{"id":7990,"date":"2019-04-01T00:00:00","date_gmt":"2019-04-01T04:00:00","guid":{"rendered":"https:\/\/icesontario.wpengine.com\/news-releases\/incentive-payments-for-family-doctors-may-not-have-intended-results\/"},"modified":"2023-06-14T18:14:35","modified_gmt":"2023-06-14T22:14:35","slug":"incentive-payments-for-family-doctors-may-not-have-intended-results","status":"publish","type":"news_release","link":"https:\/\/www.ices.on.ca\/fr\/news-releases\/incentive-payments-for-family-doctors-may-not-have-intended-results\/","title":{"rendered":"Incentive payments for family doctors may not have intended results"},"content":{"rendered":"<p>An incentive payment called the &#x201c;access bonus,&#x201d; designed to encourage better access to family medicine and discourage patients from seeking care outside their family doctor&#x2019;s office, may be inadvertently benefiting family doctors with lower levels of access in Ontario, according to a new study by researchers at <strong>ICES<\/strong> and St. Michael&#x2019;s Hospital.<\/p>\n<p>\nThe &#x201c;access bonus&#x201d; is a substantial fee Ontario doctors are paid if their patients do not seek care outside their group, such as at a walk-in clinic. The study found that the average amount family physicians were receiving for the &#x201c;access bonus&#x201d; ranged from over &#x24;17,000 per physician and exceeding &#x24;36,000 for physicians in the highest quintile.<\/p>\n<div>\n<div class=\"download-section alignwide infographic-download\" id=\"block_722625521d4fa426274a4d6481e64838\" data-style=\"deep-blue\">\n\t<div class=\"download-section-content\">\n\t\t\t\t<h2>\n\t\t\tInfographic\t\t<\/h2>\n\t\t\n\t\t\t<\/div>\n\t<div class=\"download-section-buttons\">\n\t\t\t\t\t\t<a class=\"download-section-buttons-primary\" href=\"https:\/\/www.ices.on.ca\/wp-content\/uploads\/2023\/03\/GlazierPaymentIncentivesFIN.jpg\" target=\"_blank\"\n\t\t\tdownload\t\t\taria-label=\"Download Infographic (opens in a new tab)\"\t\t>\n\t\t\tDownload Infographic\t\t\t<svg width=\"19\" height=\"19\" viewBox=\"0 0 19 19\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" role=\"presentation\">\n<path d=\"M2.78003 18.8301C2.14282 18.8301 1.59713 18.603 1.14297 18.1488C0.688813 17.6947 0.46212 17.1494 0.462893 16.5129V13.0372H2.78003V16.5129H16.6829V13.0372H19V16.5129C19 17.1502 18.7729 17.6958 18.3188 18.15C17.8646 18.6042 17.3193 18.8308 16.6829 18.8301H2.78003ZM9.73145 14.1958L3.9386 8.40295L5.5606 6.72303L8.57288 9.73531V0.292969H10.89V9.73531L13.9023 6.72303L15.5243 8.40295L9.73145 14.1958Z\" fill=\"#151D5D\"\/>\n<\/svg>\n\t\t<\/a>\n\t\t\n\t\t\t\t\t\t\t\t\t\t<button type=\"button\" class=\"download-section-buttons-secondary\" data-infographic-popup-open=\"block_722625521d4fa426274a4d6481e64838-infographic-popup\" aria-haspopup=\"dialog\">\n\t\t\t\tClick to View\t\t\t<\/button>\n\t\t\t\t\t\t<\/div>\n\n\t\t<div class=\"infographic-popup\" id=\"block_722625521d4fa426274a4d6481e64838-infographic-popup\" role=\"dialog\" aria-modal=\"true\" aria-label=\"Infographic\" hidden>\n\t\t<div class=\"infographic-popup-overlay\" data-infographic-popup-close><\/div>\n\t\t<div class=\"infographic-popup-container\">\n\t\t\t<button type=\"button\" class=\"infographic-popup-close\" data-infographic-popup-close aria-label=\"Close infographic\">&times;<\/button>\n\t\t\t<img decoding=\"async\" class=\"infographic-popup-image\" src=\"https:\/\/www.ices.on.ca\/wp-content\/uploads\/2023\/03\/GlazierPaymentIncentivesFIN.jpg\" alt=\"Infographic\">\n\t\t<\/div>\n\t<\/div>\n\t<\/div>\n<\/div>\n<p>\nThe study published today in the April issue of <em>Health Affairs<\/em>, showed that the &#x201c;access bonus,&#x201d; is being paid more often to family doctors in rural Ontario communities who have healthier patients, who made fewer primary care visits and received less after-hours care. The bonus payment could serve as an incentive for physicians to advise their patients to use emergency departments instead of lower-cost walk-in clinics because under the incentive plan, the bonus was reduced if patients sought outside care, but emergency department visits were not counted as outside care.