Skip to main content

Advertisement

SpringerLink
Log in

Incentives in Rheumatology: the Potential Contribution of Physician Responses to Financial Incentives, Public Reporting, and Treatment Guidelines to Health Care Sustainability

  • Health Economics and Quality of Life (M Harrison, Section Editor)
  • Published:
Current Rheumatology Reports Aims and scope Submit manuscript

Abstract

Concerns about the sustainability of current health care expenditure are focusing attention on the cost, quality and value of health care provision. Financial incentives, for example pay-for-performance (P4P), seek to reward quality and value in health care provision. There has long been an expectation that P4P schemes are coming to rheumatology. We review the available evidence about the use of incentives in this setting and provide two emerging examples of P4P schemes which may shape the future of service provision in rheumatology. Currently, there is limited and equivocal evidence in rheumatology about the impact of incentive schemes. However, reporting variation in the quality and provision of rheumatology services has highlighted examples of inefficiencies in the delivery of care. If financial incentives can improve the delivery of timely and appropriate care for rheumatology patients, then they may have an important role to play in the sustainability of health care provision.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA. 2012;307(14):1513–6.

    Article  CAS  PubMed  Google Scholar 

  2. Porter ME, Teisberg E. How physicians can change the future of health care. JAMA. 2007;297(10):1103–11.

    Article  CAS  PubMed  Google Scholar 

  3. Palmer S, Torgerson DJ. Definitions of efficiency. BMJ. 1999;318(7191):1136.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Eijkenaar F. Pay for performance in health care an international overview of initiatives. Med Care Res Rev. 2012;69(3):251–76.

    Article  PubMed  Google Scholar 

  5. Eijkenaar F, Emmert M, Scheppach M, Schöffski O. Effects of pay for performance in health care: a systematic review of systematic reviews. Health Policy. 2013;110(2–3):115–30. Review of the current state of knowledge of pay-for-performance schemes summarising the current lack of knowledge about the success of these type of financial incentives. There is an attempt to highlight the features of schemes that have been successful.

    Article  PubMed  Google Scholar 

  6. Berwick DM. A primer on leading the improvement of systems. BMJ. 1996;312(7031):619–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Hibbard JH, Stockard J, Tusler M. Does publicizing hospital performance stimulate quality improvement efforts? Health Aff (Millwood). 2003;22(2):84–94.

    Article  Google Scholar 

  8. Marshall MN, Shekelle PG, Davies HTO, Smith PC. Public reporting on quality in the United States and the United Kingdom. Health Aff (Millwood). 2003;22(3):134–48.

    Article  Google Scholar 

  9. Frølich A, Talavera JA, Broadhead P, Dudley RA. A behavioral model of clinician responses to incentives to improve quality. Health Policy. 2007;80(1):179–93.

    Article  PubMed  Google Scholar 

  10. Oliver A. Incentivising improvements in health care delivery. Health Econ Policy Law. 2015;10(03):327–43.

    Article  PubMed  Google Scholar 

  11. Centre H and SCI. Quality and outcomes framework [Internet]. Health and Social Care Information Centre, 1 Trevelyan Square, Boar Lane, Leeds, LS1 6AE, United Kingdom; 2015 [cited 2015 Nov 23]. Available from: http://www.hscic.gov.uk/qof.

  12. Harrison MJ, Dusheiko M, Sutton M, Gravelle H, Doran T, Roland M. Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: controlled longitudinal study. BMJ. 2014;349(nov11 1):g6423.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Walker S, Mason AR, Claxton K, Cookson R, Fenwick E, Fleetcroft R, et al. Value for money and the Quality and Outcomes Framework in primary care in the UK NHS. Br J Gen Pract. 2010;60(574):e213–20.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kmietowicz Z. New GP contract: modernisation or miscalculation? BMJ. 2006;333(7580):1192.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gibofsky A, Harrington JT. Pay for performance in rheumatology: will we get the carrot or the stick? Arthritis Care Res. 2008;59(9):1203–6.

    Article  Google Scholar 

  16. Desai SP, Yazdany J. Quality measurement and improvement in rheumatology: rheumatoid arthritis as a case study. Arthritis Rheum. 2012;63(12):3649–60.

    Article  Google Scholar 

  17. Rheumatology AC of. RISE FAQs [Internet]. 2015 [cited 2015 Dec 2]. Available from: http://www.rheumatology.org/I-Am-A/Rheumatologist/Registries/RISE/RISE-FAQs.

  18. Association AM. 2015 Physician Quality Reporting System (PQRS) measure specifications manual for claims and registry reporting of individual measures. 2014.

  19. Curtis JR, Sharma P, Arora T, Bharat A, Barnes I, Morrisey MA, et al. Physicians’ explanations for apparent gaps in the quality of rheumatology care: results from the US Medicare Physician Quality Reporting System. Arthritis Care Res. 2013;65(2):235–43. Offers insights into the reasons why physicians might not deliver optimal care on the measures collected by the Physician Quality Reporting System (PQRS). The measures collected by the PQRS will be a key component of the Value Based Payment Modifier under the Affordable Care Act.

    Article  Google Scholar 

  20. Primary Care Domain, Health and Social Care Information Centre. Quality and outcomes framework—prevalence, achievements and exceptions report: England, 2013–14. 2015.

  21. Prescribing and Primary Care Team, Health and Social Care Information Centre. Quality and outcomes framework: achievement, prevalence and exceptions data, 2012/13. Vol. V1.0. 2013.

  22. Prescribing and Primary Care Services H and SCIC. Quality and outcomes framework – prevalence, achievements and exceptions report: England, 2013–14. 2014.

  23. NHS England. 2014/15 GMS Contract Negtoiations [Internet]. 2013. Available from: file:///Z:/Incentives%20in%20rheumatology/RA%20Removal/gms-contr-let-at113.pdf.

