Incentives For Physicians Research Articles

Hospital characteristics and 30-day all-cause readmission rates.

The Centers for Medicare and Medicaid Services (CMS) publicly reports hospital-wide all-cause readmission rates, which are key indicators of quality and waste. Understanding hospital characteristics that are associated with lower readmission rates is important. The main objective of this article is to identify hospital characteristics associated with lower readmission rates. Specifically, we focus on the relationship between hospitalist staffing levels, the level of physician integration, and physician ownership with hospital-wide all-cause readmissions. We rely on data from CMS, American Hospital Association Annual Survey Database, and Area Health Resource File. We use ordinary least square regression to assess the association between readmission rates and hospitalist staffing levels, physician integration, physician ownership, and the presence of a medical home model, while controlling for key organizational and market factors such as registered nurse (RN) staffing levels and competition. Higher hospitalist staffing levels, the fully integrated physician model, and physician ownership were associated with lower readmission rates. The addition of 1 hospitalist per general and surgical bed was associated with a 0.77 percentage-points decrease in adjusted 30-day all-cause readmission rates. Fully integrated hospitals had adjusted 30-day all-cause readmission rates 0.09 percentage points lower than non-fully integrated hospitals, and hospitals partially or fully owned by physicians had adjusted readmission rates 0.36 percentage points lower than non-physician-owned hospitals. Hospitals should focus on modifiable organizational factors that influence patient outcomes such as hospitalist and RN staffing levels and explore hospital-physician arrangements that result in the greatest alignment between hospital and physician incentives. Journal of Hospital Medicine 2016;11:682-687. © 2016 Society of Hospital Medicine.

More women are medicated while more men are talked out: Persistent gender disparities in mental health care

IntroductionPhysician incentives have been shown in previous studies to help reduce socioeconomic disparities in health care. Its impact on gender disparities, however, has rarely been investigated.AimThe impact of physician incentives on gender disparities in mental health care was investigated in this retrospective study.MethodDe-identified health administrative data from physician claims, hospital separations, vital statistics, prescription database, and insurance plan registries were linked and examined. Monthly cohorts of individuals with depression who were residing in British Columbia, Canada were identified and their use of mental health services tracked for 12 months following receipt of initial diagnosis. indicators that assess receipt of the following services were created:– counseling/psychotherapy (CP);– minimally adequate counseling/psychotherapy (MACP);– antidepressant therapy (AT);– minimally adequate antidepressant therapy (MAAT).interrupted time series analysis was used to estimate changes in these indicators before (01/2005–12/2007) and after (01/2008–12/2012) physician incentives were introduced.ResultsAt the beginning of the study period, the percentage of individuals diagnosed with depression who received counseling/psychotherapy was higher, on average, among men (CP: 58.4%, MACP: 13.6%) than women (CP: 57.1%, MACP: 10.9%). in contrast, the percentage who received antidepressant therapy was higher among women (AT: 57.7%, MAAT: 47.4%) than men (AT: 53.6%, MAAT: 41.9%). Levels for these indicators have changed over time but the statistically significant differences between men and women were virtually the same before and after incentives were introduced.ConclusionsGender disparities in mental health care persist despite the introduction of physician incentives designed to enhance access to mental health services in primary care.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Can physician incentives improve continuity of care for patients receiving depression treatment in the primary care setting?

