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Brosig-Koch J, Hennig-Schmidt H, Kairies-Schwarz N, Kokot J, Wiesen D. A new look at physicians' responses to financial incentives: Quality of care, practice characteristics, and motivations. J Health Econ 2024; 94:102862. [PMID: 38401249 DOI: 10.1016/j.jhealeco.2024.102862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 01/26/2024] [Accepted: 01/31/2024] [Indexed: 02/26/2024]
Abstract
There is considerable controversy about what causes (in)effectiveness of physician performance pay in improving the quality of care. Using a behavioral experiment with German primary-care physicians, we study the incentive effect of performance pay on service provision and quality of care. To explore whether variations in quality are based on the incentive scheme and the interplay with physicians' real-world profit orientation and patient-regarding motivations, we link administrative data on practice characteristics and survey data on physicians' attitudes with experimental data. We find that, under performance pay, quality increases by about 7pp compared to baseline capitation. While the effect increases with the severity of illness, the bonus level does not significantly affect the quality of care. Data linkage indicates that primary-care physicians in high-profit practices provide a lower quality of care. Physicians' other-regarding motivations and attitudes are significant drivers of high treatment quality.
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Affiliation(s)
- Jeannette Brosig-Koch
- Otto von Guericke University Magdeburg and Health Economics Research Center (CINCH) Essen, Germany.
| | | | - Nadja Kairies-Schwarz
- Heinrich-Heine University Düsseldorf, Medical Faculty, Centre for Health and Society (chs) and German Diabetes Center, Leibniz Center for Diabetes Research, Germany.
| | - Johanna Kokot
- University of Hamburg and Hamburg Center for Health Economics, Germany.
| | - Daniel Wiesen
- University of Cologne, Department of Healthcare Management and Center for Social and Economic Behavior (C-SEB), Germany.
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Byrd JN, Cichocki MN, Chung KC. Plastic Surgeons and Equity: Are Merit-Based Incentive Payment System Scores Impacted by Minority Patient Caseload? Plast Reconstr Surg 2023; 152:534e-539e. [PMID: 36917743 DOI: 10.1097/prs.0000000000010406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND The Centers for Medicare and Medicaid Services introduced the Merit-based Incentive Payment System (MIPS) in 2017 to extend value-based payment to outpatient physicians. The authors hypothesized that the MIPS scores for plastic surgeons are impacted by the existing measures of patient disadvantage, minority patient caseload, and dual eligibility. METHODS The authors conducted a retrospective cohort study of plastic surgeons participating in Medicare and MIPS using the Physician Compare national downloadable file and MIPS scores. Minority patient caseload was defined as nonwhite patient caseload. The authors evaluated the characteristics of participating plastic surgeons, their patient caseloads, and their scores. RESULTS Of 4539 plastic surgeons participating in Medicare, 1257 participated in MIPS in the first year of scoring. The average patient caseload is 85% white, with racial/ethnicity data available for 73% of participating surgeons. In multivariable regression, higher minority patient caseload is associated with a lower MIPS score. CONCLUSIONS As minority patient caseload increases, MIPS scores decrease for otherwise similar caseloads. The Centers for Medicare and Medicaid Services must consider existing and additional measures of patient disadvantage to ensure equitable surgeon scoring.
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Affiliation(s)
- Jacqueline N Byrd
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School
- Center for Health Outcomes and Policy, University of Michigan
- Department of Surgery, University of Texas Southwestern Medical School
| | - Meghan N Cichocki
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School
| | - Kevin C Chung
- From the Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School
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Gettel CJ, Ling SM, Wild RE, Venkatesh AK, Duseja R. Centers for Medicare and Medicaid Services Merit-Based Incentive Payment System Value Pathways: Opportunities for Emergency Clinicians to Turn Policy Into Practice. Ann Emerg Med 2021; 78:599-603. [PMID: 34304917 PMCID: PMC8545831 DOI: 10.1016/j.annemergmed.2021.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Cameron J Gettel
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; National Clinician Scholars Program, Department of Internal Medicine, Yale School of Medicine, New Haven, CT.
