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Use of Care Management Practices in Small- and Medium-Sized Physician Groups: Do Public Reporting of Physician Quality and Financial Incentives Matter?


Address correspondence to Jeffrey A. Alexander, Ph.D., Health Management and Policy, School of Public Health, University of Michigan, 109 Observatory Dr., Ann Arbor, MI 48109; e-mail:



To examine the effect of public reporting (PR) and financial incentives tied to quality performance on the use of care management practices (CMPs) among small- and medium-sized physician groups.


Survey data from The National Study of Small and Medium-sized Physician Practices were used. Primary data collection was also conducted to assess community-level PR activities. The final sample included 643 practices engaged in quality reporting; about half of these practices were subject to PR.

Study Design

We used a treatment effects model. The instrumental variables were the community-level variables that capture the level of PR activity in each community in which the practices operate.


(1) PR is associated with increased use of CMPs, but the estimate is not statistically significant; (2) financial incentives are associated with greater use of CMPs; (3) practices' awareness/sensitivity to quality reports is positively related to their use of CMPs; and (4) combined PR and financial incentives jointly affect CMP use to a greater degree than either of these factors alone.


Small- to medium-sized practices appear to respond to PR and financial incentives by greater use of CMPs. Future research needs to investigate the appropriate mix and type of incentive arrangements and quality reporting.