Physician incentive program for complex patients did not reduce hospitalizations – research

Ruth Lavergne cropped
A program paying incentives to doctors of patients with complex health issues did not improve continuity of care or reduce hospitalizations, research has found.

The study, the authors of which include School of Population and Public Health associate professors Kimberlyn McGrail and Michael Law, looked at 155,754 patients who had two or more chronic health conditions, including diabetes, chronic kidney disease and congestive heart failure. Of these eligible patients, 63.7% had at least one incentive payment billed.

Kimberlyn McGrail

SPPH associate professor Kimberlyn McGrail

The research used linked healthcare data from two years prior and two years following the introduction of the program and found that it did not change continuity of care or access to a doctor, and did not reduce hospitalization or annual costs per patient.

The Complex Care Initiative, part of the Family Practice Incentive Program (FPIP), was introduced through the GP Service Committee, a partnership between the now-Doctors of B.C. and the provincial government, to compensate doctors for the time and work spent with patients who have two or more specific chronic diseases. This involves a $315 payment to participating doctors annually with the overall program costing more than $55 million in 2014-15 for 174, 893 patients.

Lead author Professor Ruth Lavergne of Simon Fraser University (pictured), who worked on the research while studying at SPPH for her doctorate, said an evaluation was commissioned as part of the program, but this evaluation compared patients who did and did not receive incentives, and had differing healthcare patterns before the incentive was introduced, meaning it was likely there was some bias in the evaluation’s results.

She said one of the key messages from the study was that there was a need for greater clarity around the goals of policy so these policies could be effectively tracked over time.

“The problem isn’t that we implemented the incentives, it’s that we didn’t track them carefully from the beginning.”

Professor Ruth Lavergne

McGrail agreed, saying the province was starting new initiatives in primary care. “B.C. has the opportunity not just to be innovative in this area, but to make a commitment to continuous learning and change based on what those innovations show.”

The other message, Lavergne said, was that while the partnership between doctors and government was exciting, more people needed to be included in primary care delivery planning. “Other care providers and especially patients need a seat at the table in care planning.”

Dr Shelley Ross, co-chair of the General Practice Services Committee, the body formed by the government and Doctors of B.C. partnership, said the study told an incomplete story, focusing on the first two years of the nine year initiative and looking at just one incentive fee out of several, themselves part of a larger array of primary care initiatives that worked together to support the patient experience.

Michael Law

SPPH associate professor Michael Law

Ross said incentive programs boosted family practice and benefited patients, allowing doctors to spend the required time on patients with chronic conditions. There was “absolutely” more to be done when it came to primary care, and the organization was moving forward in designing its future. “Key to this is our partnership with government and the Health Authorities to expand team based care – as the study suggests – and to provide a primary care home where doctors can provide patients with continuous care over their lifetime.”

Ministry of Health senior public affairs officer Stephen May said the challenges the report noted such as incentive payments and evaluating physician services were challenges faced across Canada and around the world. Feedback to the GPSC last year had shown incentives overall helped retain family physicians and made the field more attractive to graduates.

As the Conference Board of Canada had said, rather than advocating one pay model over another, the better approach was to aim for the right blend for each setting and this was why it had been willing to work with physicians and Doctors of B.C. to try new approaches to physician compensation, something it remained committed to. “In the past several years, we have continued to work collaboratively with physicians and the Doctors of BC to improve primary health care, including new ways to improve value for patients and taxpayers.”

The study was published in CMAJ.