IntroductionIn 2008, the province of British Columbia, Canada introduced financial incentives to encourage general practitioners (GPs) to assume the role of major source of care for patients seeking mental health treatment in primary care. If successful, this intervention could strengthen GP–patient attachment and consequently improve continuity of care. The impact of this intervention, however, has never been investigated.AimTo estimate the population level impact of physician incentives on continuity of care (COC).MethodThis retrospective study examined linked health administrative data from physician claims, hospital separations, vital statistics, and insurance plan registries. Monthly cohorts of individuals with depression were identified and their GP visits tracked for 12 months, following receipt of initial diagnosis. COC indices were created, one for any visits (AV) and another for mental health visits (MHV) only. COC (range: 0–100) was calculated using published formula that accounts for the number of visits and number of GPs visited. Interrupted time series analysis was used to estimate the changes in COC before (01/2005–12/2007) and after (01/2008–12/2012) the introduction of physician incentives.ResultsThe monthly number of people diagnosed with depression ranged from 7497 to 10,575; yearly rates remained stable throughout the study period. At the start of the study period, mean COC for AV and MHV were 75.6 and 82.2 respectively, with slopes of –0.11 and –0.06. Post-intervention, the downward trend was disrupted but did not reverse.ConclusionsPhysician incentives failed to enhance COC. However, results suggest that COC could have been worse without the incentives.Disclosure of interestThe authors have not supplied their declaration of competing interest.

"Professional Helper" or "Helping Professional?" The Patient-Physician Relationship in the Chronic Pain Setting, With Special Reference to the Current Opioid Debate.

There seems to be a strong cultural expectation among patients for effective pain relief. As a result, physicians often find themselves trying to bridge the gap between the chronic pain patient's expectations and harsh biomedical reality. The typology of Emanuel and Emanuel of four models for the patient-physician relationship is used in this article as a conceptual tool to examine the possible roles of physicians in the context of chronic noncancer pain. Their typology is reconceptualized as a "pathway" along which the physician is able to walk more or less far, starting from the "information" end of the path. The other end of the pathway is "caring deliberation." I then propose that, in pain medicine today, consumerism is a powerful incentive for physicians to stay at the information end of the spectrum. Against this background, I discuss the current opioid epidemic in the United States and the need for what has been called a new medical professionalism. I conclude by challenging educators involved in pain medicine continuing professional development to not only design adequate biomedical-educational programs, but also consider issues like professionalism, personal development, critical self-reflection, and the ethics of engaging in caring deliberation with chronic pain patients.

The role of peer support specialists for patients with medical and behavioral health needs – Challenges and opportunities

Six trends – movement towards value-based payment, rapid adoption of digital health technology, care delivery in non-traditional settings, development of individualized clinical guidelines, increased transparency, and growing cultural awareness about the harms of medical overuse – are driving the US health care system towards a future defined by quality- and patient-centric care. Health care organizations are responding to these changes by implementing provider and workforce changes, pursuing stronger payer-provider integration, and accelerating the use of digital technology and data. While these efforts can also improve the clinical relationship and create positive system redesign among health care organizations, they require alignment between organizational and physician incentives that can inadvertently harm the dynamic between patients and providers. Organizations can utilize several strategies to preserve the patient-physician relationship and advance the positive benefits of new organizational strategies while guarding against unintended consequences.

Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care

Behavioral economics provides insights about the development of effective incentives for physicians to deliver high-value care. It suggests that the structure and delivery of incentives can shape behavior, as can thoughtful design of the decision-making environment. This article discusses several principles of behavioral economics, including inertia, loss aversion, choice overload, and relative social ranking. Whereas these principles have been applied to motivate personal health decisions, retirement planning, and savings behavior, they have been largely ignored in the design of physician incentive programs. Applying these principles to physician incentives can improve their effectiveness through better alignment with performance goals. Anecdotal examples of successful incentive programs that apply behavioral economics principles are provided, even as the authors recognize that its application to the design of physician incentives is largely untested, and many outstanding questions exist. Application and rigorous evaluation of infrastructure changes and incentives are needed to design payment systems that incentivize high-quality, cost-conscious care.

Policy-Oriented Research on Improved Physician Incentives for Higher Value Health Care.

