An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Methodology


RAND drew a purposive sample of hospitals from the universe of hospitals included in the RHQDAPU program and PHQID to obtain a range of perspectives. RAND selected hospitals from the national pool of hospitals that provide services to Medicare patients, reflecting an array of characteristics:

  • Large and small
  • Urban and rural
  • Eligible to participate in the PHQID program but had declined
  • Invited to participate in the CMS RHQDAPU program but had declined to submit data
  • Submitted data and failed the data validation processes for RHQDAPU 
  • CAHs (which are not required to submit data under any current P4P or P4R initiatives) voluntarily submitting data under RHQDAPU. 

We also spoke to a small number of hospitals exposed to a statewide private-sector P4P program, again selecting hospitals that were both large and small in terms of number of beds. In addition, we held discussions with the major hospital associations and a small number of vendors that support the hospitals in their data submissions to comply with P4P and P4R reporting requirements.

Between October of 2006 and March of 2007, RAND held discussions with: 

  • Twenty-eight hospitals in five categories: 
  • Twelve PHQID hospitals, seven of which volunteered to participate in the P4P demonstration and five that elected not to participate.
  • Five hospitals exposed to a private-sector P4P program.
  • Seven small and CAH hospitals that had submitted RHQDAPU data and were listed on Hospital Compare website.8
  • Three hospitals that failed data submission for RHQDAPU.
  • One PPS hospital that elected not to participate in the voluntary RHQDAPU program but was eligible to submit data.
  • Seven major hospital associations:
    • The AHA, Federation of American Hospitals (FAH), AAMC, Voluntary Hospital Association (VHA), National Association of Children’s Hospitals (NACH), National Rural Health Association (NRHA), and Catholic Health Association (CHA).
  • Five hospital data vendors that support hospitals in submitting data for the RHQDAPU program.

To understand the unique characteristics and issues facing rural and CAHs hospitals that would affect their ability to fully participate in a VBP program, we held telephone discussions with seven hospitals (four rural, three CAHs), two government agencies with expertise in rural health issues, three state hospital associations located in states with a large number of rural providers and CAHs, one research center with expertise in rural health issues, and three consultancies with extensive experience working with rural providers and CAHs. For the rural hospital assessment, the organizations with which we spoke were identified through two sources: (1) hospitals reporting on the Hospital Compare website and (2) experts in the rural health field who were interviewed and asked to identify key organizations and individuals with rural health expertise in the hospital setting.

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