Financial incentives for quality in breast cancer care.
OBJECTIVE
To examine the use of financial incentives related to performance on quality measures reported by oncologists and surgeons associated with a population-based cohort of patients with breast cancer in Los Angeles County, California, and to explore the physician and practice characteristics associated with the use of these incentives among breast cancer care providers.


METHODS
Cross-sectional observational study.


METHODS
Physician self-reported financial arrangements from a survey of 348 medical oncologists, radiation oncologists, and surgeons caring for patients with breast cancer in Los Angeles County (response rate, 76%). Physicians were asked whether they were subject to financial incentives for quality (ie, patient satisfaction surveys and adherence to practice guidelines). We examined the prevalence and correlates of incentives and performed multivariate logistic regression analyses to assess predictors of incentives, controlling for other covariates.


RESULTS
Twenty percent of respondents reported incentives based on patient satisfaction, and 15% reported incentives based on guideline adherence. The use of incentives for quality in this cohort of oncologists and surgeons was modest and was primarily associated with staff- or group-model health maintenance organization (HMO) settings. In other settings, important predictors were partial physician ownership interest, large practice size, and capitation.


CONCLUSIONS
Most cancer care providers in Los Angeles County outside of staff- or group-model HMOs are not subject to explicit financial incentives based on quality-of-care measures. Those who are, seem more likely to be associated with large practice settings. New approaches are needed to direct financial incentives for quality toward specialists outside of staff- or group-model HMOs if pay-for-performance programs are to succeed in influencing care.
Tisnado
Diana M
DM
Department of Medicine, University of California, Los Angeles, 911 Broxton Plz, Los Angeles, CA 90095-1736, USA. dtisnado@mednet.ucla.edu
Rose-Ash
Danielle E
DE
Malin
Jennifer L
JL
Adams
John L
JL
Ganz
Patricia A
PA
Kahn
Katherine L
KL
D000368:Aged; D001943:Breast Neoplasms / Q000191:economics* / Q000628:therapy*; D003430:Cross-Sectional Studies; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008495:Medical Oncology / Q000191:economics* / Q000592:standards*; D008875:Middle Aged; D019370:Observation; D017060:Patient Satisfaction; D010816:Physician Incentive Plans / Q000191:economics* / Q000592:standards; D011785:Quality Assurance, Health Care / Q000191:economics*