Policy makers (both public and private) are seeking ways to improve the value delivered within our health care system, that is, using fewer resources to provide the same benefit to patients, or using equivalent resources to provide more benefit. One strategy is to alter the predominant fee‐for‐service (FFS) economic incentives in the current system. To inform such policy changes, this paper identifies areas in which little is known about the effects of specific incentives (FFS, salary, etc.) on the two components of value: resource use and quality. Specific suggestions are offered regarding research that would be informative for policy makers, focusing on fundamental “building block” studies rather than overall evaluations of complex interventions, such as accountable care organizations. This research would better identify critical aspects of the FFS model and salary‐based payments that are particularly problematic, as well as situations in which FFS or salary may be less problematic. The research would also explore when alternatives, such as episode‐based payment might be feasible, or simply be hypothetical solutions. The availability of electronic health record‐based data in various delivery systems would allow many of these studies to be accomplished in 3–5 years with budgets manageable by public and private funding sources.

Effect of Financial Incentives to Physicians, Patients, or Both on Lipid Levels: A Randomized Clinical Trial.

Financial incentives to physicians or patients are increasingly used, but their effectiveness is not well established. To determine whether physician financial incentives, patient incentives, or shared physician and patient incentives are more effective than control in reducing levels of low-density lipoprotein cholesterol (LDL-C) among patients with high cardiovascular risk. Four-group, multicenter, cluster randomized clinical trial with a 12-month intervention conducted from 2011 to 2014 in 3 primary care practices in the northeastern United States. Three hundred forty eligible primary care physicians (PCPs) were enrolled from a pool of 421. Of 25,627 potentially eligible patients of those PCPs, 1503 enrolled. Patients aged 18 to 80 years were eligible if they had a 10-year Framingham Risk Score (FRS) of 20% or greater, had coronary artery disease equivalents with LDL-C levels of 120 mg/dL or greater, or had an FRS of 10% to 20% with LDL-C levels of 140 mg/dL or greater. Investigators were blinded to study group, but participants were not. Primary care physicians were randomly assigned to control, physician incentives, patient incentives, or shared physician-patient incentives. Physicians in the physician incentives group were eligible to receive up to $1024 per enrolled patient meeting LDL-C goals. Patients in the patient incentives group were eligible for the same amount, distributed through daily lotteries tied to medication adherence. Physicians and patients in the shared incentives group shared these incentives. Physicians and patients in the control group received no incentives tied to outcomes, but all patient participants received up to $355 each for trial participation. Change in LDL-C level at 12 months. Patients in the shared physician-patient incentives group achieved a mean reduction in LDL-C of 33.6 mg/dL (95% CI, 30.1-37.1; baseline, 160.1 mg/dL; 12 months, 126.4 mg/dL); those in physician incentives achieved a mean reduction of 27.9 mg/dL (95% CI, 24.9-31.0; baseline, 159.9 mg/dL; 12 months, 132.0 mg/dL); those in patient incentives achieved a mean reduction of 25.1 mg/dL (95% CI, 21.6-28.5; baseline, 160.6 mg/dL; 12 months, 135.5 mg/dL); and those in the control group achieved a mean reduction of 25.1 mg/dL (95% CI, 21.7-28.5; baseline, 161.5 mg/dL; 12 months, 136.4 mg/dL; P < .001 for comparison of all 4 groups). Only patients in the shared physician-patient incentives group achieved reductions in LDL-C levels statistically different from those in the control group (8.5 mg/dL; 95% CI, 3.8-13.3; P = .002). In primary care practices, shared financial incentives for physicians and patients, but not incentives to physicians or patients alone, resulted in a statistically significant difference in reduction of LDL-C levels at 12 months. This reduction was modest, however, and further information is needed to understand whether this approach represents good value. clinicaltrials.gov Identifier: NCT01346189.

Multiple Imputation: A Flexible Tool for Handling Missing Data.

In this issue of JAMA, Asch et al1 report results of a cluster-randomized clinical trial designed to evaluate the effects of physician financial incentives, patient incentives, or shared physician and patient incentives on low density lipoprotein cholesterol (LDL-C) levels among patients with high cardiovascular risk. Because 1 or more follow-up LDL-C measurements were missing for approximately 7% of participants, Asch et al used multiple imputation (MI) to analyze their data and concluded that shared financial incentives for physicians and patients, but not incentives to physicians or patients alone, resulted in the patients having lower LDL-C levels. Imputation is the process of replacing missing data with 1 or more specific values, to allow statistical analysis that includes all participants and not just those who do not have any missing data. Missing data are common in research. In a previous JAMA Guide to Statistics and Methods, Newgard and Lewis2 reviewed the causes of missing data. These are divided into 3 classes: 1) missing completely at random, the most restrictive assumption, indicating that whether a data point is missing is completely unrelated to observed and unobserved data; 2) missing at random, a more realistic assumption than missing completely at random, indicating whether a data point is missing can be explained by the observed data; or 3) missing not at random, meaning that the missingness is dependent on the unobserved values. Common statistical methods used for handling missing values were reviewed.2 When missing data occur, it is important to not exclude cases with missing information (analyses after such exclusion are known as complete case analyses). Single-value imputation methods are those that estimate what each missing value might have been and replace it with a single value in the data set. Single-value imputation methods include mean imputation, last observation carried forward, and random imputation. These approaches can yield biased results and are suboptimal. Multiple imputation better handles missing data by estimating and replacing missing values many times.

Physicians' financial incentives and treatment choices in heart attack management

Using a large set of private health insurance claims, we estimate how physicians' financial incentives affect their treatment choices in heart attack management. Different insurance plans pay physicians different amounts for the same services, generating the required variation in financial incentives. We begin by presenting evidence that, unconditionally, plans that pay physicians more for more invasive treatments are associated with a larger fraction of such treatments. To interpret this correlation as causal, we continue by showing that it survives conditioning on a rich set of diagnosis and provider‐specific variables. We perform a host of additional checks to verify that differences in unobservable patient or provider characteristics across plans are unlikely to be driving our results. We find that physicians' treatment choices respond positively to the payments they receive, and that the response is quite large. If physicians received bundled payments instead of fee‐for‐service incentives, for example, heart attack management would become considerably more conservative. Our estimates imply that 20 percent of patients would receive different treatments, physician costs would decrease by 27 percent, and social welfare would increase. Physician incentives physician treatment choices health insurance heart attack management fee‐for‐service payments I11 I13 L20

Physician Incentives and Treatment Choice

I analyze the impact of physician competition for patients on treatment selection and an insurer's ability to induce its preferences through a supply-side payment mechanism. Informed patients choose the physician whose treatment practice best fits their preferences, aligning physician incentives with patient preferences. An insurer's ability to counter these incentives is not monotonic in how informed patients are, however. When demand is either perfectly inelastic to treatment practices because patients are completely uninformed or a sufficient proportion of the market is informed relative to the number of physicians in the market, then an insurer can induce its preferences through supply-side payment rules. Otherwise, more intensive policy levers such as utilization review must be employed. Programs that increase patient information can therefore improve the efficiency despite generating stronger incentive to treat according to patient preferences. I also explore how noisy signals of illness type and diagnostic testing further complicate the insurer's problem

Incentives for Physicians to Pursue Primary Care in the ACA Era.

The American Recovery and Reinvestment Act and the Affordable Care Act have made changes to induce medical students to pursue primary care careers and to support primary care training programs.

The role of hematologists in a changing United States health care system

AbstractMajor and ongoing changes in health care financing and delivery in the United States have altered opportunities and incentives for new physicians to specialize in nonmalignant hematology. At the same time, effective clinical tools and strategies continue to rapidly emerge. Consequently, there is an imperative to foster workforce innovation to ensure sustainable professional roles for hematologists, reliable patient access to optimal hematology expertise, and optimal patient outcomes. The American Society of Hematology is building a collection of case studies to guide the creation of institutionally supported systems-based clinical hematologist positions that predominantly focus on nonmalignant hematology. These roles offer a mix of guidance regarding patient management and the appropriate use and stewardship of clinical resources, as well as development of new testing procedures and protocols.

