Medicare

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

Asch SM, Kerr EA, Keesey J, Adams JL, Setodji CM, Malik S, McGlynn EA. (2006) Who Is at Greatest Risk for Receiving Poor-Quality Health Care? New England Journal of Medicine 354(11):1147–1156. Asch B, Warner J. (1996) Incentive Systems: Theory and Evidence. In Lewin D, Mitchell D, Zaidi M (eds), The Human Resource Management Handbook , Part

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

Cypress Healthcare Kansas Department of Health and Environment, Office of Local and Rural Health Health Resources and Services Administration, Office of Rural Health Policy National Rural Health Association Stratis Health (Minnesota QIO) Stroudwater Associates Upper Midwest Rural Health Research Center

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

Hospital Corporation of America Illinois Hospital Association Maryland Hospital Association Premier Health System Quantros Thomson Healthcare

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

American Hospital Association Association of American Medical Colleges Catholic Health Association Federation of American Hospitals National Association of Children’s Hospitals & Related Institutions North Carolina Hospital Association South Dakota Hospital Association Voluntary Hospital Association

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Hospitals and Health Systems

Amsterdam Memorial Hospital, Amsterdam, NY Baptist Health System of East TN, Knoxville, TN Bleckley Memorial Hospital, Cochran, GA Crenshaw Community Hospital, Luverne, AL Fairchild Medical Center, Yreka, CA Foote Memorial Hospital, Jackson, MI Franklin Medical Center, Greenfield, MA Geisinger Health System, Danville, PA Hacken

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Hospital P4P and Public Reporting Program Sponsors

Anthem, National office Anthem, VA Blue Cross Blue Shield, HI Blue Cross Blue Shield, IL Blue Cross Blue Shield, MA Blue Cross Blue Shield, MI Blue Shield, Northeastern NY The Employer Healthcare Alliance Cooperative (“The Alliance”) Employers’ Coalition on Health Excellus/Univera Fallon Community Health Plan Harvar

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Appendix D: List of Organizations Participating in the Environmental Scan

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Appendix C: Inpatient Hospital Measures

Measure Organizations Collecting/Utilizing Measures Joint Commission CMS 1 HQA 2 CMS-RHQDAPU 3 Premier 4

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Appendix B: Summary of Pay-for-Performance Design Principles

This appendix builds on the summary of P4P design principles and recommendations presented in Chapter 1 of this report. Here we present and summarize the P4P design principles established by 26 organizations representing a variety of stakeholders, including purchasers, health care providers, policy organizations, accreditation organizations, healt

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

What is the scope of outpatient hospital services, and which of these services could be initially targeted for performance measurement and potential reward? Are there programs currently under way to align reimbursement with value-based purchasing (VBP) in the outpatient hospital setting?

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Cross-Cutting Themes

How can hospital P4P be integrated into the Medicare purchasing environment? What is the evidence of the impact of P4P programs on changing provider performance? What features are necessary for the sustainability of programs?

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 w

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

What types of incentives, financial or non-financial, currently exist or are under consideration (e.g., financial, public recognition, public reporting, confidential peer comparisons, systems support)? How effective are different types of incentives at influencing provider behavior? Should incentives be based on thresholds, improvemen

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

What data collection, data management, reporting infrastructure, and data outreach were required to implement existing P4P programs (e.g., sampling methodology, storage capacity)? How do current P4P programs address data collection issues, including sampling and minimizing burden, such as

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

Define the set of services provided in the outpatient hospital setting to identify what could be measured and potentially rewarded. What measures of performance (e.g., clinical effectiveness, efficiency, patient experience, care coordination/transitions) are currently being used for both inpatient and outpatient hospital care in pra

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 o

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Appendix A: Design Issues Explored as Part of the Environmental Scan

This appendix lists the complete set of design issues that were identified by ASPE and CMS as being of interest for exploring through the environmental scan work.

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

Mounting cost pressures and substantial deficits in the quality of care within the U.S. health care system have led policy makers to consider options for system reform to drive improvements. Value-based purchasing is one reform option being examined and tested by payers in the public and private sectors, and it includes both financial (e.g., P4P

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Advice Offered by Hospitals Regarding P4P Program Designs

The key recommendations that hospitals had for anyone considering designing and implementing a P4P program were as follows:

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Hospital Experiences with Premier PHQID

Among Premier hospitals that were voluntarily participating in PHQID, we found broad agreement that their decision to participate reflected a desire to “get in at the start to hopefully shape it” and a recognition that “P4P is coming, and it is a way to gain experience.” Some of the Premier hospitals that were eligible to participate but h

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