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Financial incentives and performance feedback to physicians may not increase cancer screening for Medicaid enrollees

Low-income women have lower survival times and higher death rates from breast, cervical, and colorectal cancer than other women. Their doctors need to follow cancer screening guidelines to improve cancer detection and prognosis among these women. Yet financial incentives and feedback on cancer prevention guideline adherence did not improve compliance among doctors in a Medicaid health maintenance organization (HMO), finds a study supported in part by the Agency for Health Care Policy and Research (HS07720). The cancer screening guidelines were adapted from national recommendations that women 50 years of age and older receive an annual breast examination, mammogram, Pap smear, and colorectal cancer screening.

Alan L. Hillman, M.D., M.B.A., and his colleagues at the University of Pennsylvania randomly assigned 52 primary care sites to the intervention (semiannual written feedback and a financial bonus for performing these preventive procedures) and no intervention (usual care). From 1993 to 1995, cancer screening rates doubled overall from 24 percent to 50 percent, with no significant differences between intervention and control group sites. This dramatic increase in cancer screening at all sites mirrored national trends at the time. The financial incentives and feedback had no significant, additional impact on physician screening practices.

The financial incentive provided 10 to 20 percent additional capitation for each site's population of female members 50 years of age and older. These bonuses ranged from $570 to $1,260 per site, with an average of $775 per audit. Because physicians participated in many plans, the bonus for the HMO members alone may not have had the necessary impact on physicians' overall income, suggest the researchers. The second possible explanation is lack of physician awareness. Despite repeated mailings, awareness of the study was low (67 percent of intervention sites, with 30 percent not responding). Finally, the study many not have been long enough, in a setting of improving national trends, to have found a significant additional influence due to the intervention.

See "Physician financial incentives and feedback: Failure to increase cancer screening in Medicaid managed care," by Dr. Hillman, Kimberly Ripley, M.A.S., Neil Goldfarb, B.S., and others, in the November 1998 American Journal of Public Health 88(11), pp. 1699-1701.

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