Association Between Physician Quality Improvement Incentives and Ambulatory Quality Measures

Objectives: To determine the prevalence of physician incentives for quality and to test the hypothesis that the quality of ambulatory medical care is better when provided by physicians with these incentives. Study Design: Cross-sectional study using data from the National Ambulatory Medical Care Survey. Methods: We examined the association between 12 measures of high-quality ambulatory care and physician compensation based on quality, physician compensation based on satisfaction, and public reporting of quality measures. Results: Overall, 20.8% of visits were to physicians whose compensation was partially based on quality, 17.7% of visits were to physicians whose compensation was partially based on patient satisfaction, and 10.0% of visits were to physicians who publicly reported quality measures. Quality of ambulatory care varied: weight reduction counseling occurred in 12.0% of preventive care visits by obese patients, whereas no urinalysis in patients with no indication was achieved in 93.0% of preventive care visits. In multivariable analyses, there were no statistically significant associations between compensation for quality and delivery of any of the 12 measures, nor between compensation for satisfaction and 11 of the 12 measures; the exception was body mass index screening in preventive visits (47.8% vs 56.2%, adjusted P = .004). There was also no statistically significant association between public reporting and delivery of 11 of 12 measures; the exception was weight reduction counseling for overweight patients (10.0% vs 25.5%, adjusted P = .01). Conclusions: We found no consistent association between incentives for quality and 12 measures of high-quality ambulatory care.