Financial incentives and mortality: taking pay for performance a step too far

2016 ◽  
Vol 26 (2) ◽  
pp. 164-168 ◽  
Author(s):  
Kiran Gupta ◽  
Robert M Wachter ◽  
Allen Kachalia
Keyword(s):  
Financial Incentives ◽  
Pay For Performance

scholarly journals Pay-for-Performance

2016 ◽  
Vol 74 (1) ◽  
pp. 3-78 ◽  
Author(s):  
Adam A. Markovitz ◽  
Andrew M. Ryan
Keyword(s):  
Financial Incentives ◽  
Pay For Performance ◽  
Organizational Size ◽  
Physician Practices ◽  
Marginal Costs ◽  
Staffing Levels ◽  
Physician Performance ◽  
Teaching Status ◽  
And Gender ◽  
Program Characteristics

Research on the effects of pay-for-performance (P4P) in health care indicates largely disappointing results. This central finding, however, may mask important heterogeneity in the effects of P4P. We conducted a literature review to assess whether hospital and physician performance in P4P vary by patient and catchment area factors, organizational and structural capabilities, and P4P program characteristics. Several findings emerged: organizational size, practice type, teaching status, and physician age and gender modify performance in P4P. For physician practices and hospitals, a higher proportion of poor and minority patients is consistently associated with worse performance. Other theoretically influential characteristics—including information technology and staffing levels—yield mixed results. Inconsistent and contradictory effects of bonus likelihood, bonus size, and marginal costs on performance in P4P suggest organizations have not responded strategically to financial incentives. We conclude that extant heterogeneity in the effects of P4P does not fundamentally alter current assessments about its effectiveness.

scholarly journals BPH Procedural Treatment: The Case for Value-Based Pay for Performance

2008 ◽  
Vol 2008 ◽  
pp. 1-6 ◽  
Author(s):  
Mark Stovsky ◽  
Irina Jaeger
Keyword(s):  
Financial Incentives ◽  
Positive Reinforcement ◽  
Large Scale ◽  
Pay For Performance ◽  
Free Market ◽  
Therapy Outcomes ◽  
Public And Private ◽  
Provider Payment ◽  
Traditional Service ◽  
Low Performance

The concept of “pay for performance” (P4P) applied to the practice of medicine has become a major foundation in current public and private payer reimbursement strategies for both institutional and individual physician providers. “Pay for performance” programs represent a substantial shift from traditional service-based reimbursement to a system of performance-based provider payment using financial incentives to drive improvements in the quality of care. P4P strategies currently embody rudimentarystructureandprocess(as opposed tooutcomes) metrics which set relatively low-performance thresholds. P4P strategies that align reimbursement allocation with “free market” type shifts in cognitive and procedural care using evidence-based data and positive reinforcement are more likely to produce large-scale improvements in quality and cost efficiency with respect to clinical urologic care. This paper reviews current paradigms and, using BPH procedural therapy outcomes, cost, and reimbursement data, makes the case for a fundamental change in perspective tovalue-based pay for performanceas a reimbursement system with the potential to align the interests of patients, physicians, and payers and to improve global clinical outcomes while preserving free choice of clinically efficacious treatments.

scholarly journals Using Financial Incentives to Improve Rates of Viral Suppression and Engagement in Care of Patients Receiving HIV Care at 3 Health Clinics in Louisiana: The Health Models Program, 2013-2016

2018 ◽  
Vol 133 (2_suppl) ◽  
pp. 75S-86S ◽  
Author(s):  
Antoine D. Brantley ◽  
Samuel Burgess ◽  
Jacquelyn Bickham ◽  
Deborah Wendell ◽  
DeAnn Gruber
Keyword(s):  
Financial Incentives ◽  
Viral Suppression ◽  
Minority Groups ◽  
Pay For Performance ◽  
Laboratory Data ◽  
The United States ◽  
Hiv Care ◽  
Engagement In Care ◽  
Supportive Services ◽  
Hiv Surveillance

Objectives: The Care and Prevention in the United States Demonstration Project aimed to reduce HIV/AIDS-related morbidity and mortality among racial/ethnic minority groups in 8 states. We evaluated Health Models, a pay-for-performance program piloted by the Louisiana Department of Health that used financial incentives to improve rates of engagement in HIV medical care and viral suppression among people with HIV. Methods: We enrolled 2076 patients of 3 urban HIV specialty clinics in Louisiana in the Health Models pay-for-performance program on a rolling basis from September 2013 through September 2016 and gave patients cash incentives to attend HIV medical appointments, achieve or maintain viral suppression, and link to supportive services. We used laboratory data collected from Louisiana’s HIV surveillance database to calculate rates of engagement in care and viral suppression during the first 24 months of enrollment. Results: Of the 2076 patients who enrolled, 1400 (67.4%) were non-Hispanic black, 1480 (71.3%) were male, 1175 (56.6%) were men who have sex with men, and 1371 (66.0%) reported an annual income of <$15 000. At enrollment, 1456 (70.1%) patients were engaged in HIV care, and 1197 (57.7%) patients were virally suppressed. After 12 months of enrollment, 1474 of 1783 (82.7%) patients were virally suppressed. Of enrolled patients with at least 12 or 24 months of follow-up data, 1299 of 1317 (98.6%) patients were engaged in care during their first 12 months of enrollment, and 995 of 1033 (96.3%) patients were engaged in care between 12 and 24 months of enrollment. Conclusions: During the implementation of Health Models, enrolled patients had increases in rates of viral suppression and achieved rates of engagement in care and viral suppression that were higher than national levels; however, additional supportive services may be needed to further reduce socioeconomic disparities in the rates of viral suppression.

scholarly journals Health Care Professionals’ Perceptions of Pay-for-Performance in Practice: A Qualitative Metasynthesis

2020 ◽  
Vol 57 ◽  
pp. 004695802091749
Author(s):  
Barbara Martin ◽  
Jacqueline Jones ◽  
Matthew Miller ◽  
Rachel Johnson-Koenke
Keyword(s):  
Health Care ◽  
Health Outcomes ◽  
Performance Measurement ◽  
Health Care Professionals ◽  
Financial Incentives ◽  
Pay For Performance ◽  
Research Process ◽  
Future Research ◽  
Limiting Factor ◽  
Integrate Health Care

Incentive-based pay-for-performance (P4P) models have been introduced during the last 2 decades as a mechanism to improve the delivery of evidence-based care that ensures clinical quality and improves health outcomes. There is mixed evidence that P4P has a positive effect on health outcomes and researchers cite lack of engagement from health care professionals as a limiting factor. This qualitative metasynthesis of existing qualitative research was conducted to integrate health care professionals’ perceptions of P4P in clinical practice. Four themes emerged during the research process: positive perceptions of the value of performance measurement and associated financial incentives; negative perceptions of the performance measurement and associated financial incentives; perceptions of how P4P programs influence the quality/appropriateness of care; and perceptions of the influence of P4P program on professional roles and workplace dynamics. Identifying factors that influence health care professionals’ perceptions about this type of value-based payment model will guide future research.

National Priorities Partnership Focus on Eliminating Overuse

2011 ◽  
Vol 26 (6) ◽  
pp. 485-490 ◽  
Author(s):  
David J. Ballard ◽  
Bradley M. Leonard
Keyword(s):  
Financial Incentives ◽  
Clinical Decision Making ◽  
Pay For Performance ◽  
Care Delivery ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Clinical Decision ◽  
The United States ◽  
Appropriate Use ◽  
Cardiac Revascularization

As one of several initiatives to transform health care delivery across the United States, the National Priorities Partnership has identified “eliminating overuse while ensuring the delivery of appropriate care” as a top priority. Cardiac revascularization procedures, including coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI), constitute one area of focus for reduction of overuse. Despite the multiyear development of clinical guidelines to define appropriate use of cardiac revascularization, substantial variability in the application of these procedures is observed. Concurrent data collection tools to support real-time clinical decision making regarding appropriateness are needed and can be used, along with financial incentives such as pay-for-performance programs and public reporting of performance information, to support more appropriate use of cardiac revascularization. Efforts to achieve more rational use of CABG and PCI should be made carefully and with the goal that patients receive the most appropriate and effective care.

scholarly journals Paying for improvements in quality: recent experience in the NHS in England

2014 ◽  
Vol 2 (1) ◽  
Author(s):  
Rachel Meacock ◽  
Søren Kristensen ◽  
Matt Sutton
Keyword(s):  
Financial Incentives ◽  
Best Practice ◽  
Pay For Performance ◽  
Financial Incentive ◽  
Health Care Systems ◽  
Cost Effective ◽  
Quality Improvement Initiative ◽  
Recent Experience ◽  
Large Patient ◽  
Care Systems

