Family physician perception of economic incentives for the provision of office procedures

Abstract

Background and objectives: The influence of capitation versus fee-for-service reimbursement for services provided by primary care physicians is an important topic as capitation becomes increasingly prevalent. This study ascertained whether family physicians perceive an economic incentive to perform flexible sigmoidoscopy, colposcopy, and vasectomy under capitated versus fee-for-service payment structures.

Methods: In May 1995, questionnaires were mailed to 592 randomly selected physician "diplomates" of the American Board of Family Practice in California, Florida, Texas, Virginia, and Minnesota. Nonrespondents received an additional mailing in July 1995.

Results: The return rate was 62%. Of 336 responses: 1) 177 (52%) provide flexible sigmoidoscopy; 68 (20%) think capitation and 173 (51%) think fee for service provide sufficient reimbursement to make this procedure profitable. 2) 69 (20%) provide colposcopy; 50 (16%) think capitation and 99 (30%) think fee for service provide sufficient reimbursement to make this procedure profitable. 3) 91 (27%) provide flexible sigmoidoscopy; 36 (11%) think capitation and 84 (25%) think fee for service provide sufficient reimbursement to make this procedure profitable.

Conclusions: A significant number of family physicians provide these three procedures in their offices. Most physicians view fee-for-service payment as providing an economic incentive to provide these procedures. Capitation was less frequently perceived as providing sufficient reimbursement to make the provision of these procedures profitable.