Michigan's fee-for-value physician incentive program reduces spending and improves quality in primary care.

As policy makers and others seek to reduce health care cost growth while improving health care quality, one approach gaining momentum is fee-for-value reimbursement. This payment strategy maintains the traditional fee-for-service arrangement but includes quality and spending incentives. We examined Blue Cross Blue Shield of Michigan's Physician Group Incentive Program, which uses a fee-for-value approach focused on primary care physicians. We analyzed the program's impact on quality and spending from 2008 to 2011 for over three million beneficiaries in over 11,000 physician practices. Participation in the incentive program was associated with approximately 1.1 percent lower total spending for adults (5.1 percent lower for children) and the same or improved performance on eleven of fourteen quality measures over time. Our findings contribute to the growing body of evidence about the potential effectiveness of models that align payment with cost and quality performance, and they demonstrate that it is possible to transform reimbursement within a fee-for-service framework to encourage and incentivize physicians to provide high-quality care, while also reducing costs.

MP9-03 THE EFFECT OF HEALTHCARE SYSTEM ON APPROPRIATENESS OF PROSTATE CANCER IMAGING: DO PATIENTS GET BETTER CARE IN VA OR FEE-FOR-SERVICE MEDICARE?

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Evidence-based Medicine & Outcomes II1 Apr 2015MP9-03 THE EFFECT OF HEALTHCARE SYSTEM ON APPROPRIATENESS OF PROSTATE CANCER IMAGING: DO PATIENTS GET BETTER CARE IN VA OR FEE-FOR-SERVICE MEDICARE? Danil Makarov, Heather Gold, Dawn Walter, Evercita Eugenio, Scott Sherman, Cary Gross, and Steven Zeliadt Danil MakarovDanil Makarov More articles by this author , Heather GoldHeather Gold More articles by this author , Dawn WalterDawn Walter More articles by this author , Evercita EugenioEvercita Eugenio More articles by this author , Scott ShermanScott Sherman More articles by this author , Cary GrossCary Gross More articles by this author , and Steven ZeliadtSteven Zeliadt More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.363AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Encouraging appropriate prostate cancer imaging is an important national healthcare priority highlighted by AUA and ASCO. Prior efforts have been unsuccessful, possibly because factors associated with this behavior have been incompletely studied. Healthcare system and physician incentives can affect quality of care. We sought to determine the appropriateness of prostate cancer imaging among patients treated in the VA (an integrated healthcare system) and those treated in a Fee-for-Service Medicare system. METHODS We performed a retrospective cohort study of patients with incident prostate cancer. We created a novel dataset by merging data for patients with incident prostate cancer diagnosed from 2004–2008 in the VA Central Cancer Registry and SEER-Medicare. We used a logistic regression model clustered by VA region to test the association between appropriateness of prostate cancer imaging and healthcare system. Our dependent variable was appropriateness of prostate cancer imaging, as defined by the NCCN; we stratified our analysis by whether guidelines suggested a patient should have imaging (high risk) or not (low risk). Our independent variable of interest was healthcare system (VA, FFS Medicare, or VA with Medicare utilization). We adjusted for clinicopathologic and sociodemographic characteristics that could confound this relationship. RESULTS We identified 27,811 VA only, 14,385 VA with some Medicare, and 56,671 FFS Medicare patients. Among low risk patients in whom imaging is not guideline-indicated, patients treated in VA (39%) and VA with Medicare utilization patients (44%) had less inappropriate imaging than their FFS Medicare (47%) peers (RR:0.79; 95%CI: 0.67-0.92 vs RR: 0.87; 95%CI 0.76-0.98, respectively where Medicare=reference). Among high risk patients in whom imaging is guideline-indicated, there was no difference in appropriate utilization of imaging in any group: VA (69%), VA with Medicare utilization (72%) and FFS Medicare (67%); RR 1.00; 95%CI 0.95-1.06 vs RR 1.04; 95%CI 0.98-1.09, respectively where Medicare=reference. CONCLUSIONS Using a novel dataset, we determined that patients with incident prostate cancer diagnosed in VA received the same appropriate imaging compared to peers in FFS Medicare but received 21% less inappropriate imaging. Our results suggest that an integrated healthcare system with a lack of physician financial incentives to provide more care can deliver optimal imaging for prostate cancer patients. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e102-e103 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Danil Makarov More articles by this author Heather Gold More articles by this author Dawn Walter More articles by this author Evercita Eugenio More articles by this author Scott Sherman More articles by this author Cary Gross More articles by this author Steven Zeliadt More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Représentations et ressentis des médecins généralistes sur les normes de pratiques médicales auxquelles ils sont confrontés

