Background:
Global payment contracts are increasingly common agreements between insurance payers and healthcare providers that incorporate aspects of risk‐adjustment, capitation and pay‐for‐performance. While industry surveys suggest that healthcare organizations view physicians as a significant obstacle to successful implementation of payment reform, little is actually known about internist opinion, knowledge or specific internist attributes that might predict global payment contract support.
Methods:
Beth Israel Deaconess Care Organization (BIDCO) is an independent physician organization, with 2000 physician providers, affiliated with Beth Israel Deaconess Medical Center and several Boston‐area community hospitals. In 2009, BIDCO became an early adopter of global payment contracts, and now participates in four such agreements. We designed a two‐part survey for internists within BIDCO to (1) assess knowledge regarding global payment contracts, and (2) investigate internist support for these agreements and the association between physician attributes, knowledge, and level of support.
Results:
2Of the 568 internists contacted, 49.5% completed our survey. General medicine internists comprised 52% of respondents (versus 48.0% specialist internists). Eighty‐two percent of respondents reported previously consulting information sources to learn more about global payment contracts. Median score on the knowledge survey was 70%. Eighty‐four percent of respondents reported agreeing or strongly agreeing with BIDCO’s decision to enter into global payment contracts. In a multivariate ordinal logistic regression model, two physician attributes were associated with higher levels of support for entry into global payment contracts: scoring above the 50th percentile in the knowledge assessment (p=.01) and previously consulting any informational sources about global payment systems (p=.01). Status as a specialist versus a non‐specialist did not affect the likelihood of supporting entry into global payment contracts.
Conclusions:
Four years since first engaging in a global payment contract, a majority of internists within our care organization support this decision. Notably, internists who reported consulting informational sources about global payment systems and those with higher levels of knowledge about such systems were significantly more likely to support the adoption of global payment contracts. Though the cross‐sectional nature of our study limits the conclusions we can draw, our findings suggest that physician education efforts may be potential strategies for shaping physician opinion on an organizational‐level. As health systems refine incentives to affect the behavior of physicians, research on determinants of physician attitudes will become an increasingly important area of study.