Content by Keyword: Medicare

In our discussions with hospitals about the Medicare RHQDAPU program, which as of 2007 held 2 percent of a hospital’s APU at risk for reporting, there was widespread sentiment that they would publicly report on these measures absent the RHQDAPU effort. The historical evidence suggests the contrary, however. Prior to tying reporting of performanc

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:

RAND held discussions with a broad cross-section of hospitals, hospital associations, and hospital data vendors to learn about the experiences hospitals and their support vendors have had with the Medicare RHQDAPU P4R program, various private-sector P4P programs, and/or the CMS PHQID. Within the hospitals, we spoke to the Chief Executive Officer (

Not all sponsors agreed that public reporting should be a part of P4P programs. While some viewed it as an important component that compliments the financial incentive, others saw it as contentious and detrimental to creating a collaborative relationship with hospitals.

Sponsors unanimously agreed that interaction with hospitals is critical to P4P program success. They stated it was important to engage and work collaboratively with hospitals “early and often” in all aspects of the program design and operation. Sponsors noted that this builds a sense of ownership and partnership among hospitals involved, whi

The majority of P4P program sponsors advocated making the program as positive as possible. In this spirit, they suggested focusing on collaboration and rewards and avoiding financial withholds, which are viewed as punitive. This sentiment is consistent with the principle of framing noted in our review of economic theories in Chapter 2. Program s

Sponsors reported that minimizing the data collection burden was critical for hospital acceptance of P4P programs. Suggested strategies for minimizing hospital burden included (1) alignment of measures and data collection across programs and (2) selection of a reasonable number of measures to include as part of the P4P program. Sponsors were una

Program sponsors said that based on their experience, the use of evidence-based measures that are standardized and have achieved a consensus base (i.e., are NQF  and HQA endorsed) reduces hospital pushback. Sponsors noted that they would like to expand measurement beyond areas in which hospitals are already doing well to avoid the “teachin

Program sponsors said that coordinating and aligning their P4P programs with other P4P programs and hospital reporting requirements constituted one of the most important considerations in designing a successful program. They noted that hospitals are often overwhelmed with requests for disparate information from a variety of organizations, and th

We asked hospital P4P program sponsors to discuss the key lessons they have learned and the challenges they have faced in designing, implementing, and maintaining their hospital P4P programs. Their insights and recommendations based on their experiences are presented here for six key areas: overall design, measures, data collection, payment struct

Most sponsors to whom we spoke were not conducting formal evaluations of their hospital P4P programs (5/22). However, some noted anecdotal evidence of positive program impact. For example, some said hospitals have improved their quality improvement infrastructure (e.g., dedicated quality improvement staff, regular quality improvement meetings) in

Measures. Looking forward, many sponsors (11/20) plan to expand and/or modify the measure sets they are currently using. They anticipated including more measures in one or more of the following areas: 

Engagement. The majority of sponsors consulted with hospitals about overall program design (15/22), typically through in-person or telephone meetings during which they discussed ways to structure the P4P program. These sponsors strongly felt that such engagement was and continues to be critical to the success of their programs. In addition, the

Payout Method. The sponsors with whom we spoke tended to use one of two performance-based rewards. About half (10/22) pay a lump-sum bonus, usually annually. The other half (9/22) pay the reward on a continuous basis (e.g., an ongoing “bump up” to per diem or DRG payments) and use past performance to determine the future year’s payment in

Data Collection .

Measure Set Determination . We identified two general approaches used by sponsors to determine the measure set for their hospital P4P programs. The first is a standardized, “one-size-fits-all” approach in which the measures applied to hospitals in the program do not vary.

Length of Time in Operation. Of the 23 P4P programs, a majority were relatively new. Seven had made their first incentive payment to hospitals in 2006 or were about to make a payout early in 2007, five had made their first payout in 2004 or 2005, and 11 had made their first incentive payments starting in 2003 or earlier. Only one program report

We used several sources to identify candidate private- and public-hospital P4P programs to construct the universe of hospital P4P programs: