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


  •  What hospital-quality public reporting systems are currently available, and what is the evidence of their use and impact? What features (in terms of both design of the report and publicity associated with the report) of those systems are associated with greater impact?
  •  How do private and state purchasers address the policy issues with which CMS has struggled, and what lessons can be learned about these issues:
    •  How should reports simplify data and make them easier to use? Should reports be created by rank-ordering by performance? And should they use symbols, bars, or numerical rates? What are the most effective ways of conveying confidence intervals and data uncertainty to the general public, health care providers, and hospital quality improvement staff? Are there some hospital quality measures that have utility only for quality monitoring and improvement, only through financial incentives, or only through public reporting? Do some publicly reported measures (e.g., outcome measures) have significant effect on hospital quality improvement activity without being tied to financial incentives, while others (e.g., process measures) have less effect unless they are tied to financial incentives? 
    •  If hospitals are penalized for not improving above a threshold (along the lines of the theoretical penalty that the Premier demo will be imposing on underperforming hospitals), should CMS publicly report and highlight the fact of the penalty? 
    •  Should CMS report improvement in quality, performance above certain benchmarks in quality, or relative ranking among peers on quality measures—or all of the above? What evidence do we have that one type of public reports has greater impact than other types? 
    •  What cost measures are most important to display for different audiences? Who does or would use cost data for decisionmaking, and how can such data be more effectively displayed for that audience? 
    •  How do we best display and explain efficiency measures? How do different audiences interpret these measures? Given evidence that consumers may misinterpret such measures (e.g., longer lengths of stay mean “this hospital cares more about their patients than other hospitals do”), what are the most effective ways of explaining such measures to the public? 
    •  How can we display efficiency measures and absolute costs together most effectively? 
    •  How do token financial incentives to patients impact their understanding and weighting of quality and efficiency measures? For example, would co-pay discounts based on quality scores increase the awareness and credibility of quality measures among patients?                        
  •  How can CMS reach all of its customers, from beneficiaries to providers to researchers? How does CMS meet the needs of different audiences and the different uses to which they put the data? How does CMS provide transparency and access to data while ensuring adequate protections for privacy and not overwhelming CMS’ data management capabilities?
  •  How should CMS and DHHS portray the hospital P4P program to the public to engage the interest and support of consumers and the general public? What reactions from the provider community can be anticipated and planned for?

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