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Consequences of Influencing Physician Behavior—Reply

Consequences of Influencing Physician Behavior—Reply In Reply In response to our Viewpoint on extrinsic and intrinsic motivations to change physician behavior, Dr Meador states that incentives should be assessed for intended and unintended consequences, and we agree. However, Meador argues that the rise of financial motivators has directly caused a decrease in clinical research and teaching. This argument is difficult to make conclusively, since so many factors have changed in academic medicine over this period. Our thesis in the Viewpoint was that a careful balance of extrinsic and intrinsic motivators, thoughtfully customized to one’s own organization, is key to promoting efficiency and drive. It is unlikely that any single financial motivator is decreasing the time spent on research and teaching. Instead, it is the balance of motivators and shifts in that balance that may affect how physicians spend their time. We also agree that despite significant improvements, quality metrics are imperfect. Some metrics are crucial to patient safety, whereas others may simply add to documentation and fail to achieve any improvement in outcomes.1 However, quality metrics and electronic medical record systems can also be used to boost intrinsic motivation. Too often, quality metrics are relayed to physicians only when there are failings—eg, low patient satisfaction scores or high rates of readmissions. Instead, organizations can harness the power of the electronic medical record to create dashboards that allow physicians to see their positive effect on patient health. For example, for a primary care physician who has improved rates of hemoglobin A1C control in patients with diabetes, the dashboard could relay how many incidents of microvascular complications like diabetic retinopathy are thereby being prevented. Section Editor: Jody W. Zylke, MD, Deputy Editor. Back to top Article Information Corresponding Author: Allan S. Detsky, MD, PhD, Department of Medicine, Mount Sinai Hospital and University Health Network, 600 University Ave, Room 429, Toronto ON M5G 1X5, Canada (adetsky@mtsinai.on.ca). Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Volpp reported that he has served as a consultant to CVS Health; is a principal of VAL Health; and has received grant funding from Weight Watchers, CVS Health, Merck, Humana and Horizon Blue Cross Blue Shield, the Hawaii Medical Services Association, and Vitality (Discovery South Africa). No other disclosures were reported. References 1. Wachter B. How measurement fails doctors and teachers. New York Times. January 16, 2016. http://www.nytimes.com/2016/01/17/opinion/sunday/how-measurement-fails-doctors-and-teachers.html?_r=1. Accessed January 17, 2016. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

Consequences of Influencing Physician Behavior—Reply

JAMA , Volume 315 (21) – Jun 7, 2016

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Publisher
American Medical Association
Copyright
Copyright © 2016 American Medical Association. All Rights Reserved.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.2016.1226
Publisher site
See Article on Publisher Site

Abstract

In Reply In response to our Viewpoint on extrinsic and intrinsic motivations to change physician behavior, Dr Meador states that incentives should be assessed for intended and unintended consequences, and we agree. However, Meador argues that the rise of financial motivators has directly caused a decrease in clinical research and teaching. This argument is difficult to make conclusively, since so many factors have changed in academic medicine over this period. Our thesis in the Viewpoint was that a careful balance of extrinsic and intrinsic motivators, thoughtfully customized to one’s own organization, is key to promoting efficiency and drive. It is unlikely that any single financial motivator is decreasing the time spent on research and teaching. Instead, it is the balance of motivators and shifts in that balance that may affect how physicians spend their time. We also agree that despite significant improvements, quality metrics are imperfect. Some metrics are crucial to patient safety, whereas others may simply add to documentation and fail to achieve any improvement in outcomes.1 However, quality metrics and electronic medical record systems can also be used to boost intrinsic motivation. Too often, quality metrics are relayed to physicians only when there are failings—eg, low patient satisfaction scores or high rates of readmissions. Instead, organizations can harness the power of the electronic medical record to create dashboards that allow physicians to see their positive effect on patient health. For example, for a primary care physician who has improved rates of hemoglobin A1C control in patients with diabetes, the dashboard could relay how many incidents of microvascular complications like diabetic retinopathy are thereby being prevented. Section Editor: Jody W. Zylke, MD, Deputy Editor. Back to top Article Information Corresponding Author: Allan S. Detsky, MD, PhD, Department of Medicine, Mount Sinai Hospital and University Health Network, 600 University Ave, Room 429, Toronto ON M5G 1X5, Canada (adetsky@mtsinai.on.ca). Conflict of Interest Disclosures: The authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Volpp reported that he has served as a consultant to CVS Health; is a principal of VAL Health; and has received grant funding from Weight Watchers, CVS Health, Merck, Humana and Horizon Blue Cross Blue Shield, the Hawaii Medical Services Association, and Vitality (Discovery South Africa). No other disclosures were reported. References 1. Wachter B. How measurement fails doctors and teachers. New York Times. January 16, 2016. http://www.nytimes.com/2016/01/17/opinion/sunday/how-measurement-fails-doctors-and-teachers.html?_r=1. Accessed January 17, 2016.

Journal

JAMAAmerican Medical Association

Published: Jun 7, 2016

References