<\/p>\n<p>\n&#x201c;Primary care payment reform needs to be designed and implemented differently for diverse settings such as small rural communities and densely populated downtown cores,&#x201d; says <a href=\"\/ices-scientists\/rick-glazier\/\">Dr. Richard Glazier<\/a>, senior author of the study and ICES senior scientist.<\/p>\n<p>\nMost doctors in Ontario who are eligible for the &#x201c;access bonus&#x201d; are paid under the Family Health Organization model which was introduced in 2006. This model involves formal patient enrollment; a requirement that family doctors provide extended office hours on weekday evenings and on weekends; and blended payments to physicians that include capitation (a fee per person enrolled per month), incentives and bonuses, and fee-for-service payments.<\/p>\n<p>\nThe researchers found that the incentive bonus did not flow to physicians with the best after-hours availability or most complex patients and there were higher rates of emergency department visits for patients whose family doctor received the access bonus.<\/p>\n<p>\n&#x201c;Our findings show that these payments and their intended purpose do not align. Financial incentives should be evaluated and frequently revisited to ensure that they are helping the healthcare system be more efficient and equitable,&#x201d; adds Glazier, who is also a family physician and researcher at St. Michael&#x2019;s.<\/p>\n<p><em><br \/>\nAuthor block: Richard Glazier, Michael E. Green, Eliot Frymire, Alex Kopp, William Hogg, Kamila Premji, and Tara Kiran.<\/em><\/p>\n<p>\nThe report &#x201c;Do incentive payments reward the wrong providers? A study of primary care reform in Ontario, Canada,&#x201d; is published in the April 1 issue of <em>Health Affairs<\/em>.<\/p>\n<div><div class=\"about-ices-shortcode\"><p><strong>ICES<\/strong> is an independent, non-profit research institute 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. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: <a href=\"https:\/\/twitter.com\/ICESOntario\" target=\"_blank\" rel=\"noopener\">@ICESOntario<\/a><\/p>\n<\/div><\/div>\n<p>\nSt. Michael&#x2019;s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future healthcare professionals in 29 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital&#x2019;s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael&apos;s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.<\/p>\n<p>\nUnity Health Toronto, comprised of Providence Healthcare, St. Joseph&#x2019;s Health Centre and St. Michael&#x2019;s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit <a href=\"http:\/\/www.unityhealth.to\" title=\"opens external link\">www.unityhealth.to<\/a>.<\/p>\n<h2>\nFor more information, please contact:<\/h2>\n<p>\nDeborah Creatura<br \/>\nMedia Advisor, ICES<br \/>\n<a href=\"mailto:deborah.creatura@ices.on.ca\">deborah.creatura@ices.on.ca<\/a><br \/>\n(o) 416-480-4780 or (c) 647-406-5996<\/p>\n<p>\nMichael Oliveira<br \/>\nManager, Media Relations, St. Michael&#x2019;s Hospital<br \/>\n416-864-5047<br \/>\n<a href=\"mailto:OliveiraM@smh.ca\">OliveiraM@smh.ca<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>An incentive payment called the &#x201c;access bonus,&#x201d; designed to encourage better access to family medicine and discourage patients from seeking care outside their family doctor&#x2019;s office, may be inadvertently benefiting family doctors with lower levels of access in Ontario, according to a new study by researchers at ICES and St. Michael&#x2019;s Hospital. The &#x201c;access bonus&#x201d; [&hellip;]<\/p>\n","protected":false},"template":"","migration-helper-automated":[],"migration-manual":[],"topic":[61,62,28],"class_list":["post-7990","news_release","type-news_release","status-publish","hentry","topic-health-economics","topic-health-services-research","topic-primary-care"],"acf":{"infographic":[9528],"journal_article":[5681],"research_report":[],"atlas":[],"research_program":[],"site":[6733],"ices_scientist":[1250],"announce_or_event":[],"video":[],"iitn_type":false,"iitn_title":"Access