Physician Financial Incentives and Care for the Underserved in the United States

Objectives: To estimate: (1) the percentage of physicians whose compensation is variable; (2) the frequency at which performance incentives for productivity, care quality, patient satisfaction, and resource use were used to determine compensation; and (3) how much incentives differ for physicians who serve greater percentages of patients who are Medicaid-insured, racial/ethnic minorities, or who face language barriers, versus those who do not. Study Design: Cross-sectional study of 3234 nationally representative physicians responding to the 2008 Center for Studying Health System Change's Health Tracking Physician Survey (HTPS). Methods: We examined the degree to which practices' percentage of Medicaid revenues and physicians' panel characteristics were associated with physicians' financial incentives using chi(2) statistics and multivariate logistic regression (adjusting for physician specialty, practice type, and capitation levels, and area-based factors). Results: Compensation was variable for 69% of respondents, was most frequently tied to productivity (68%), and less often to care quality (19%), patient satisfaction (21%), or resource use (14%). Physicians were significantly less likely to report variable compensation if the percentage Medicaid revenues was 50% or more (adjusted odds ratio [OR] 0.73, 95% confidence interval [Cl], 6.57-0.95) or if physician panels were at least 50% Hispanic (adjusted OR 0.74, 95% Cl, 0.56-0.99). However, physicians were significantly more likely to report use of all 4 performance incentives if percentage of Medicaid revenues was 6% to 24%. Conclusions: Physicians report different types of financial incentives designed to alter care quality and quantity; incentive types differ by the degree that practices derive revenues from Medicaid or serve Hispanic patients. Further investigation is needed to understand how to align financial incentives with disparity-reduction efforts.