The method of payment for services rendered by physicians in Ontario affects whether patients actually receive the recommended treatments, according to research published in the Canadian Journal of Diabetes.
“When it comes to diabetes, not all Ontarians are getting equal care,” Tara Kiran, MD, of the Li Ka Shing Knowledge Institute of St. Michael’s Hospital in Toronto, said in a press release. “Ontarians whose doctors are paid a lump sum per patient are more likely to get the diabetes tests they need.”
In the past decade, the province has moved from traditional fee-for-service payment models, in which physicians bill Ontario Health Insurance Plan for each patient visit, to fee-for-service plus a lump sum payment for number of patients enrolled in a practice; 40% of primary care physicians are now paid in this blended capitation model.
Kiran and fellow researchers from St. Michael’s and the Institute for Clinical Evaluative Sciences examined available administrative data for 757,928 patients aged at least 40 years with type 1 and type 2 diabetes — approximately 12% of Ontario’s population.
The investigators assigned patients to PCPs, then followed them for 2 years to determine whether they received three key monitoring tests. Multivariable generalized estimating equation models were used to analyze the associations among assorted primary care models and acknowledgement of recommended testing.
Clinical practice guidelines from the Canadian Diabetes Association recommend patients with diabetes undergo four HbA1c laboratory tests for blood glucose, two cholesterol tests and a retina exam; optimum care was defined as receiving all three types in 2 years.
Patients with diabetes enrolled in a non-team blended capitation model (OR=1.18; 95% CI, 1.09-1.27) or a team-based blended capitation model (OR=1.2; 95% CI, 1.13-1.28) were more likely to receive optimal care vs. those in a blended fee-for-service model. Patients assigned to a traditional fee-for-service physician, and not enrolled in any model, were least likely to receive optimal care vs. those enrolled in a blended fee-for-service model (OR=0.6; 95% CI, 0.57-0.62).
“Lump sum funding gives family physicians the flexibility to spend more time with complex patients, collaborate with other professionals, and integrate email and phone calls into their practices,” Kiran said in the release.