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Lipid Control: The Impact of Financial Incentives

Lipid Control: The Impact of Financial Incentives

Despite the well-documented benefits of statins to lower LDL cholesterol (LDL-C) and help reduce cardiovascular-related mortality, research suggests that physicians underprescribe these drugs. Other data indicate that clinicians frequently fail to intensify therapy when appropriate and that patient adherence to these medications is often subpar. The consequences of these actions can be severe among patients with cardiovascular disease, including worse outcomes, higher hospitalization and mortality rates, and increased healthcare costs. One approach to increase attention to the management of lipids is to tie physician financial incentives to clinical goals, but another strategy may be to offer incentives to patients for reaching their goals. Both of these approaches might be enhanced by applying insights from behavioral economics.   Assessing Approaches For a study published in JAMA, Kevin G. Volpp, MD, PhD, and colleagues compared the provision of financial incentives for physicians only, for patients only, or for shared incentives for both parties and looked at their effectiveness at reducing LDL-C levels among people with elevated cardiovascular risks. The interventions were tested over 12 months from 2011 to 2014 in three healthcare delivery systems in the northeastern United States. Doctors in the physician incentive group were eligible to receive up to $1,024 per enrolled patient meeting LDL-C goals. Participants in the patient incentive group were eligible for the same amount, while physicians and patients in the shared incentives group shared these incentives. A control group was also involved in the analysis and received no incentives that were tied to outcomes. That said, all patient participants received up to $355 each for participating in the trial. “Sharing financial incentives for both patients...
Performance Measures for CAD & Hypertension

Performance Measures for CAD & Hypertension

During the past decade, there has been increased awareness of the need to improve the quality of care delivered to patients with coronary artery disease (CAD) and hypertension. In keeping consistent with this focus, the American College of Cardiology Foundation (ACCF) and the American Heart Association (AHA) have developed guidelines and related performance measures that focus on these areas of care. In the July 12, 2011 issue of Circulation, the ACCF and AHA revised their original performance measures for adults with CAD and hypertension, which were developed in conjunction with the Physician Consortium for Performance Improvement (PCPI) and previously released in 2005. More Than a “Routine” Update for CAD & Hypertension With a general policy to revise performance measures no more than every 3 years, the AHA, ACCF, and PCPI had been working on revising the measurement sets for more than a year before they were published. “These new measurements represent a change in the science and methodology of how per­formance measures are typically developed,” says Joseph Drozda, Jr, MD, FACC, who co-chaired the PCPI panel. “The new mea­surements bring a focus on the outcomes of treatment rather than purely measures of process. We’re focusing on the things that make a difference and doing it in a way that will allow physicians to track their own per­formance in these key areas.” The 2011 ACCF/AHA performance measure sets consist of 10 total measures derived from several professional guidelines. It includes revisions to measures that were released in the 2005 document and five new measures (Table 1). “There are robust guidelines for CAD, supported by strong levels of evidence with respect...
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