Disclosing doctor incentives could help boost patient trust

NATIONAL REPORTS-Concern regarding financial conflict of interest for physicians has led to calls for disclosure of financial incentives to patients.

"There has not been widespread disclosure by physicians or physician groups in part because there were concerns that disclosure would be too complex, might raise troubling questions for patients, and ultimately might damage the doctor-patient relationship," explains Steven D. Pearson, MD, of Harvard Medical School in Boston.

Transparency is a critical factor in advancing consumerism in healthcare, but disclosing physician incentives is only one part of the puzzle, according to MHE Editorial Advisor Joel Brill, MD, chief medical officer for Predictive Health LLC.

"Once the patient knows what their dollar is purchasing, and what they are receiving for it, they can then make an intelligent value-based purchasing decision, one that should help to restore patient trust in the healthcare system."

Dr. Pearson and colleagues conducted a study to evaluate the impact of physician group disclosure to their patients of the compensation model and key financial incentives for primary care physicians in the physician groups.

The study, which was published in the Annals of Internal Medicine (March 27, 2006), found that among diverse patient populations at two large physician groups in the Los Angeles and Boston areas, a single, mailed disclosure letter was associated with improved knowledge of physicians' compensation models.

"Patients' trust in their physicians was unharmed, and their loyalty to their physician group was strengthened," Dr. Pearson says. "This study suggests that many patients hold mistaken impressions of how their primary care physician is paid, a mistaken impression that may be based on negative press in the 1990s on the 'perverse' incentives of managed care. Since the current managed care landscape for physician compensation has shifted in recent years, disclosure by physicians groups may help disabuse patients of fears of intense financial conflict of interest.

"For physician groups with similar compensation programs to those of the groups in this study, which are compensation programs likely similar to many larger physician groups, a single mailed letter of disclosure to patients should be considered an effective method to enhance the patient-physician relationship and to improve loyalty of patients to the physician group," Dr. Pearson adds.