Physicians’ Lack of Awareness of How They Are Paid: Implications for New Models of Reimbursement | Health Care Reform | JAMA Internal Medicine | JAMA Network
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Research Letter
Health Care Reform
October 14, 2013

Physicians’ Lack of Awareness of How They Are Paid: Implications for New Models of Reimbursement

Author Affiliations
  • 1Division of General Internal Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia
  • 2Division of Outcomes and Effectiveness Research, Department of Public Health, Weill Cornell Medical College, New York, New York
  • 3Department of Medicine, Weill Cornell Medical College, New York, New York
JAMA Intern Med. 2013;173(18):1745-1746. doi:10.1001/jamainternmed.2013.9270

As pay-for-performance initiatives continue to propagate throughout the health care system, studies report mixed findings regarding their effect on physician behavior and patient outcomes.1,2 One possible reason that pay-for-performance efforts have failed is that physicians might not know about the incentives. Although some early reports have commented on a lack of physician awareness of pay-for-performance programs even in the setting of controlled research interventions,3-5 physician awareness of incentives has not been assessed on a national scale. Using data from a national survey of physicians, we looked at physician awareness of pay-for-performance.

We performed a cross-sectional analysis using the 2007-2008 National Ambulatory Medical Care Survey (NAMCS), which is a nationally representative survey administered by the Centers for Disease Control and Prevention’s National Center for Health Statistics. The NAMCS is a survey of nonfederal, non–hospital-based physicians who see patients in the ambulatory setting. The NAMCS uses a complex sampling design with physician weighting so that national estimates of physician and practice characteristics can be reliably generated. The institutional review board at Weill Cornell Medical College approved this study.