Effects of removing a fee-for-service incentive on specialist chronic disease services: a time-series analysis

Effects of removing a fee-for-service incentive on specialist chronic disease services: a time-series analysis

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IntroductionPhysician payment models are known to affect the nature and volume of services provided.Our objective was to study the effects of removing a financial incentive, the fee-for-service premium, on the provision of chronic disease follow-up services by internal medicine, cardiology, nephrology and gastroenterology specialists.MethodsWe collected linked administrative health care data for the period 1 April 2013 to 31 March 2017 from databases held at the Institute for Clinical Evaluative Sciences (ICES) in Ontario, Canada.

We conducted a time-series analysis before and after the removal of the fee-for-service premium on 1 April 2015.The primary outcome was total monthly visits for chronic disease follow-up Wipes services.Secondary outcomes were monthly visits for total follow-up services and new patient consultations.

We compared internal medicine, cardiology, nephrology and gastroenterology specialists practising during the study timeframe with respirology, hematology, endocrinology, rheumatology and infectious diseases Wireless In-Ear specialists who remained eligible to claim the premium.We chose this comparison group as these are all subspecialties of internal medicine, providing similar services.ResultsThe number of chronic disease follow-up visits decreased significantly after removal of the premium, but there was no decrease in total follow-up visits.

There was also a significant downward trend in new patient consultations.No changes were observed in the comparison group.ConclusionThe decrease in volume of chronic disease follow-up visits can be explained by diagnostic criteria being met less often, rather than an actual reduction in services provided.

Potential effects on patient outcomes require further exploration.