The Canadian province of Ontario spent almost $110 million ($102 million U.S.) on bonuses intended to motivate family physicians to screen more of their patients for breast, cervical, and colorectal cancer, but the program didn't translate into improved screening rates, according to a new study in the Annals of Family Medicine.
Researchers from Toronto tracked screening rates for cervical, breast, and colorectal cancer in Ontario each year from 2000 through 2010. An incentive program was introduced in 2006, in which payments varied depending on the percentage of appropriate patients (determined by age and medical history) who received the screening test.
Dr. Tara Kiran from St. Michael's Hospital.Physicians who had 60% of their eligible patients screened for cervical cancer received $220 ($205 U.S.) a year; the payment rose to $2,200 ($2,050 U.S.) if 80% were screened. In 2010, 84% of eligible family doctors received at least one bonus payment and 22% received the maximum bonus payment of $8,400 ($7,829 U.S.) a year, according to lead author Dr. Tara Kiran and colleagues (Ann Fam Med, July/August 2014, Vol. 12:4, pp. 1-8).
Between 2006 and 2010, $28.3 million ($26.3 million U.S.), $31.3 million ($29.1 million U.S.), and $50 million ($46.6 million U.S.) in incentive payments were paid to physicians for cervical, breast, and colorectal cancer screening, respectively. Despite this cash outlay, cervical and breast cancer screening rates were relatively unchanged, shifting from 55% to 57% for cervical cancer and 60% to 63% for breast cancer, respectively.
Rates for colorectal cancer screening did increase by about 5% per year after incentives were introduced, from 20% to 51%, but these were already increasing by 3% per year before the bonuses went into effect.
"Screening rates are not as high as we'd like them to be, and doctors are trying to provide counseling to their patients," Kiran, from St. Michael's Hospital in Toronto, told AuntMinnie.com. "[Using] pay-for-performance incentives is one strategy the government has tried, but it doesn't appear to be working."
Does fault for the lack of screening -- particularly for breast and cervical cancer -- rest solely on physicians' shoulders? Not necessarily, according to the authors. Organizational and patient factors also come into play.
"Practices with electronic reminder systems have been shown to provide superior preventive care, yet only 66% of primary care physicians in Ontario reported using electronic medical records and only 37% said they could easily generate a list of patients due for preventive care," Kiran's team wrote.
The stability of cervical and breast cancer screening rates over the past decade "may relate to some patients making an informed choice not to be screened," they added. "Other patients may need access to a female provider or education to address misconceptions before agreeing to be screened."
