Physician compensation from salary and quality of diabetes care.
OBJECTIVE
To examine the association between physician-reported percent of total compensation from salary and quality of diabetes care.


METHODS
Cross-sectional analysis.


METHODS
Physicians (n = 1248) and their patients with diabetes mellitus (n = 4200) enrolled in 10 managed care plans.


METHODS
We examined the associations between physician-reported percent compensation from salary and processes of care including receipt of dilated eye exams and foot exams, advice to take aspirin, influenza immunizations, and assessments of glycemic control, proteinuria, and lipid profile, intermediate outcomes such as adequate control of hemoglobin A1c, lipid levels, and systolic blood pressure levels, and satisfaction with provider communication and perceived difficulty getting needed care. We used hierarchical logistic regression models to adjust for clustering at the health plan and physician levels, as well as for physician and patient covariates. We adjusted for plan as a fixed effect, meaning we estimated variation between physicians using the variance within a particular health plan only, to minimize confounding by other unmeasured health plan variables.


RESULTS
In unadjusted analyses, patients of physicians who reported higher percent compensation from salary (>90%) were more likely to receive 5 of 7 diabetes process measures and more intensive lipid management and to have an HbA1c<8.0% than patients of physicians who reported lower percent compensation from salary (<10%). However, these associations did not persist after adjustment.


CONCLUSIONS
Our findings suggest that salary, as opposed to fee-for-service compensation, is not independently associated with diabetes processes and intermediate outcomes.
Kim
Catherine
C
Division of General Internal Medicine, Department of Internal Medicine and Department of Obstetrics & Gynecology, University of Michigan, Ann Arbor, MI, USA. cathkim@umich.edu
Steers
W Neil
WN
Herman
William H
WH
Mangione
Carol M
CM
Narayan
K M Venkat
KM
Ettner
Susan L
SL
D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000191:economics* / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians / Q000191:economics*; D011787:Quality of Health Care / Q000191:economics*; D012456:Salaries and Fringe Benefits / Q000191:economics*