US Primary Care Physician Payments for Productivity and Quality: Trends from Longitudinal National Practice Surveys

Le résumé fourni par la source

We conducted a retrospective cohort study of two US national surveys of primary care practice leaders about their practices’ capabilities and characteristics. Among 1959 original survey respondents sampled, 722 (37%) responded to the second survey; of these, 432 practices (60%) answered compensation questions in both and were included in the analysis. Examined characteristics of practices with missing compensation data including ownership, practice size, and VBP model participation were not statistically different from practices with complete compensation data. Our primary outcome was the prevalence of three predominant approaches to compensation: salary, productivity, or both, in each time period. Secondary outcomes were the frequency and amount of compensation for quality (including patient satisfaction). We stratified outcomes by practice ownership structure (independent, physician group, hospital/health system, or Federally Qualified Health Center (FQHC), which disproportionately serves low-income and racially minoritized communities), with the aim of examining changes over time and differences between ownership types. Results were weighted for survey sampling and non-response. Detailed survey methods are described elsewhere. Stata 17.0 was used for analysis. The Dartmouth College Committee for the Protection of Human Subjects deemed this study exempt. Respondent practices are described in Table 1 . Overall, compensation primarily through productivity declined by 6% between 2017–2018 and 2022–2023, while salary correspondingly increased; mixed productivity/salary compensation was steady. While over half of practices paid for quality, it represented small proportions of total compensation. FQHCs were far more likely to compensate via salary, and practices paying primarily salary were less likely to pay for quality. There was wide variation in base and quality compensation across all ownership types (Table 2 ).

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