Unbiased Analysis of Today's Healthcare Issues
Background Do pay-for-performance (P4P) programs work? P4P programs pay paying providers (or health plans) more if they have better outcomes or follow specific best practices. Whether or not they lead to better outcomes has been much debated. However, many P4P programs implemented in the real world have been evaluated using a pre-post design which could…
There have been many pay-for-performance (P4P) programs that have been implemented to attempt to improve quality and reduce cost. The vast majority of these programs have not been able to demonstrate large or even any improvement in quality or cost. Some researchers claim that these programs have not worked due to the size of the…
Does Medicaid use pay-for-performance (P4P) for providers? If so, how does it work? And does it affect quality and cost? These are the questions of interest to Rosenthal et al. (2015) in their study of P4P programs in Alabama, Minnesota, and Pennsylvania. Although all three focus on physicians, the Alabama program is a “medical home ”…
In pay-for-performance (P4P) or value-based purchasing (VBP) schemes, health care provider reimbursement rates depend on performance. Physicians can receive bonuses for following best practices, and hospitals can increase reimbursement rates from Medicare if they improve clinical processes and patient satisfaction. As an economist, rewarding good performance with financial payments makes perfect sense. Or does it?…
General Practitioners (GPs) in the UK NHS are paid a mixture of capitation, lump sum allowances, and a pay-for-performance bonus. The P4P element, the Quality and Outcomes Framework (QOF), rewards GPs according to their performance on a large number of indicators. QOF payments represented up to 20% of GPs ’ income in the first year…
Ontario implemented a physician pay-for-performance (P4P) scheme in 2002. This P4P framework was a jointly agreed upon by the Ontario government and the Ontario Medical Association. The Ontario P4P program is described in Hurley, DeCicca and Buckley (2013) in more detail below: [Ontario’s P4P program] targets performance bonuses on effective preventive services whose rates of provision were…
Why do physician practice patterns differ so much? One cause of the regional variation the utilization of medical care is due to regional variation in patient health status. Maynard, however, states that variation in patient health is not a primary cause of regional variation in the utilization of medical services. He cites an article by…
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…
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,…
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.…