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


  •  What are the goals of existing pay-for-performance (P4P) programs and demonstrations in the hospital setting?
  •  What should Medicare’s goals be for P4P in the hospital setting?
  •  What is the most effective way to transition from pay-for-reporting (P4R) to P4P? What assistance should CMS offer to providers in the   implementation of P4P?
  •  What are the lessons learned by organizations with P4P and P4R programs in practice or participating in demonstrations? How do these programs   demonstrate that such programs improve both quality of care and the efficiency of health care delivery?
  •  How are hospitals included in the design and implementation of P4P and P4R programs?
  •  What mechanisms are used to communicate with hospitals about the program, and what lessons have been learned about engaging providers?
  •  Is participation voluntary or mandated?
  •  If participation is voluntary, what inducements for participation are being used, and how effective are they at encouraging participation?
  •  What mechanisms are put in place to monitor for unintended consequences, both for clinical care and data quality/gaming?
  •  What is the return on investment (ROI) for P4P and how should it be calculated? 
  •  Should Medicare P4P be based on all adult patients, as hospital public reporting is currently structured, or only patients eligible for Medicare?
  •  How can Medicare recognize the unique challenges faced by rural and critical access hospitals (e.g., small patient volumes, limited staff resources) in   the design and implementation of P4P?
  •  What choices in measure selection, payment methodology, and coordination and communication can best support state and private purchasers   engaged in P4P while also reducing the burden on providers?
  •  How should other types of hospitals, beyond subsection (d) hospitals, be integrated into P4P in the future?
  •  How should outpatient hospital services be integrated in the future?

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