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PubMed2005

Pay for performance: will your hospital be ready?

With increased payment-or, in some cases, even the ability to contract with a payer-likely to be tied to the achievement of quality measures, providers need to: work with physicians in developing associated care delivery protocols, establish compliance mechanisms that are acceptable to clinicians and meet appropriate regulatory and legal standards.

Aged↗
PubMed2005

Pay for performance and the hospital quality initiative.

This paper describes the history of the Hospital Quality Initiative (HQI) and describes plans that the Centers for Medicare and Medicaid Services (CMS) have for this data set. There are suggestions on how to improve physician acceptance of these benchmarks and how an institution can improve compliance rates with the data elements. There is also a discussion with respect to weaknesses and strengths of HQI. The advantages occuring to both the patient and physician when the physician participates in the HQI initiative are emphasized.

Benchmarking↗
PubMed2005

Putting smart money to work for quality improvement.

OBJECTIVE: To investigate the effects of paying physicians for performance on quality measures of diabetes care when combined with other care management tools. DATA SOURCES/STUDY SETTING: In 2001, a managed care organization in upstate New York designed and implemented a pilot program to financially reward doctors for the quality of care delivered to diabetic patients. In addition to paying a performance bonus, physicians were also supplied with a diabetic registry and met in groups to discuss progress in meeting goals for diabetic care. Primary data on diabetes care at the patient level were collected from each physician during the 8-month period, April 2001-January 2002. STUDY DESIGN: Physicians were scored on individual process and outcome measures of diabetes care on three separate occasions; these individual scores were combined into a composite score on which the financial reward was allocated. The study design is pre/post for the patients whose physicians participated in the performance pay program. The control group is a large sample of the health plan's diabetic members. DATA COLLECTION: Data on patient outcomes were self-reported by physicians participating in the study. These data were audited with spot checks of medical charts. Data for the control group were collected as part of the health plan's annual HEDIS data collection. PRINCIPAL FINDINGS: Physicians and patients achieved significant improvement on five out of six process measures, and on two out of three outcome measures (HbA1c control and LDL control). Thirteen out of 21 physicians improved their average composite score enough to earn some level of financial reward. Of the eight physicians not receiving any of the three levels of reward, six improved their composite scores. CONCLUSIONS: Financial incentives for physicians, bundled with other care management tools, led to improvement on objectively measured quality of care for diabetic patients. Self-selection by physicians into the pay pilot and the small sample size of participating physicians limit the generalizability of the results.

Case-Control Studies↗
PubMedDate not supplied

Using compensation to improve primary care.

Progressive primary care networks are now placing significant portions of physician salaries at risk by linking compensation to quantifiable measures such as net medical revenue (collections), reduced practice expenses, cost and utilization, quality of care and patient satisfaction. For most networks, a combination of productivity increases and expense reductions are critical to ensure financial survival. This case study illustrates how one network's unique incentive compensation program targeted higher productivity levels by incentivizing desirable behaviors.

Efficiency, Organizational↗