  24. DeWitt E, Glick HA, Albert DA, Joffe MM, Wolfe F. MEdicare coverage of tumor necrosis factor α inhibitors as an influence on physicians’ prescribing behavior. Arch Intern Med. 2006;166(1):57–63.

    Article  PubMed  Google Scholar 

  25. Doshi JA, Li P, Puig A. Impact of the medicare modernization act of 2003 on utilization and spending for medicare part B–covered biologics in rheumatoid arthritis. Arthritis Care Res. 2010;62(3):354–61.

    Article  Google Scholar 

  26. Bombardier C, Mian S. Quality indicators in rheumatoid arthritis care: using measurement to promote quality improvement. Ann Rheum Dis. 2013;72 suppl 2:ii128–31.

    Article  PubMed  Google Scholar 

  27. Harrington JT. Quality of care in rheumatic diseases: performance measures and improvement. Curr Opin Rheumatol. 2008;20(2):153–8.

    Article  PubMed  Google Scholar 

  28. Carli C, Bridges JFP, Ask J, Lindblad S, Register for the SRA. Charting the possible impact of national guidelines on the management of rheumatoid arthritis. Scand J Rheumatol. 2008;37(3):188–93.

    Article  CAS  PubMed  Google Scholar 

  29. Harrold LR, Harrington JT, Curtis JR, Furst DE, Bentley MJ, Shan Y, et al. Prescribing practices in a US cohort of rheumatoid arthritis patients before and after publication of the American College of Rheumatology treatment recommendations. Arthritis Rheum. 2012;64(3):630–8.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Adhikesavan LG, Newman ED, Diehl MP, Wood GC, Bili A. American college of rheumatology quality indicators for rheumatoid arthritis: benchmarking, variability, and opportunities to improve quality of care using the electronic health record. Arthritis Care Res. 2008;59(12):1705–12.

    Article  Google Scholar 

  31. DeMaria L, Acelajado MC, Luck J, Ta H, Chernoff D, Florentino J, et al. Variations and practice in the care of patients with rheumatoid arthritis: quality and cost of care. J Clin Rheumatol. 2014;20(2):79–86. Study identifying variations in quality and cost of rheumatology service provision in the US. Highlights opportunities for cost control, quality improvement and greater efficiency.

    Article  PubMed  Google Scholar 

  32. Deal CL, Hooker R, Harrington T, Birnbaum N, Hogan P, Bouchery E, et al. The United States rheumatology workforce: supply and demand, 2005–2025. Arthritis Rheum. 2007;56(3):722–9.

    Article  PubMed  Google Scholar 

  33. Harrison MJ, Morley KD, Symmons DPM. Developments in rheumatology consultant manpower provision: the BSR/arc Workforce Register 2003–05. Rheumatology. 2006;45(11):1416–21.

    Article  CAS  PubMed  Google Scholar 

  34. Harrison MJ, Deighton C, Symmons DPM. An update on UK rheumatology consultant workforce provision: the BSR/ARC Workforce Register 2005–07: assessing the impact of recent changes in NHS provision. Rheumatology. 2008;47(7):1065–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Harrison MJ, Lee S, Deighton C, Symmons DP. UK rheumatology consultant workforce provision 2007–9: results from the BSR/Arthritis Research UK Consultant Workforce Register. Clin Med. 2011;11(2):119–24.

    Article  Google Scholar 

  36. Turner G, Symmons D, Bamji A, Palferman T. Consultant rheumatology workforce in the UK: changing patterns of provision 1997–2001. Rheumatology. 2002;41(6):680–4.

    Article  CAS  PubMed  Google Scholar 

  37. QOF Advisory Committee. QOF Indicator Assessment Report—Advice for NHS England [Internet]. National Institute for Health and Care Excellence; 2013 [cited 2015 Dec 21]. Available from: https://www.nice.org.uk/media/default/Get-involved/Meetings-In-Public/QOF-Advisory-Committee/QOF-indicator-assessment-report-18-September-2013.pdf.

  38. Guthrie B, Morales DR. What happens when pay for performance stops? BMJ. 2014;348:g1413.

    Article  PubMed  Google Scholar 

  39. Cush JJ. Biological drug use: US perspectives on indications and monitoring. Ann Rheum Dis. 2005;64 Suppl 4:iv18–23

  40. Schneider EC, Epstein AM. Use of public performance reports: a survey of patients undergoing cardiac surgery. JAMA. 1998;279(20):1638–42.

    Article  CAS  PubMed  Google Scholar 

  41. The World Bank. Health expenditure, total (% of GDP) [Internet]. [cited 2016 May 3]. Available from: http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS.

  42. Dhalla I. Canada’s health care system and the sustainability paradox. Can Med Assoc J. 2007;177(1):51–3.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Pharmaceutical Sciences, University of British Columbia, 4625-2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada

    Mark Harrison & Tamara Mihic

  2. Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, BC, Canada

    Mark Harrison, Katherine Milbers & Aslam H. Anis

  3. School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada

    Aslam H. Anis

Authors
  1. Mark Harrison
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Katherine Milbers
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tamara Mihic
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aslam H. Anis
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mark Harrison.

Ethics declarations

Conflict of Interest

MH, KM, TM and AHA declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Health Economics and Quality of Life

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Harrison, M., Milbers, K., Mihic, T. et al. Incentives in Rheumatology: the Potential Contribution of Physician Responses to Financial Incentives, Public Reporting, and Treatment Guidelines to Health Care Sustainability. Curr Rheumatol Rep 18, 42 (2016). https://doi.org/10.1007/s11926-016-0596-6

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11926-016-0596-6

Keywords

Search

Navigation