Financial incentives for physicians not effective in increasing follow-up after hospital discharge

A financial incentive for physicians to see patients sooner after discharge from hospital had no sizable impact on 14-day physician follow-up rates, according to a new study by researchers at the Institute for Clinical Evaluative Sciences (ICES).

Patients who have been discharged home following a hospital stay are vulnerable; 10 to 20 per cent will return to hospital within 30 days as a result of worsening symptoms, complications from treatment, or new medical problems.

Early follow-up with a physician may be one way to help patients during this high-risk period.

“Financial incentives to improve follow-up after hospital discharge have been introduced in the United States and Canada, but their effect was unknown. What we found was that physicians with the highest uptake of the incentive had the highest follow-up rates at baseline, and they did not increase their follow-up rates after the incentive code was introduced,” says Dr. Lauren Lapointe-Shaw, a doctoral student  at ICES and an internal medicine physician.

A fee code introduced to Ontario in 2006 incentivised early physician follow-up after discharge. To understand whether it improved early physician follow-up of rates, researchers from ICES, the University of Toronto and Mount Sinai Hospital, part of Sinai Health System looked at data on more than eight million patients discharged home from hospital in Ontario between 2002 and 2015. The study authors excluded newborns and pregnant women delivering in hospital, palliative care patients, psychiatric patients and those in hospital for more than 100 days.

This code was claimed by 51 per cent of eligible physicians and cost about $2.1 million annually.

“We found that despite uptake of the incentive by physicians, this financial incentive did not change rates of early follow-up after hospital discharge,” says Dr. Lapointe-Shaw. “Physicians with the highest uptake of the incentive had the highest 14-day follow-up rates before and after the intervention, which suggests the incentive rewarded the highest performing providers without modifying their behaviour.”

Lack of immediacy in incentive payments and barriers outside a physician’s control may explain why this policy initiative has not improved follow-up rates.

However, the researchers do add that 66 per cent of patients did have a follow-up visit with a physician within 14 days after discharge.

“Effectiveness of a financial incentive to physicians for timely follow-up after hospital discharge: a population-based time series analysis,” was published today in CMAJ.

Author block: Lauren Lapointe-Shaw, Muhammad Mamdani, Jin Luo, Peter C. Austin, Noah M. Ivers, Donald A. Redelmeier and Chaim M. Bell.

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

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