bonuses to doctors create unintended consequences in Ontario: report","iitn_short_title":"","iitn_source_link_url":"https:\/\/ottawacitizen.com\/news\/local-news\/access-bonuses-to-doctors-create-unintended-consequences-in-ontario-report","iitn_source_link_text":"The Ottawa Citizen","sitecore_item_id":"52F5047C-1ED6-4AA0-9766-3FE2C270D9D4","sitecore_item_name":"Incentive-payments-for-family-doctors-may-not-have-intended-results","sitecore_field_values":"{\n  \"Content\": \"<p>An incentive payment called the &ldquo;access bonus,&rdquo; designed to encourage better access to family medicine and discourage patients from seeking care outside their family doctor&rsquo;s office, may be inadvertently benefiting family doctors with lower levels of access in Ontario, according to a new study by researchers at <strong>ICES<\/strong> and St. Michael&rsquo;s Hospital.<\/p>n<p>nThe &ldquo;access bonus&rdquo; is a substantial fee Ontario doctors are paid if their patients do not seek care outside their group, such as at a walk-in clinic. The study found that the average amount family physicians were receiving for the &ldquo;access bonus&rdquo; ranged from over $17,000 per physician and exceeding $36,000 for physicians in the highest quintile.<\/p>n<p><a href=\"~\/media\/868FE4126922499AA3C9458EA888882D.ashx\" onclick=\"_gaq.push(['_trackEvent','Download', GlazierPaymentIncentivesInfographicApril2019',this.href]);\"><img height=\"379\" alt=\"Unintended consequences of Ontario primary care payment bonus meant to improve access\" width=\"350\" src=\"~\/media\/DCAA4190C4054E15A58AF0EDD6E270E6.ashx?h=379&amp;w=350\" style=\"height: 379px; width: 350px;\" \/><\/a><span class=\"grey\" style=\"font-size: 12px; font-weight: bold; display: block; color: #5b5656;\">Click image to enlarge<\/span><\/p>n<p>nThe study published today in the April issue of <em>Health Affairs<\/em>, showed that the &ldquo;access bonus,&rdquo; is being paid more often to family doctors in rural Ontario communities who have healthier patients, who made fewer primary care visits and received less after-hours care. The bonus payment could serve as an incentive for physicians to advise their patients to use emergency departments instead of lower-cost walk-in clinics because under the incentive plan, the bonus was reduced if patients sought outside care, but emergency department visits were not counted as outside care.<\/p>n<p>n&ldquo;Primary care payment reform needs to be designed and implemented differently for diverse settings such as small rural communities and densely populated downtown cores,&rdquo; says <a href=\"~\/link.aspx?_id=2C81C93CB401432B874183841744D4CA&amp;_z=z\">Dr. Richard Glazier<\/a>, senior author of the study and ICES senior scientist.<\/p>n<p>nMost doctors in Ontario who are eligible for the &ldquo;access bonus&rdquo; are paid under the Family Health Organization model which was introduced in 2006. This model involves formal patient enrollment; a requirement that family doctors provide extended office hours on weekday evenings and on weekends; and blended payments to physicians that include capitation (a fee per person enrolled per month), incentives and bonuses, and fee-for-service payments.<\/p>n<p>nThe researchers found that the incentive bonus did not flow to physicians with the best after-hours availability or most complex patients and there were higher rates of emergency department visits for patients whose family doctor received the access bonus.<\/p>n<p>n&ldquo;Our findings show that these payments and their intended purpose do not align. Financial incentives should be evaluated and frequently revisited to ensure that they are helping the healthcare system be more efficient and equitable,&rdquo; adds Glazier, who is also a family physician and researcher at St. Michael&rsquo;s.<\/p>n<p><em>nAuthor block: Richard Glazier, Michael E. Green, Eliot Frymire, Alex Kopp, William Hogg, Kamila Premji, and Tara Kiran.