Unbiased Analysis of Today's Healthcare Issues
At a recent AcademyHealth presentation, Cheryl Damberg discussed her research to design a P4P program for implementation for Integrated Healthcare Association (IHA). One thing I noticed about the presentation was that smaller provider groups had patients with lower risk scores (i.e., healthier patients). Is it really the case that small providers treat much healthier patients?…
“In January 2009 Blue Cross Blue Shield of Massachusetts launched a new provider payment system called the Alternative Quality Contract that exemplifies the type of experimentation with novel payment models that the Affordable Care Act encourages. The Alternative Quality Contract is a modified global payment model in which annual payments to medical groups are linked to a per member per month budget.” Today I…
As part of health reform, Medicare is looking to institute value-based purchasing or pay-for-performance programs in a number of settings. In fact, in my work for Acumen, I have worked on a number of these initiatives (e.g., P4P for physician efficiency profiling, implementing a VBP system in home health). Medicare, however, isn’t the only…
On the importance of Nursing homes: “More than 1.5 million people reside in U.S. nursing homes at a cost of more than $120 billion per year (Kaiser Family Foundation, 2007). Medicaid is the majority payer of nursing home services, giving indigent people access to nursing home care by directly reimbursing facilities for the care of…
Survey Results A 2004 poll of a sample of 400 randomly selected physicians found the following: 71% of physicians supported payments based on the quality of care they provide, over 60% of physicians thought that hospitals should also be paid based on the quality of care they provide, Almost 90% of physicians thought that the…
More than 3 million frail and disabled individuals rely on nursing home services in any given year. About half of these individuals consider the nursing home to be their primary place of residence. Nursing home quality, however, has often been called into question. Some experts believe pay-for-performance schemes will improve nursing home quality. Today, I…
The call for the adoption of value based purchasing programs has gained in popularity in recent years. These programs give physicians, hospitals, or other providers bonuses (or penalties) depending on the quality of care their patients receive. The Affordable Care Act (ACA a.k.a Health Reform) includes provisions to establish a VBP program for hospital payments…
The Health Reform (ACA) legislation mandated Medicare establish a hospital value-based purchasing (VBP) program by 2012. In fact, the Deficit Reduction Act of 2005 already authorized Medicare to develop a plan to implement VBP for 2009. How will they do this? A CMS report from 2007 sheds some light on the topic. Since 2005,…
“Reinforcement theory from psychology literature suggests that changing behavior by incentives is easiest when the linkage between behavior and incentive (or positive reinforcer) is clearest, and the reinforcers are placed in routine. ” Does that mean that more frequent P4P evaluations and payments are optimal? More frequent physician performance payments increase administrative cost, but may…
“Pay-for-performance (P4P) is one of the primary tools used to support healthcare delivery reform. Substantial heterogeneity exists in the development and implementation of P4P in health care and its effects.” Today, I review a paper which summarizes evidence, obtained from studies published between 1990-2009, concerning P4P effects. Measure Effectiveness Which types of measures produce the…