What Role Does Efficiency Play in Understanding the Relationship Between Cost and Quality in Physician Organizations?

Relationship of pay-for-performance and provider pay

BACKGROUND

Policymakers and health care leaders search for a payment model to balance the interests of providers, patients, and payers. This has shifted reimbursement from a fee-for-service (FFS) to pay-for-performance (P4P) model. The FFS model of reimbursement may lead to provider overuse. The P4P model incentivizes quality, not quantity, of care. However, the payer's reimbursement shift to P4P has not affected compensation of individual providers.

OBJECTIVES

To explore the effects of payment compensation models on provider behavior and employment.

DATA SOURCES

CINAHL, Cochrane, and EBSCO databases were searched. To ensure accuracy, a PRISMA flow diagram was used. A thematic analysis was performed using 52 articles.

CONCLUSIONS

Four themes emerged: health care as an economic anomaly, the ability to incentivize value, ethics, and provider-employer-payer alignment. Basic economic principles are distorted in health care because of payment layers and competing goals. Although payment structure affects health care provider (HCP) performance, the correlation is not understood. There is a lack of knowledge on several key areas: 1) HCP behavioral research, 2) how employment may be influencing existing HCP attitudes and actions, 3) how nurse practitioners (NPs) differ from physicians, and 4) P4P outcome data. There is also a lack of literature involving NP's and reimbursement.

IMPLICATIONS FOR PRACTICE

Nurse practitioners must be included in compensation model research. Payment reform should address all individual HCP compensation. Reforms will be limited if focus remains on payer-organization reform and ignores HCP compensation. As HCPs, it is imperative to understand how payers reimburse services to establish guiding principles for equitable and ethical compensation negotiations.