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PCP incentive payment program improved compensation, not access to care

Although it succeeded in improving compensation for PCPs, British Columbia’s $240 million payment incentive program for physicians caring for patients with two or more chronic conditions did not expand access or continuity, according to data published in the Canadian Medical Association Journal.

“Patients with multiple chronic conditions drive growing demand for health care, but their needs may be poorly met by systems oriented toward acute care and management of single disease,” M. Ruth Lavergne, PhD, of the University of British Columbia, in Vancouver, Canada, and colleagues wrote. “… Several jurisdictions in Canada and internationally have introduced incentive payments for primary care providers targeting the treatment of patients with chronic illnesses.”

According to the researchers, British Columbia’s Complex Care Initiative offers PCPs an annual payment of $315 for taking on comprehensive, continuous and guideline-informed care for a patient with two or more chronic diseases. Implemented in 2007 within the existing fee-for-service payment system, it came with no additional support for team-based care or other service delivery models.

To determine the impact of the program on primary care access and continuity, rates of hospital admission and costs, the researchers used population-based and provider-specific administrative data to analyze all patients in British Columbia who qualified for the incentive. In all, there were 155,754 eligible patients.

The researchers tracked contacts and continuity, total hospital admissions and cost of physician services, hospital care and pharmaceuticals for 24 months before, and 24 months after, the intervention.

According to the researchers, 63.7% of eligible patients had at least one incentive payment billed. The incentive payments made no impact on primary care contacts (change per patient per month: 0.016; 95% CI, –0.047 to 0.078), or continuity of care (mean monthly change: 0.012; 95% CI, –0.001 to 0.024). In addition, the incentive payments were associated with increased total rates of hospital admission (change in admission per 1,000 patients per month: 1.46; 95% CI, 0.04 to 2.89), relative to trends prior to the intervention. Annual costs per patient did not decline (mean change: $455.81; 95% CI, –$2.44 to $914.08).

“Our analysis shows that incentive payments to individual physicians for the care of patients with two or more chronic conditions, in the absence of other changes to primary care payment or delivery, have not changed access or continuity, nor have they prevented hospital admissions or led to cost avoidance elsewhere in the health care system,” Lavergne and colleagues wrote. “British Columbia’s $240 million investment in this program may have improved compensation for physicians doing the important work of caring for patients with complex illness, but has not yielded measurable improvements in the outcomes examined. Other strategies are needed to improve care for this group.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.