title: Do physician organizations located in lower socioeconomic status areas score lower on pay-for-performance measures?
abstract: BACKGROUND
  Physician organizations (POs)--independent practice associations and medical groups--located in lower socioeconomic status (SES) areas may score poorly in pay-for-performance (P4P) programs.
  
  
  OBJECTIVE
  To examine the association between PO location and P4P performance.
  
  
  METHODS
  Cross-sectional study; Integrated Healthcare Association's (IHA's) P4P Program, the largest non-governmental, multi-payer program for POs in the U.S.
  
  
  METHODS
  160 POs participating in 2009.
  
  
  METHODS
  We measured PO SES using established methods that involved geo-coding 11,718 practice sites within 160 POs to their respective census tracts and weighting tract-specific SES according to the number of primary care physicians at each site. P4P performance was defined by IHA's program and was a composite mainly representing clinical quality, but also including measures of patient experience, information technology and registry use.
  
  
  RESULTS
  The area-based PO SES measure ranged from -11 to +11 (mean 0, SD 5), and the IHA P4P performance score ranged from 23 to 86 (mean 69, SD 15). In bivariate analysis, there was a significant positive relationship between PO SES and P4P performance (p < 0.001). In multivariate analysis, a one standard deviation increase in PO SES was associated with a 44% increase (relative risk 1.44, 95%CI, 1.22-1.71) in the likelihood of a PO being ranked in the top two quintiles of performance (p < 0.001).
  
  
  CONCLUSIONS
  Physician organizations' performance scores in a major P4P program vary by the SES of the areas in which their practice sites are located. P4P programs that do not account for this are likely to pay higher bonuses to POs in higher SES areas, thus increasing the resource gap between these POs and POs in lower SES areas, which may increase disparities in the care they provide.
authors.affiliation: Division of General Pediatrics, Children's Hospital Boston, and Department of Pediatrics, Harvard Medical School, 21 Autumn Street-Room 223, Boston, MA 02215, USA. alyna.chien@childrens.harvard.edu
authors.forename: Alyna T
authors.initials: AT
authors.lastname: Chien
authors.forename: Kristen
authors.initials: K
authors.lastname: Wroblewski
authors.forename: Cheryl
authors.initials: C
authors.lastname: Damberg
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Williams
authors.forename: Dolores
authors.initials: D
authors.lastname: Yanagihara
authors.forename: Yelena
authors.initials: Y
authors.lastname: Yakunina
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Casalino
mesh_terms: D003430:Cross-Sectional Studies; D054625:Healthcare Disparities / Q000191:economics*; D006801:Humans; D007193:Independent Practice Associations / Q000191:economics* / Q000592:standards; D010816:Physician Incentive Plans / Q000191:economics*; D011787:Quality of Health Care; D012052:Reimbursement, Incentive / Q000191:economics*; D012923:Social Class; D014481:United States