<\/em><\/p>n<p>nThe report &ldquo;Do incentive payments reward the wrong providers? A study of primary care reform in Ontario, Canada,&rdquo; is published in the April 1 issue of <em>Health Affairs<\/em>.<\/p>n<p><em><span style=\"color: #002060;\">ICES is an independent, non-profit research institute 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. In October 2018, the institute formerly known as the Institute for Clinical Evaluative Sciences formally adopted the initialism ICES as its official name. For the latest ICES news, follow us on Twitter: <a href=\"http:\/\/www.twitter.com\/ICESOntario\">@ICESOntario<\/a><\/span><\/em><\/p>n<p>nSt. Michael&rsquo;s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future healthcare professionals in 29 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital&rsquo;s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael's Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.<\/p>n<p>nUnity Health Toronto, comprised of Providence Healthcare, St. Joseph&rsquo;s Health Centre and St. Michael&rsquo;s Hospital, works to advance the health of everyone in our urban communities and beyond. Our health network serves patients, residents and clients across the full spectrum of care, spanning primary care, secondary community care, tertiary and quaternary care services to post-acute through rehabilitation, palliative care and long-term care, while investing in world-class research and education. For more information, visit <a href=\"http:\/\/www.unityhealth.to\" title=\"opens external link\">www.unityhealth.to<\/a>.<\/p>n<h2>nFor more information, please contact:<\/h2>n<p>nDeborah Creatura<br \/>nMedia Advisor, ICES<br \/>n<a href=\"mailto:deborah.creatura@ices.on.ca\">deborah.creatura@ices.on.ca<\/a><br \/>n(o) 416-480-4780 or (c) 647-406-5996<\/p>n<p>nMichael Oliveira<br \/>nManager, Media Relations, St. Michael&rsquo;s Hospital<br \/>n416-864-5047<br \/>n<a href=\"mailto:OliveiraM@smh.ca\">OliveiraM@smh.ca<\/a><\/p>\",\n  \"Title\": \"Incentive payments for family doctors may not have intended results\",\n  \"Short title\": \"Incentive payments for family doctors\",\n  \"Teaser image\": \"<image mediaid=\"{A322F4BD-074D-4BD9-A21A-A9A358DE2CFF}\" alt=\"&quot;&quot;\" height=\"\" width=\"\" hspace=\"\" vspace=\"\" \/>\",\n  \"Summary\": \"An incentive payment called the \u201caccess bonus,\u201d designed to encourage better access to family medicine, may be inadvertently benefiting family doctors with lower levels of access in Ontario.\",\n  \"Location\": \"Toronto\",\n  \"In The News\": \"{0FD339A5-99FD-4ECC-86C0-4217AA545723}\",\n  \"ICES Scientists\": \"{2C81C93C-B401-432B-8741-83841744D4CA}\",\n  \"ICES Locations\": \"{4FCAABBA-14A5-42E6-8F33-BC6C2F1D9908}\",\n  \"Research Programs\": \"{5B1AF319-EC9B-4BF0-A9CD-D066ABE49D71}\",\n  \"Posted Date\": \"20190401T000000\",\n  \"Publication Link\": \"<link text=\"Abstract\" linktype=\"internal\" title=\"Links to related abstract\" querystring=\"\" target=\"\" id=\"{6ADBB4DB-E8AB-4470-999F-D79EA4F36B4B}\" \/>\",\n  \"Related Link\": \"<link text=\"Infographic\" linktype=\"external\" url=\"~\/Publications\/Infographics?year=2019&amp;page=2#GlazierPaymentIncentives\" anchor=\"\" title=\"Link to related infographic\" target=\"\" \/>\",\n  \"Related Link2\": \"<link text=\"Ices in the News | Ottawa Citizen\" linktype=\"external\" url=\"https:\/\/ottawacitizen.com\/news\/local-news\/access-bonuses-to-doctors-create-unintended-consequences-in-ontario-report\" anchor=\"\" title=\"opens external link\" target=\"\" \/>\"\n}","previous_url":"https:\/\/www.ices.on.ca\/Newsroom\/News-Releases\/2019\/Incentive-payments-for-family-doctors-may-not-have-intended-results"},"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>ICES | Incentive payments for family doctors may not have intended results<\/title>\n<meta name=\"description\" content=\"An incentive payment called the &#x201c;access bonus,&#x201d; 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