Since the early 1990s, national health institutions including the national health insurance increase the incentives for physicians to comply with standards of good practice dedicating these standards in medical practices. The objective of this study was to explore GP's on standards of medical practice in a context of standardization. Individual semi-structured qualitative interviews with 16 GPs in Île-de-France. Thematic analysis of 16 interviews has highlighted that doctors had the impression of being confronted with multiple medical practice guidelines from various sources. They said they consider these standards as indicative benchmarks and not as imperatives to comply. Strict standardization of practices did not seem compatible with their profession given the singular and complex nature of each situation and the necessary comprehensive care to their patients. They opposed ethical arguments insistent standardization. Mandatory standards appeared detrimental to their quality of care. Doctors have said it better accept scientific guidelines than standards of health insurance that seemed directed to them by economic considerations. They said also to experience a significant normative pressure from health insurance. GPs had spotted increasing standards governing their practices. They were not opposed to the fact that they may be indicative targets provided they are not mandatory.

Who gets a family physician through centralized waiting lists?

BackgroundNorth American patients are experiencing difficulties in securing affiliations with family physicians. Centralized waiting lists are increasingly being used in Organisation for Economic Co-operation and Development countries to improve access. In 2011, the Canadian province of Quebec introduced new financial incentives for family physicians’ enrolment of orphan patients through centralized waiting lists, the Guichet d’accès aux clientèles orphelines, with higher payments for vulnerable patients. This study analyzed whether any significant changes were observed in the numbers of patient enrolments with family physicians’ after the introduction of the new financial incentives. Prior to then, financial incentives had been offered for enrolment of vulnerable patients only and there were no incentives for enrolling non-vulnerable patients. After 2011, financial incentives were also offered for enrolment of non-vulnerable patients, while those for enrolment of vulnerable patients were doubled.MethodsA longitudinal quantitative analysis spanning a five-year period (2008–2013) was performed using administrative databases covering all patients enrolled with family physicians through centralized waiting lists in the province of Quebec (n = 494,697 patients). Mixed regression models for repeated-measures were used.ResultsThe number of patients enrolled with a family physician through centralized waiting lists more than quadrupled after the changes in financial incentives. Most of this increase involved non-vulnerable patients. After the changes, 70% of patients enrolled with a family physician through centralized waiting lists were non-vulnerable patients, most of whom had been referred to the centralized waiting lists by the physician who enrolled them, without first being registered in those lists or having to wait because of their priority level.ConclusionCentralized waiting lists linked to financial incentives increased the number of family physicians’ patient enrolments. However, although vulnerable patients were supposed to be given precedence, physicians favoured enrolment of healthier patients over those with greater health needs and higher assessed priority. These results suggest that introducing financial incentives without appropriate regulations may lead to opportunistic use of the incentive system with unintended policy consequences.

Locoregional prostate cancer treatment pattern variation in independent cancer centers: policy effect, patient preference, or physician incentive?

