Content by Keyword: Quality of Services and Information

  • Home
  • Quality of Services and Inform...
  • print
  • email
  • twitter
  • compact
Report page
Measures

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

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
Report page
Overall Design

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

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
Report page
Critical Lessons Learned

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

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
Report page
Program Evaluation

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

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
Report page
Program Evolution

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

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: 
Report page
Hospital Assistance and Engagement

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Hospital Assistance and Engagement

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
Report page
Public Reporting

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

Report page
Payment Structure

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

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
Report page
Data Collection and Validation

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

Data Collection .
Report page
Measures

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

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.
Report page
General Descriptive Characteristics of Hospital

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. General Descriptive Characteristics of Hospital P4P Programs

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
Report page
Findings from Discussions with Program Sponsors

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Findings from Discussions with Program Sponsors

Report page
Methodological Approach

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

We used several sources to identify candidate private- and public-hospital P4P programs to construct the universe of hospital P4P programs:
Report page
III. Summary of Discussions with Pay-for-

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. III. Summary of Discussions with Pay-for-Performance Program Sponsors

Given the scarcity of empirical data showing the effects of P4R and P4P programs on improving quality, safety, or efficiency and showing the effects of design elements that may influence provider behavior, RAND held discussions with a broad cross-section of P4P programs to gather information on the current state-of-the-art of P4P program design an
Report page
Conclusions

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

Together, the economic and management theories that we reviewed suggest that the way in which P4P incentives are structured, or framed, may influence whether they achieve the desired behavioral response. Incentives that are framed as withholdings, paid out in small and frequent payments, and paid out close to the time that care is delivered might
Report page
Intrinsic Versus Extrinsic Motivation

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Intrinsic Versus Extrinsic Motivation

Empirical meta-analyses of studies that examined incentive programs show that such programs have a mixed response; some studies show an impact, and many others show little or even a negative impact (Rothe, 1970; Deci, Koestner, and Ryan, 1999; Cameron, Banko, and Pierce, 2001). Researchers have tried to reconcile the mixed results by theorizing th
Report page
Multidimensional Output

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

Multidimensional output, or multitasking, refers to situations in which the responsibilities of an individual encompass multiple activities or outputs that may require different types of skills to accomplish (Holmstrom and Milgrom, 1991). A hospital’s output includes many different components, such as managing a patient’s chronic illness, the
Report page
Limitations in Using Economic Theories to Predict

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Limitations in Using Economic Theories to Predict Behavioral Response

Report page
A Series of Tiered Absolute Thresholds May Be

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. A Series of Tiered Absolute Thresholds May Be Better Than One Absolute Threshold

An individual’s motivation and effort when faced with a goal greatly depend on that individual’s baseline performance. Economists and psychologists have described this phenomenon as a “goal gradient” (Heath, Larrick, and Wu, 1999). If baseline performance is far away from goal performance, the individual exerts little effort, because the g
Report page
Reducing the Time Lags Between Performance and

An Environmental Scan of Pay for Performance in the Hospital Setting: Final Report. Reducing the Time Lags Between Performance and Receipt of Incentive Can Help to Achieve Maximum Response

In economics, the principle of discounting is based on the fact that individuals value having a sum of money now more than sometime in the future, even after accounting for inflation. The concept of discounting and the use of a discount rate are well accepted in both accounting and economics. Studies have found, however, that individuals discount

Pages

Form Approved OMB# 0990-0379 Exp. Date 9/30/2020