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Financial incentive fails to encourage doctors to conduct timely follow-ups

A $25 premium did not entice physicians to conduct follow-up visits within 2 weeks of patients leaving the hospital, according to findings recently published in the Canadian Medical Association Journal.

“The period following hospital discharge is marked by a high risk of adverse events and omissions of care, including failure to follow-up on in-hospital testing or implement a recommended work up. Timely follow-up may mitigate some of these risks by providing an opportunity for education, medication reconciliation, review of hospitalist recommendations and recognition of clinical deterioration,” Lauren Lapointe-Shaw, MD, of the department of medicine at the University of Toronto, and colleagues wrote.

“It is uncertain whether financial incentives to physicians improve quality of care,” they noted. “However, such incentives may be one way to increase rates of early follow-up.”

Researchers performed a time series analysis of all surgical and medical patients sent home from the hospital from Apr. 1, 2002, to Jan. 30, 2015, in Canada. Lapointe-Shaw and colleagues then assessed an intervention comprised of a supplemental billing code first established in 2006 that gave providers a $25 premium for performing an outpatient visit within 2 weeks of hospital discharge.

Researchers defined the primary outcome as an outpatient visit within 14 days of discharge, and secondary outcomes as 7-day follow-up and a composite of nonelective hospital readmission, ED visits and death within 14 days.

Overall, more than 8 million patient discharge records were examined.

According to results, the incentive code was used in 31% of qualifying visits by 51% of qualifying physicians, costing $17.5 million during the study period.

In primary outcome analysis, researchers found no significant difference in the average monthly rate of outcomes the year before the incentive’s introduction (66.5%) vs. the year after (67%; P = .5). In addition, there were similar monthly outcome rates between groups with 7-day physician follow-up (44.9% vs. 44.9%; P = .5) and the composite outcome (year before, 16.7% vs. year after, 16.9%; P = .2).

“Although a well-designed incentive may be motivating, without automated supporting processes, the delivery of early follow-up may be partly beyond the control of the outpatient physician,” Lapointe-Shaw and colleagues wrote, later adding that in a complex system, much of the responsibility is placed on the patient for ensuring continuity of care. – by Janel Miller

Disclosures: Lapointe-Shaw reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.