Clinical Quality Measurement: Disincentives to Serve the Underserved?

November 17, 2010

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By Neil A. Busis, MD, AAN.com Practice and Technology Editor

A recent study in JAMA demonstrates an unanticipated consequence of ranking physicians by the "quality" of their clinical performance: "among primary care physicians practicing within the same large academic primary care system, patient panels with greater proportions of underinsured, minority, and non–English-speaking patients were associated with lower quality rankings for primary care physicians."

Participation in the Physician Quality Reporting Incentive (PQRI) program is associated with economic incentives. In the future, there will be penalties for nonparticipation. Hong et al. found that clinical quality measures are a measurement of the interaction between physicians and their patients and are not a reflection of physician performance alone.

Does the PQRI program have disincentives to serve the underserved?

Reference: Hong CS, Atlas SJ, Chang Y, et al. Relationship between patient panel characteristics and primary care physician clinical performance rankings. JAMA. 2010 Sep 8;304:1107-13.