There is a long-term international trend towards linking payments more closely to providers’ performance. The US and England have been at the forefront of the design and introduction of such pay-for-performance (P4P) schemes. England’s experience is, however, likely to have greater salience for the Nordic countries’ health care systems due to the publicly funded finance structure. We review the development of five of England’s major schemes and summarise the available evidence on their impacts. These schemes are: the Quality and Outcomes Framework (QOF); Advancing Quality; the Commissioning for Quality and Innovation (CQUIN) framework; Best Practice Tariffs; and the newest ‘non-payment’ policies. Much of the evidence is limited by the non-experimental way in which the schemes have been introduced, with limited data available prior to the introduction of the schemes and no experimentally unexposed providers to serve as controls. Nonetheless, the existing evidence suggests that P4P can result in modest short-term improvements in the incentivised aspects of performance. There is little evidence of effort diversion, yet some to suggest positive spillovers of these schemes onto non-incentivised aspects of performance. While there is some evidence of gaming and inequitable consequences, these do not appear to be widespread. The gains that can accrue across large patient populations as a result of relatively small financial incentives mean that P4P schemes can be cost-effective. P4P programmes are likely to be most effective when introduced as a supporting part to a wider quality improvement initiative, and when results are published to encourage a reputational as well as a financial incentive for improvement. Though the accumulation of evidence to support P4P has not been systematic or especially robust, it remains a popular policy tool with decision-makers in England, with its reach set to increase further in the future.

Exploring the Effectiveness of a P4P Scheme from the Italian General Practitioners’ Perspective: A Replication Study

2020 ◽  
Author(s):  
MONICA GIANCOTTI ◽  
MARIANNA MAURO ◽  
FRANCESCO RANIA
Keyword(s):  
General Practitioners ◽  
Financial Incentives ◽  
Pay For Performance ◽  
Healthcare Providers ◽  
Implementation Process ◽  
Quality Of Healthcare ◽  
Successful Implementation ◽  
Performance Quality ◽  
Italian Context

Abstract Background A major problem of the primary healthcare systems is represented by the deficiencies in performance quality. Financial incentives can be used in order to improve the quality of healthcare. According to this, since 1993 many countries have introduced pay for performance reimbursement schemes to encourage practitioner behaviour to align with the specific objectives of the decision maker and to incentivize the provision of targeted services. In this context the study of Krauth et al. (2016) was the first in Europe to determine whether general practitioners would participate in a pay for performance programme and under what conditions. Our research replicates the German survey, adjusting it to the Italian context. This article explores whether financial incentives can improve the quality of healthcare from the perspective of general practitioners. The purposes were as follows: to assess the attitudes of Italian general practitioners towards the current remuneration scheme; to determine if they would participate in a pay for performance programme; and to analyse how such views vary among the groups of respondents. Methods Our tool for data collection was a questionnaire elaborated on the basis of a theoretical framework developed by Krauth et al. The questionnaires were distributed from September to December 2017. Results Results confirm that for a successful implementation of a quality-based compensation scheme, it is crucial to gain the acceptance and support of healthcare providers. Conclusions To ensure that healthcare providers can realistically achieve the programme’s targets, they should be involved in the implementation process. Our study offers useful information for developing an effectiveness remuneration scheme in Italy for general practice.

scholarly journals Understanding efficiency and the effect of pay-for-performance across health facilities in Tanzania

2020 ◽  
Vol 5 (5) ◽  
pp. e002326
Author(s):  
Peter Binyaruka ◽  
Laura Anselmi
Keyword(s):  
Technical Efficiency ◽  
Financial Incentives ◽  
Pay For Performance ◽  
Health Centre ◽  
Health Facilities ◽  
Care Hospital ◽  
Health Providers ◽  
Health Centres ◽  
Before And After ◽  
The Impact

BackgroundEnsuring efficient use and allocation of limited resources is crucial to achieving the UHC goal. Performance-based financing that provides financial incentives for health providers reaching predefined targets would be expected to enhance technical efficiency across facilities by promoting an output-oriented payment system. However, there is no study which has systematically assessed efficiency scores across facilities before and after the introduction of pay-for-performance (P4P). This paper seeks to fill this knowledge gap.MethodsWe used data of P4P evaluation related to healthcare inputs (staff, equipment, medicines) and outputs (outpatient consultations and institutional deliveries) from 75 health facilities implementing P4P in Pwani region, and 75 from comparison districts in Tanzania. We measured technical efficiency using Data Envelopment Analysis and obtained efficiency scores across facilities before and after P4P scheme. We analysed which factors influence technical efficiency by regressing the efficiency scores over a number of contextual factors. We also tested the impact of P4P on efficiency through a difference-in-differences regression analysis.ResultsThe overall technical efficiency scores ranged between 0.40 and 0.65 for hospitals and health centres, and around 0.20 for dispensaries. Only 21% of hospitals and health centres were efficient when outpatient consultations and deliveries were considered as output, and <3% out of all facilities were efficient when outpatient consultations only were considered as outputs. Higher efficiency scores were significantly associated with the level of care (hospital and health centre) and wealthier catchment populations. Despite no evidence of P4P effect on efficiency on average, P4P might have improved efficiency marginally among public facilities.ConclusionMost facilities were not operating at their full capacity indicating potential for improving resource usage. A better understanding of the production process at the facility level and of how different healthcare financing reforms affects efficiency is needed. Effective reforms should improve inputs, outputs but also efficiency.

