Half of the nation's primary care physicians view the increased use of quality-of-care metrics and financial penalties for unnecessary hospitalizations as potentially troubling for patient care, according to a new survey from The Commonwealth Fund and the Kaiser Family Foundation.
Fifty percent of primary care physicians say the increased use of quality metrics to assess provider performance is having a negative impact on quality of care. Far fewer (22%) see quality metrics as having a positive impact on quality.
Similarly, 52 percent say programs that impose financial penalties for unnecessary hospital admissions or readmissions are having a negative effect on quality of care, while just one in eight (12%) say such programs have a positive effect. Nurse practitioners and physician assistants view quality metrics and admissions penalties somewhat more favorably but still are more likely to see negative impacts than positive ones.
The findings are from a new brief based on the 2015 National Survey of Primary Care Providers, which captures the experiences and views of primary care physicians, nurse practitioners, and physician assistants related to recent changes in health care delivery and payment, including accountable care organizations (ACOs), medical homes, and increased use of health information technology.
Many primary care providers see the increased use of health information technology (IT) as improving quality of care. Half (50%) of physicians and nearly two-thirds (64%) of nurse practitioners and physician assistants see the advance of health IT having a positive impact on practices' ability to provide quality care to their patients. Fewer physicians (28%), nurse practitioners and physician assistants (20%) say health IT is having a negative impact on quality.
More primary care physicians view the spread of ACOs as having a negative (26%) rather than positive (14%) impact on quality, though the majority either sees no impact or is not sure. Three in 10 (29%) primary care physicians say they currently participate in an ACO. Among those who participate, views are more favorable, though still mixed (30% positive, 24% negative).
Among the other survey findings:
- A third (33%) of primary care physicians see the increased use of medical homes as having a positive impact on quality, more than twice the proportion who see a negative impact (14%). An even larger share (40%) of nurse practitioners and physician assistants view the impact as positive. Those who participate in medical homes are more likely to take a positive view than those who don’t: 43 percent of physicians and 63 percent of nurse practitioners and physician assistants practicing in medical homes have a positive view of their impact on quality of care.
- Most (55%) of the nation's primary care physicians are currently receiving financial incentives based on quality or efficiency measures, an indication of the reach of ongoing efforts by public and private payers to reward providers for quality of care rather than for the amount of services delivered to patients.
- Nearly half (47%) of physicians and just over a quarter (27%) of nurse practitioners and physician assistants say the recent trends in health care are leading them to consider an earlier retirement. This continues a 20-year trend of physician dissatisfaction with market trends in health care.
The Kaiser/Commonwealth Fund 2015 National Survey of Primary Care Providers, conducted by mail and online from January 5 through March 30, 2015, is based on a nationally representative sample of 1,624 primary care physicians, supplemented by a separate nationally representative sample of 525 nurse practitioners and physician assistants in primary care practices. The margin of sampling error is plus or minus 3 percentage points for physicians and 5 percentage points for nurse practitioners and physician assistants. For results based on subgroups, the margin of sampling error is higher.