Association between physician compensation methods and delivery of guideline-concordant STD care: is there a link?

OBJECTIVE: To examine the association between primary care physician (PCP) reimbursement and delivery of sexually transmitted disease (STD) services.

STUDY DESIGN: Cross-sectional sample of PCPs contracted with Medicaid managed care organizations in 2002 in 8 California counties with the highest rates of Medicaid enrollment and chlamydia cases.

METHODS: The association between physician reimbursement methods and physician practices in delivery of STD services was examined in multiple logistic regression models, controlling for a number of potential confounders.

RESULTS: Evidence of an association between reimbursement based on management of utilization and the PCP practice of providing chlamydia drugs for the partner's treatment was most apparent. In adjusted analyses, physicians reimbursed with capitation and a financial incentive for management of utilization (odds ratio [OR] = 1.63) or salary and a financial incentive for management of utilization (OR = 2.63) were more likely than those reimbursed under other methods to prescribe chlamydia drugs for the partner. However, PCPs least often reported they annually screened females aged 15-19 years for chlamydia (OR = 0.63) if reimbursed under salary and a financial incentive for productivity, or screened females aged 20-25 years (OR = 0.43) if reimbursed under salary and a financial incentive for financial performance.

CONCLUSION: Some physician reimbursement methods may influence care delivery, but reimbursement is not consistently associated with how physicians deliver STD care. Interventions to encourage physicians to consistently provide guideline-concordant care despite conflicting financial incentives can maintain quality of care. In addition, incentives that may improve guideline-concordant care should be strengthened.