Reimbursement and Pay-For-Performance Pay-for-performance This entails day-to-day programs designed to offer monetary incentives to health care providers and physicians to meet efficiency, quality and other defined targets. Pay-for-performance entails Agency for health care and quality, which defined as improved strategies in health care delivery, which majorly relies on the use of purchase power or the market power Heywood,
Point out that the study did not document that patients in these hospitals had worse outcomes. Point out that it was an observational study and factors other than those analyzed could have influenced the results.
In an analysis of three years' worth of key performance measures, these hospitals fared worse at baseline than hospitals with fewer Medicaid patients, and they had significantly smaller improvements thereafter, suggesting a grim reimbursement fate if the model becomes more widespread.
So reported Rachel M.
They predicted a growing quality gap. From data on 3, hospitals, the investigators conducted a longitudinal study of the relationship between hospital performance and percentage of Medicaid coverage from to The researchers grouped the hospitals into quartiles according to the percentage of Medicaid patients in their caseloads.
The two quartiles in between were defined as a "middle" group. The performance data were on 10 standard measures of quality within three disease categories: The researchers created composite scores on a point scale within each category. Performance measures in the heart failure category included rates of assessment and ACE inhibitor usage for left ventricular dysfunction.
In pneumonia, the performance measures included oxygenation evaluation, pneumococcal vaccination, and timing of initial antibiotic therapy. Myocardial infarction measures included use of aspirin at admission and discharge, beta-blockers at admission and discharge, and use of ACE inhibitors for left ventricular dysfunction.
The composite scores were: But the percentage gains were significantly larger for those treating low numbers of Medicaid patients. The composite scores for myocardial infarction improved 3.
Werner and colleagues also calculated what would happen to reimbursements at the study hospitals if a pilot pay-for-performance plan developed by CMS in were applied to all of them.
Werner and colleagues determined that, under this scheme, hospitals with the fewest Medicaid patients mean 2. The researchers worried that such incentive systems mean poorer-performing hospitals will have less money to invest in quality improvements and "exacerbate existing disparities in healthcare.
Werner and colleagues did not recommend abandoning pay-for-performance incentives.
Rather, they suggested that safety-net hospitals need a different financing structure, with dedicated funding for quality improvement programs. The researchers said such an approach is already in place for outpatient clinics in a program sponsored by the government's Health Resources and Services Administration.
No potential conflicts of interest were reported. Reviewed by Zalman S.PHILADELPHIA, May 13 -- Pay-for-performance reimbursement measures may have dire unintended consequences for safety-net hospitals, according to researchers here.
The pay-for-performance model offers financial incentives to providers (physicians, hospitals, medical groups, etc.) to improve quality and efficiency. Typically, incentives are paid on top of the standard fee-for-service compensation if the provider meets or exceeds certain pre-established metrics of performance.
REIMBURSEMENT AND PAY-FOR-PERFORMANCE 2 Reimbursement and Pay-for-Performance Since the early ’s, the pay-for-performance healthcare payment system has become a widespread practice amongst providers and health care facilities.
Prior to the use of pay for performance, the common practice was fee for service. Under fee for service, providers and facilities received payment .
Oct 24, · "Pay for performance" rewards doctors, hospitals, and other health care providers for attaining targeted service goals, like meeting health care quality or efficiency standards. RAND research has explored a range of policy and economic implications related to the use of pay-for-performance .
Pay for performance (P4P) is a model that attempts to align financial incentives with better outcomes and value rather than the current system of rewarding volume and intensity of care delivered. P4P has been implemented in other countries besides the United States and is perhaps most advanced in the United Kingdom.
One reason is that this change represents the leading edge of a series of anticipated CMS reforms of provider payment, which include a shift toward pay for performance.