Surveillance, Epidemiologic, and End Results (SEER) registry data abstracted from a priority 2 or higher reporting source from 2006 to 2008 were used to compare treatment patterns in 45–64-year old men diagnosed with locoregional prostate cancer (LRPC) across states with or without radiation therapy-directed certificate of need (CON) laws and across independent cancer centers (ICCs) compared to large multi-specialty groups (LMSGs). Adjusted treatment percentages for the five most common LRPC treatments (surgery, external beam radiation therapy (EBRT), combination brachytherapy with EBRT, brachytherapy, and observation) were compared using cross-sectional logistic regression between CON-unregulated and -regulated states and between LMSGs and ICCs. LRPC EBRT rates were no different across CON regions, but are increased in ICCs compared to LMSGs (37.00% vs. 13.23%, P < 0.001). Variation in LRPC treatment patterns by reporting source merits further scrutiny under the Affordable Care Act of 2010, considering the intent of incentivized accountable care organizations (ACOs) established by the Patient Protection and Affordable Care Act of 2010 (PPACA) and the implications of early descriptions of these new healthcare provider organizations on prostate cancer treatment patterns.

Biosimilars Versus Brands for Rheumatoid Arthritis: Eu5 Payers and Prescribers Place their Bets.

The entrenched positioning of biologics to treat moderate-to-severe rheumatoid arthritis (RA) has generated a lucrative market. However, amid ongoing economic constraints, the EU5 (France, Germany, Italy, Spain, and the UK) must tighten their health care belts. As biosimilars versions of key brands appear on the horizon, this study explored the expected impact of these cheaper options on reimbursement and prescribing for RA in each country. Across the EU5, 254 rheumatologists were surveyed regarding their views on biosimilars for RA and on current and expected prescribing patterns. In addition, 15 payers who influence reimbursement at national or regional level were interviewed. Considering 54-week Phase III data, ≥80% of surveyed rheumatologists in each country believe CT-P13 (biosimilar infliximab) has similar efficacy to branded Remicade; however, respondents are less confident in the biosimilar’s safety. Furthermore, >80% of respondents in most countries are willing to prescribe biosimilars of infliximab, and of etanercept and rituximab, though largely not before branded biologics. Unsurprisingly, given likely price discounts, interviewed payers will somewhat encourage biosimilar uptake. However, excluding those in Germany, consensus is that discounts offered on biosimilars will not significantly impact their budgets. German payers, however, report that additional rebates to statutory insurers are expected; they admit to financial incentives for physicians to prescribe rebated drugs, thus manufacturers may consider robust uptake will compensate for hefty discounts. Available data have inspired prescriber confidence in biosimilar efficacy, although safety concerns, likely stemming from complex biosimilar manufacturing and lack of long-term safety data, will ensure continued brand uptake, at least initially. Furthermore, the expected modesty of biosimilar discounts in most countries will somewhat curb payer policy promoting use of such agents. However, as prescribers become more familiar with biosimilars, and, as the full extent of cost savings are revealed, increasing uptake of biosimilars is probable.

Changing Physician Incentives for Affordable, Quality Cancer Care: Results of an Episode Payment Model

This study tested the combination of an episode payment coupled with actionable use and quality data as an incentive to improve quality and reduce costs. Medical oncologists were paid a single fee, in lieu of any drug margin, to treat their patients. Chemotherapy medications were reimbursed at the average sales price, a proxy for actual cost. Five volunteer medical groups were compared with a large national payer registry of fee-for-service patients with cancer to examine the difference in cost before and after the initiation of the payment change. Between October 2009 and December 2012, the five groups treated 810 patients with breast, colon, and lung cancer using the episode payments. The registry-predicted fee-for-service cost of the episodes cohort was $98,121,388, but the actual cost was $64,760,116. The predicted cost of chemotherapy drugs was $7,519,504, but the actual cost was $20,979,417. There was no difference between the groups on multiple quality measures. Modifying the current fee-for-service payment system for cancer therapy with feedback data and financial incentives that reward outcomes and cost efficiency resulted in a significant total cost reduction. Eliminating existing financial chemotherapy drug incentives paradoxically increased the use of chemotherapy.