: J
authors.lastname: Etchason
mesh_terms: D015179:Colorectal Neoplasms / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D010816:Physician Incentive Plans; D012189:Retrospective Studies; D014481:United States