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. 2013 Jul;19(7):554-61.

Healthcare system effects of pay-for-performance for smoking status documentation

Gina R Kruse  1 , Yuchiao Chang, Jennifer H K Kelley, Jeffrey A Linder, Jonathan S Einbinder, Nancy A Rigotti
Affiliations

Healthcare system effects of pay-for-performance for smoking status documentation

Gina R Kruse et al. Am J Manag Care. 2013 Jul.

Abstract

Objectives: To evaluate the impact on smoking status documentation of a payer-sponsored pay-for-performance (P4P) incentive that targeted a minority of an integrated healthcare delivery system's patients.

Study design: Three commercial insurers simultaneously adopted P4P incentives to document smoking status of their members with 3 chronic diseases. The healthcare system responded by adding a smoking status reminder to all patients' electronic health records (EHRs). We measured change in smoking status documentation before (2008-2009) and after (2010-2011) P4P implementation by patient P4P eligibility.

Methods: The P4P-eligible patients were compared primarily with a subset of non-P4P-eligible patients who resembled P4P-eligible patients and also with all non-P4P-eligible patients. Multivariate models adjusted for patient and provider characteristics and accounted for provider-level clustering and preimplementation trends.

Results: Documentation increased from 48% of 207,471 patients before P4P to 71% of 227,574 patients after P4P. Improvement from 56% to 83% occurred among P4P-eligible patients (adjusted odds ratio [AOR], 3.6; 95% confidence interval [CI], 2.9-4.5) and from 56% to 80% among the comparable subset of non-P4P-eligible patients (AOR, 3.0; 95% CI, 2.3-3.9). The difference in improvement between groups was significant (AOR, 1.3; 95% CI, 1.1-1.4; P = .009).

Conclusions: A P4P incentive targeting a minority of a healthcare system's patients stimulated adoption of a system wide EHR reminder and improved smoking status documentation overall. Combining a P4P incentive with an EHR reminder might help healthcare systems improve treatment delivery for smokers and meet "meaningful use" standards for EHRs.

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Conflict of interest statement

Financial Disclosures and Potential Conflicts of Interest: GRK none. YC none. JHHK none. JAL none. JE none. NAR unpaid consultancy for Pfizer and Alere Wellbeing, research grants to Massachusetts General Hospital from Nabi Biopharmaceuticals, and royalties from UpToDate.

Figures

Figure 1
Figure 1
Patient population before (2008–2009) and after (2010–2011) pay-for-performance (P4P) implementation * Patients with ineligible visits had only a visit outside of their academic-affiliated or community-based primary care practice. CAD=coronary artery disease, DM=diabetes mellitus. Shaded boxes constitute all non-P4P-eligible patients. †These patients who had CAD, DM or hypertension and a commercial insurer who did not participate in the P4P contract were the subset of non-P4P-eligible patients who were most similar to P4P-eligible patients and were the primary comparison group in adjusted models. ‡Participating commercial insurers were three, not-for-profit insurers who contracted for P4P.
Figure 2
Figure 2
Unadjusted smoking status documentation by Pay-for-Performance (P4P) eligibility and year * Patients with commercial insurer that did not participate in the P4P contract and a chronic condition (diabetes mellitus, hypertension, or coronary artery disease).
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