scholarly journals Payment Incentives and Integrated Care Delivery: Levers for Health System Reform and Cost Containment

2011 ◽  
Vol 48 (4) ◽  
pp. 277-287 ◽  
Author(s):  
Holly Korda ◽  
Gloria N. Eldridge
Keyword(s):  
Health Care ◽  
Health System ◽  
Integrated Care ◽  
Financial Incentives ◽  
Pay For Performance ◽  
Care Delivery ◽  
System Reform ◽  
Patient Centered ◽  
Health System Change ◽  
Payment Methods

The Patient Protection and Affordable Care Act encourages use of payment methods and incentives to promote integrated care delivery models including patient-centered medical homes, accountable care organizations, and primary care and behavioral health integration. These models rely on interdisciplinary provider teams to coordinate patient care; health information and other technologies to assure, monitor, and assess quality; and payment and financial incentives such as bundling, pay-for-performance, and gain-sharing to encourage value-based health care. In this paper, we review evidence about integrated care delivery, payment methods, and financial incentives to improve value in health care purchasing, and address how these approaches can be used to advance health system change.

scholarly journals Impact of financial incentives for primary care to give long acting reversible contraceptive advice

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
R Ma ◽  
E Cecil ◽  
R French ◽  
A Bottle ◽  
S Saxena
Keyword(s):  
Primary Care ◽  
Financial Incentives ◽  
Primary Care Physicians ◽  
Pay For Performance ◽  
Age Groups ◽  
Step Change ◽  
Practice Research ◽  
Care Practice ◽  
Clinical Practice Research Datalink ◽  
Long Acting

Abstract Background Long acting reversible contraceptives (LARC) are cost-effective but uptake remains poor even in high income settings. In 2009/10, a pay-for-performance (P4P) scheme in the United Kingdom was introduced for primary care physicians to offer advice about LARC to women attending for contraceptive care. We examined the equity and impact of this scheme on LARC uptake and abortions Methods We examined records of women aged 13 to 54 years registered with a primary care practice in the UK Clinical Practice Research Datalink from 2004/05 to 2013/14. We used interrupted time series analysis to examine trends in annual LARC and non-LARC hormonal contraception (NLHC) uptake and abortion rates, stratified by age, region and deprivation groups, before and after P4P was introduced in 2009/10. Results LARC uptake among women of all ages increased immediately after P4P with step change of 5.36 per 1,000 women (95% CI 5.26 to 5.45). Largest increase was in women aged 20 to 24 years (8.40, 8.34 to 8.47). NLHC uptake fell in all women with a step change of -22.9 (-24.5 to -21.2). Among LARC methods, contraceptive injection and implant had the greatest increase after P4P; step changes were 1.68 (1.67 to 1.70) and 1.64 (1.63 to 1.65) respectively. Abortion rates fell across all 12 regions in UK and in all women immediately after P4P with a step change of -2.28 (-2.99 to -1.57). The largest falls occurred in women aged 13 to 19 years (step change -5.04, -7.56 to -2.51) and women from the most deprived group (step change -4.40, -6.89 to -1.91). Conclusions Pay-for-performance scheme for primary care physicians to give LARC advice to women attending for contraception was associated with desirable impact and equity of LARC prescriptions and abortion. LARC uptake increased in women of all ages, especially 13-19 and 20-24 years. Abortion rates fell in all UK regions and age groups, particularly 13-19 and 20-24 years and those from deprived quintile. Key messages Pay-for-performance scheme for primary care practitioners to give LARC advice to women attending for contraception was associated with desirable impact and equity of LARC prescriptions and abortion. LARC uptake increased in women of all ages, especially 13-19 and 20-24 years. Abortion rates fell in all UK regions and age groups, particularly 13-19 and 20-24 years and those from deprived quintile.

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