Medicare

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Findings from the Literature Review

As of June 2007, few peer-reviewed studies existed on the use of financial incentives to affect quality, patient experience, safety, or the efficient use of resources. While more than 40 hospital-based P4P programs are operating in the U.S., few of them are undergoing formal evaluations to assess their impact. The nine articles in our review a

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

Our review of the empirical literature on the effects of P4P included all peer-reviewed published studies describing the impact of a hospital P4P program for either inpatient or outpatient hospital services. We defined outpatient hospital services as any medical or surgical services performed primarily in an outpatient/ambulatory care setting that

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Summary of the Empirical Evidence on the Impact of Hospital Pay for Performance

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. II. A Review of the Evidence on Hospital Pay for Performance

This chapter summarizes the empirical evidence on the effect of P4P in the hospital setting, based on application and theory. We begin with a review of published studies that assess the impact of P4P programs on health care quality, safety, and/or resource use, including studies that address P4P in either the hospital inpatient or the hospital out

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Content and Structure of This Report

The remainder of this report presents the findings of RAND’s environmental scan of hospital P4P. Chapter 2 reviews the empirical literature on the impact of hospital P4P. It also draws from the economics and organizational management theoretical literature that has examined the effect of incentives on behavior to assess possible implications for

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Principles for Pay-for-Performance Programs

Numerous organizations have developed design principles for P4P programs in the hopes of influencing how CMS and other P4P sponsors structure their P4P programs (see Appendix B). Among these organizations are MedPAC, the Joint Commission, employer coalitions, the American Medical Association (AMA) and other physician groups, the American Hospital

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Defining Value-Based Purchasing

VBP is a strategy that strengthens the link between quality and provider payments by rewarding providers that deliver high-quality, cost-efficient care. VBP encompasses a number of activities that can be used individually or as a mutually supportive set to engender provider behavior change. One activity that falls under the VBP umbrella and has ga

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Development of the Value-Based Purchasing Plan

In response to the DRA mandate, CMS created an internal hospital VBP workgroup with responsibility for developing the VBP plan. To inform the development of the plan, the Assistant Secretary for Planning and Evaluation (ASPE), in collaboration with CMS, contracted with the RAND Corporation in July 2006 to conduct a literature review to synthesize

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Federal Actions to Reform the System

On August 22, 2006, President Bush issued an Executive Order, “Promoting Quality and Efficient Health Care,” that requires the federal government to: (1) ensure that federal health care programs promote quality and efficient delivery of health care and (2) make readily useable information available to beneficiaries, enrollees, and providers. T

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Calls for System Reform

The 2001 IOM report Crossing the Quality Chasm called upon policymakers in the public and private sectors to make reforms that would address problems of quality and inefficiencies. A key reform recommended by the IOM was to create financial incentives for quality and to make performance information transparent to ensure public accountability. More

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. The Disconnect Between Payments and Performance

Existing mechanisms for paying hospitals, both Medicare’s per-hospitalization payments using diagnosis-related groups (DRGs) and the per diem payments used by commercial payers, do not differentiate payments to hospitals providing efficient, high quality care. Current payment policies in both the public and the private sector reward the quantity

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. The Cost and Quality Problems

Substantial, well-documented deficiencies exist in the quality of care that is provided to patients in the United States (Institute of Medicine [IOM], 2001; Schuster, McGlynn, and Brook, 1998; Wenger et al., 2003). In a landmark study published in 2003, McGlynn et al. (2003) found that adult patients received only about 55 percent of recommended c

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

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

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

Abbreviation Definition AAFP American Academy of Family Physicians AAMC Association of American Medical Colleges ACC American College of Cardiology ACR American College of Radiology AHA American Hospital Association AHIP Association of Health Insurance Plans

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

We gratefully acknowledge the sponsors of the pay-for-performance programs and the hospitals, hospital associations, and data vendors whose people willingly made the time to participate in individual discussions with us. They offered us valuable information and insights about their experiences in designing and implementing pay-for-reporting and pa

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Program Implementation Challenges

The environmental scan also uncovered a number of program implementation challenges that warrant consideration during program design and implementation.

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

Discussions with program sponsors, hospitals, and data vendors revealed the following lessons about P4P program design and operation:

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Findings from the Key Informant Discussions

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Theoretical Literature and Implications for P4P Design

P4P is common in industries other than health care, and economists and management experts have studied and developed theories on how individuals respond to financial incentives. The economic and management theories that we reviewed suggest that the way in which P4P incentives are structured, or framed, could influence whether they achieve the de

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