Pay For Performance Is An Incentive Program

Pay-for-performance payment model – healthcare payment systems that offer financial rewards to providers who achieve, improve or excel their performance on specified quality of care and cost measures (HealthCare Incentives Improvement Institute, N.D.)

In 2012, the ACA found an excessive amount of readmissions of patients that were hospitalized within 30 days for the same medical conditions. This factor viewed under the ACA as a quality issue and CMS implemented value-based incentive payments based on performance in a set of quality measures. The plan is to implement a pay for performance (P4P) in formulas used by Medicare to reimbursement providers. “The objective is to link reimbursement to quality and efficiency as an incentive to improve the quality of health care, as well as reduce system-wide costs” (Shi and Singh, 2015). In addition to the P4P, nonprofit hospitals also focus on continual improvement, data and cost containment throughout the organization (Adamopoulos,

According to the United State’s Centers for Disease Control report in 2003, 86% of Americans over 65 have one cardiovascular disease, arthritis, asthma, cancer, chronic pulmonary disease or diabetes and the cost for treatment of these will create a drain on an already taxed health care insurance agency (Implications for Health….Workers, 2003). Although the government has attempted to curb the cost of health care with The Tax Equinity and Fiscal Responsibility Act, The Prospective Payment System, HMOs and DRGs they were not able to demonstrate a high rate of return that has been associated with bundling of payments, pay-for-performance and shared savings programs (Williams & Torrens, 2010). In addition, as the population ages and requires additional services, the need to adjust physician reimbursement model will have to accommodate the new trend. In the 1990, physician services reached a high of 23 percent of Medicare spending and in 1992 Medicare initiated a resource based relative-value scale were implemented to adjust for geographic cost/price variations but CMS is now moving toward pay-for-performance to link the patients overall healthcare to outcomes (Williams & Torrens,

Pay for performance has been a topic debated for many years in a wide range of professional settings as a way to increase employee productivity by basing their pay on the quality of the employee’s performance. Pay for Performance used within the medical community is defined as a payment system that offers financial rewards to medical professionals who meet or exceed specified benchmarks (“Pay-For”, 2009). Most approaches adjust the payments to physicians and hospitals on the basis of

The reason why physicians should be paid by the quality of their work is because it has the best impact on healthcare and patients. This is due to all the evidence based practices showing quality improves patient care due to quality being about safety, effectiveness, efficiency, timelines, patient centeredness, and equity. Not only is quality all about that, but it is also about correcting any flaws or mistakes, rather than denying and ignoring them, in order to move forward and keep improving. Moreover, quality impacts the underserved patients along with patients of all natures. For instance, Centers for Medicare and Medicate Services (CMS) developed several programs, such as the Value Based Purchasing program. These programs are meant to measure data to improve the quality in patient care by taking preemptive measures to prevent readmissions, heart attacks, and pneumonia. Additionally, the programs lower costs not only for patients, but for

Performance-based health care and evidence-based evaluation must be aligned with the interests of patients to ensure the disposition is appropriate, timely, and patients are treated in an ethical manner before considering performance-based incentives (Wharam et al., 2012). If these ethical and comprehensive quality measures are met, it is recommended that payers implement a compensation system based on the genuine data from the quality of care patients receive to reward healthcare providers (Wharam et al., 2012).

Studies of reimbursement programs show more emphasis on penalties rather than incentives (Roland & Dudley, 2015). The strategic plan of the institution in this paper is to provide optimal patient care at the lowest cost. Executive leadership understands this plan and supports the importance of the pay for performance programs. The communication to all leaders on the pay for performance benefits is extremely beneficial in implementing change related to these projects. When the quality department works to develop new processes associated with pay for performance metrics, staff is more willing to support

Demonstrable metrics of patient improvement due to physician proficiency, or patient deterioration due to preventable circumstances, must be established and recorded in an unbiased manner. Improvements, or lack thereof, must be recorded and assessed in order to implement alterations to the pay-for-performance model at THR (Ryan & Blustein, 2012).

Hospital and physician arrangements are increasingly becoming a desirable integration model as health care organizations are restructuring their methods to care in the pay-for-performance environment. “Governmental and commercial pay for performance (“P4P”) programs indicate that compensating hospitals for quality care is becoming more common.” (Johnson, CFA,

The pay for performance model of reimbursement is a way of tracking the quality of care patients are receiving and outcomes. The reimbursement/reward or lack thereof is a direct reflection on the care patients are receiving.

The pay for performance model encourages physicians and hospitals to have a clear and accurate picture of what is required and expected of them. This is often done by setting clear concise goals and measuring care that was provided. Researchers believe that the factors that are to be measured need to be simple. Making them simple

When you hear the term “Pay for Performance”, you generally think of a car salesman or maybe a professional sports athlete, but what you’re probably not thinking of is a physician or healthcare organization. Pay for performance isn’t necessarily a new concept, as it has been around in some fashion or the other since its inception in the early 2000s. (James, 2012, para. 6) However, due to complex nature of the healthcare sector, pay for performance systems have evolved throughout the years.

Armour, B. S. Et al., explained that explicit financial incentive may be helpful if the purpose is to control the health care resource use, however such outcome may compromise the quality of care. Meanwhile, if the objective of certain incentive concentrates on better quality rather than cost control, the decision makers can make adjustment to meet this goal. For example, Alexander, J. A. Et al., approve that combining the public “quality performance reporting” with pay for performance programs will gain better health outcomes by increasing information transparency. However, this may lead to another extreme situation that physicians might avoid to perform high-risk treatment because they do not want to have a negative score in their public quality performance report, which might be recognized as bad reputation. If large amount of physicians switch their major field due to risk-aversion, the access to these kind of treatment or care may be reduced after a certain period of time, causing corresponding negative health care outcome. Therefore, how to mix the public quality performance report with pay for performance programs might be a subtle and critical

Performance measurement is vital to improving health care and supporting the success of health reform. Effective performance measures are a foundation of informed decision making by consumers, of payment reform, and of information that providers and patients can use to transform care. This critical review examines an article that magnify the accessibility of performance measure to improve care The link between demonstrated performance and economic success, which began more than a decade ago, will move from the border to the center of healthcare. Health care organizations, and individual physicians, will have to respond. Now is the time for them to prepare.

Pay-for-performance has the potential to positively and negatively impact healthcare and patient outcomes. A positive aspect of the system includes transparency in the care received and patient outcomes. In turn, this impacts nurses working in coordination with