Pay-for-performance (P4P) may be better at improving documentation of outcomes rather than actually improving outcomes. Farmer, Black and Bonow give the following example: Beginning in the fourth quarter of 2008, [CMS] ceased to reimburse for costs due to selected preventable adverse events, including patient safety indicator 5 (PSI-5) (leaving a foreign object in the body [...]
Read the rest of this entry »Archive for the 'Quality' Category
Will missing data affect physician P4P scores?
The answer is yes, but maybe not as much as you may thought. A paper by Ryan and Bao use data from a randomized controlled trial (RCT) called IMPACT (Improving Mood-Promoting Access to Collaborative Treatment) to determine if errors in physician quality profiling are due mostly to random variation or missing data. For this report, [...]
Read the rest of this entry »How Missing Data affects Physicians’ P4P Bonuses
Pay-for-performance programs often offer bonuses (or penalties) for physicians, hospitals and other providers based on the quality of care patients receive. Measuring quality of care, however, is often difficult. For chronic conditions, for instance, many patients eligible for outcome measures may be lost to follow-up. This issue can potentially affect provider evaluations and bonus payments. [...]
Read the rest of this entry »P4P in Australia
Pay for performance (P4P) is the latest rage in healthcare quality monitoring. Paying physicians more who provide high quality care makes sense intituitvely. The U.S. isn’t the only country to hop on the P4P bandwagon. In 2001, the Australian government initiated a financial incentive program for “improved management of diseases such as asthma and diabetes [...]
Read the rest of this entry »Baskets of Care
What are the best practices for providing care for a specific condition? This question is not easy to answer. Further, the best practices for treating the average patient may differ from the best practice for treating certain other types of patients; particularly when a patient suffers from multiple conditions simultaneously. Despite these challenges, this information [...]
Read the rest of this entry »The Effect of Medicaid P4P on Nursing Home Quality
Over 10 million Americans need long-term services and supports to assist them in life’s daily activities. Of these, 1.6 million reside in a nursing home. Nursing home care, however, is expensive ($74,800 per year) and and quality is highly variable. To improve the quality of care, many states have begun adopting pay-for-performance (P4P) programs for nursing homes. Between [...]
Read the rest of this entry »Effect of Nursing Home Ownership on Quality
Do non-profit nursing home provide better quality than for-profit nursing homes? Generally, for-profit nursing homes appear to have better quality measures, but this could be due to the fact that non-profit nursing homes act as a safety net, whereas non-profit nursing homes treat sicker patients. Today, I look at Grabowski et al. (2012)‘s attempt to [...]
Read the rest of this entry »P4P and Diabetes Care
In April 2006, Ontario instituted the Diabetes Management Incentive (DMI) that increased payments to physicians that provided high-quality diabetes care. Did the incentive improve payments quality? According to a paper by Kantarevic and Kralj (2012), it turns out that the answer is yes, but the magnitude of the change depends on the type of physician. [...]
Read the rest of this entry »Nursing Home Quality
Typically, Nursing Home quality is measured using metrics from Nursing Home Compare. These metrics are calculated based on survey and certification processes and resident assessments from from the Minimum Data Set (MDS). These, however, are not the only quality metrics one can use. For instance, one can use consumer complaints as a measure of quality [...]
Read the rest of this entry »Effect of P4P on Hospital Profits
How do value-based purchasing programs affect hospitals’ bottom lines? This is a particularly important question as the Affordable Care Act (ACA) mandates that CMS reward high-quality, low-cost hospitals with bonuses and give financial penalties to low-quality, high-cost hospitals. In 2003, CMS began a pay-for-performance (P4P) demonstration. Using this demonstration as a natural experiment, Kruse et [...]
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