NEW YORK — Disclosing how physicians are compensated may increase patient loyalty, and does not appear to undermine patients’ trust in their doctors, a new study shows.
“This study suggests that regulators, policy makers, and physician groups themselves should renew their consideration of disclosure as an instrument to advance the best interests of patients and physicians,” Dr. Steven D. Pearson of Harvard Medical School in Boston and colleagues conclude.
Since the 1990s, concerns have arisen over whether physician payment structures that “reward cost savings” harm quality of care, Pearson and colleagues note the Archives of Internal Medicine.
Many states have passed laws requiring health plans to disclose incentives they offer to physicians, but most physician groups do not provide this information to their patients. Opponents of the practice argue that disclosure would not be helpful to patients and could harm the physician-patient relationship.
To investigate, the researchers examined the effects of disclosure among 8000 patients in two large group practices in Boston and Los Angeles. Half of the patients were mailed a letter written by the chief medical officer that explained how physicians in the group were compensated, while the other half of the patients did not receive a letter.
Both practices received payment from a number of insurers, which include both capitation and fee-for-service, and physicians were paid based on a combination of salary and performance incentives.
Three months later, the researchers surveyed all patients on knowledge of how their physician is compensated, their trust in their primary care physician and their loyalty to the medical group.
Patients who received the disclosure letter were more likely to accurately identify their physician’s compensation structure; in Boston, for example, fewer control patients answered the question correctly compared with patients who received the disclosure.
Those who remembered receiving the disclosure also were more likely to believe they had enough information to understand how their physician’s compensation structure might influence the quality of care provided.
About three-quarters of patients who remembered receiving the letter said the information didn’t affect their level of trust in their physician, while roughly one quarter said it increased their trust. Less than five percent of patients in either city said the information reduced their trust somewhat.
Patients who received the disclosure were also slightly more likely to say that they felt loyal to their physician group and would not switch.
More than half of patients felt they didn’t know enough about how their physicians were compensated to judge whether it had any effect on their health care.
“Further creative efforts are, therefore, needed to improve patients’ understanding of the existence, or lack, of significant financial conflicts of interest in their health care relationships,” the clinicians say. “Disclosure is likely to fill an important role in this effort.”
SOURCE: Archives of Internal Medicine, March 27, 2006.
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