Pay for Performance

Resident Grand Rounds

 

 

·        Pay for Performance is a new health policy initiative that seeks to link incentive payments with measurable quality goals for physicians

 

·        Pay for Performance has evolved from recent research that shows Americans are not receiving consistent, high quality medical care as well as the hope that health care cost containment can occur

 

·        Multiple Pay-for-Performance programs are currently underway, sponsored by both public and private efforts and can be found in hospital and ambulatory settings

 

·        Evaluation of  HMO-based Pay for Performance program on three indicators of quality – cervical cancer screening, mammography, and hemoglobin A1c testing

 

o       Pay-for-Performance groups only did significantly better in one area, cervical cancer screening

 

·        The Centers of Medicare and Medicaid Services (CMS) is sponsoring a large demonstration project in hospitals where bonuses are provided based on performance on quality measures in 5 conditions

 

o       Evaluation of this project reveals that Pay-for-Performance hospitals consistently performed better than control hospitals although results were modest

 

·        Challenges for Pay-for-Performance Programs:

o       How should bonuses be paid?

o       Should the current size and scope of Pay-for-Performance programs be changed?

o       How can programs ensure that there will be no selection bias against sicker or less adherent patients?

o       Should there be standard clinical areas and clinical measures?

o       Should there be negative consequences to ‘overuse’ of the health care system?

 

·        Despite the many challenges and modest results of Pay for Performance programs, they are becoming increasingly popular and will likely continue to proliferate in the near future