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From the Christiana Health Care Center Division of Neonatology in the Department of Pediatrics at the Thomas Jefferson University School of Medicine (Dr Locke) in Newark, Del, and the Department of Medicine at the University of California Davis School of Medicine (Dr Srinivasan) in Sacramento.

Address correspondence to Robert G. Locke, DO, Neonatalogy, MAP-1 Suite 217, 4745 Ogletown-Stanton Rds, Newark, DE 19713-2074. E-mail: rlocke{at}christianacare.org

Context: Pay-for-performance (P4P) programs reward physicians who meet—and electronically document—specific healthcare standards during patient encounters, incentivizing certain aspects of medical care. Although such documentation can be time consuming and technology intensive, noncompliance can result in decreased physician reimbursement.

Objective: To assess the attitudes of primary care osteopathic physicians toward P4P initiatives.

Methods: In 2006, a 20-item questionnaire was mailed to 1000 osteopathic physicians randomly pulled from the American Osteopathic Association database for this cross-sectional, survey-based study. Distinctions were not made between physician practice type or group size when the mailing list was compiled.

Results: Two hundred thirty responses were received for a response rate of 23%. Of these respondents, 123 physicians (54%) were in primary care practices comprising fewer than five physicians. Of these practitioners, 94% felt unprepared for P4P initiatives, 81% did not have the resources for appropriate technological investments, and 75% required additional P4P education and training to respond to P4P initiatives. In addition, the 28% of respondents who used electronic medical records were almost five times more likely (odds ratio, 4.80; 95% confidence interval, 1.91-12.06) to report that they could meet P4P reporting requirements. The majority of survey respondents were skeptical that P4P would appropriately capture the quality of their work and did not believe that health outcomes should influence their reimbursement.

Conclusions: Although the current study's sample size may limit generalizability, small group primary care osteopathic physicians will need assistance—both technological and educational—to meet P4P measures.