Survey: Community Health Centers Offer Better Patient Care

A new survey suggests that when physicians are rewarded with quality- and value-based incentives, patients get better treatment.

Stanford University School of Medicine researchers recently revealed, in a study published online in the American Journal of Preventive Medicine, that government-funded community health centers, which serve low-income and uninsured patients, provide better care than private practices.

Led by Randall Stafford, a physician and professor of medicine at the Stanford Prevention Research Center, researchers at University of California, San Francisco looked at the actions physicians took when patients visited private practices versus the actions that were taken at community health centers (also referred to as Federally Qualified Health Centers and FQHC Look-Alikes, both of which receive government support).

Data is based on the analysis of records of 73,074 visits to private practices and community health centers that receive enhanced Medicare and Medicaid reimbursement, as well as government grants. Researchers evaluated physicians' adherence to professional and federal guidelines for 18 measures, which included treatments for specific diseases, screening for certain conditions, and diet and lifestyle counseling.

Community health center physicians performed as well as their private practice colleagues in 13 of the 18 measures. For the remaining five measures - use of ACE inhibitors for congestive heart failure, use of beta blockers, use of inhaled corticosteroids for adult asthmatics, blood pressure screening, and avoidance of electrocardiograms in low-risk patients - the community physicians followed recommendations a higher percent of the time.

"The fact that community health centers look better is perhaps surprising,” said Stafford, noting that patients at community health centers have more health and socioeconomic challenges and therefore take up more physician time. "On the other hand, having worked in community health centers, I can see how it makes sense. These are centers where physicians are not as profit-driven and many have incentives more in line with providing quality care."

The study reinforces the notion that providing a higher caliber of care means patients will experience better outcomes, which physicians at volume-driven practices should consider. It’s also reflective of the direction physician compensation is going: Productivity incentives, based on relative value units, remain the most common form of bonus payments to doctors, but new payment methodologies that tie bonuses to quality and cost-savings are emerging at practices.

"Compensation models help direct physician behavior," Medical Group Management Association consultant Ken Hertz told Physicians Practice when interviewed about our most recent Physicians PracticePhysician Compensation Survey. "If payers are saying to us 'quality indicators are important,' then we want our physicians to keep quality indicators in mind when caring for patients. So if we develop a compensation plan that rewards for quality, we're serving our patients and our payers."