| | - Shari M Ling
- Department of Health and Human Services, Centers for Medicare & Medicaid Services, Baltimore, MD
| | - Richard E Wild
- Centers for Medicare & Medicaid Services, Atlanta Regional Office, Atlanta, GA
| | - Arjun K Venkatesh
- Department of Emergency Medicine, Yale School of Medicine, New Haven, CT; Center for Outcomes Research and Evaluation, Yale School of Medicine, New Haven, CT
| | - Reena Duseja
- Department of Health and Human Services, Centers for Medicare & Medicaid Services, Baltimore, MD
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Crum E. Clinicians and payers expect to wait and see before embracing CMS MIPS value pathways. Am J Manag Care 2021; 27:SP245-SP246. [PMID: 34407363 DOI: 10.37765/ajmc.2021.88735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
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Affiliation(s)
- Vinay K Rathi
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston
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Johnston KJ, Hockenberry JM, Joynt Maddox KE. Physician Performance in the Medicare Merit-based Incentive Payment System-Reply. JAMA 2021; 325:309. [PMID: 33464333 DOI: 10.1001/jama.2020.22810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kenton J Johnston
- Department of Health Management and Policy, Saint Louis University, St Louis, Missouri
| | - Jason M Hockenberry
- Department of Health Policy and Management, Emory University, Atlanta, Georgia
| | - Karen E Joynt Maddox
- Washington University Center for Health Economics and Policy, Washington University School of Medicine, St Louis, Missouri
- Associate Editor, JAMA
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Khullar D, Schpero WL, Bond AM, Qian Y, Casalino LP. Association Between Patient Social Risk and Physician Performance Scores in the First Year of the Merit-based Incentive Payment System. JAMA 2020; 324:975-983. [PMID: 32897345 PMCID: PMC7489811 DOI: 10.1001/jama.2020.13129] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE The US Merit-based Incentive Payment System (MIPS) is a major Medicare value-based payment program aimed at improving quality and reducing costs. Little is known about how physicians' performance varies by social risk of their patients. OBJECTIVE To determine the relationship between patient social risk and physicians' scores in the first year of MIPS. DESIGN, SETTING, AND PARTICIPANTS Cross-sectional study of physicians participating in MIPS in 2017. EXPOSURES Physicians in the highest quintile of proportion of dually eligible patients served; physicians in the 3 middle quintiles; and physicians in the lowest quintile. MAIN OUTCOMES AND MEASURES The primary outcome was the 2017 composite MIPS score (range, 0-100; higher scores indicate better performance). Payment rates were adjusted -4% to 4% based on scores. RESULTS The final sample included 284 544 physicians (76.1% men, 60.1% with ≥20 years in practice, 11.9% in rural location, 26.8% hospital-based, and 24.6% in primary care). The mean composite MIPS score was 73.3. Physicians in the highest risk quintile cared for 52.0% of dually eligible patients; those in the 3 middle risk quintiles, 21.8%; and those in the lowest risk quintile, 6.6%. After adjusting for medical complexity, the mean MIPS score for physicians in the highest risk quintile (64.7) was lower relative to scores for physicians in the middle 3 (75.4) and lowest (75.9) risk quintiles (difference for highest vs middle 3, -10.7 [95% CI, -11.0 to -10.4]; highest vs lowest, -11.2 [95% CI, -11.6 to -10.8]; P < .001). This relationship was found across specialties except psychiatry. Compared with physicians in the lowest risk quintile, physicians in the highest risk quintile were more likely to work in rural areas (12.7% vs 6.4%; difference, 6.3 percentage points [95% CI, 6.0 to 6.7]; P < .001) but less likely to care for more than 1000 Medicare beneficiaries (9.4% vs 17.8%; difference, -8.3 percentage points [95% CI, -8.7 to -8.0]; P < .001) or to have more than 20 years in practice (56.7% vs 70.6%; difference, -13.9 percentage points [95% CI, -14.4 to -13.3]; P < .001). For physicians in the highest risk quintile, several characteristics were associated with higher MIPS scores, including practicing in a larger group (mean score, 82.4 for more than 50 physicians vs 46.1 for 1-5 physicians; difference, 36.2 [95% CI, 35.3 to 37.2]; P < .001) and reporting through an alternative payment model (mean score, 79.5 for alternative payment model vs 59.9 for reporting as individual; difference, 19.7 [95% CI, 18.9 to 20.4]; P < .001). CONCLUSIONS AND RELEVANCE In this cross-sectional analysis of physicians who participated in the first year of the Medicare MIPS program, physicians with the highest proportion of patients dually eligible for Medicare and Medicaid had significantly lower MIPS scores compared with other physicians. Further research is needed to understand the reasons underlying the differences in physician MIPS scores by levels of patient social risk.
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Affiliation(s)
- Dhruv Khullar
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
- Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
- NewYork-Presbyterian Hospital, New York, New York
| | - William L. Schpero
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Amelia M. Bond
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Yuting Qian
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
| | - Lawrence P. Casalino
- Division of Health Policy and Economics, Department of Population Health Sciences, Weill Cornell Medical College, New York, New York
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Johnston KJ, Wiemken TL, Hockenberry JM, Figueroa JF, Joynt Maddox KE. Association of Clinician Health System Affiliation With Outpatient Performance Ratings in the Medicare Merit-based Incentive Payment System. JAMA 2020; 324:984-992. [PMID: 32897346 PMCID: PMC7489823 DOI: 10.1001/jama.2020.13136] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Integration of physician practices into health systems composed of hospitals and multispecialty practices is increasing in the era of value-based payment. It is unknown how clinicians who affiliate with such health systems perform under the new mandatory Centers for Medicare & Medicaid Services Merit-based Incentive Payment System (MIPS) relative to their peers. OBJECTIVE To assess the relationship between the health system affiliations of clinicians and their performance scores and value-based reimbursement under the 2019 MIPS. DESIGN, SETTING, AND PARTICIPANTS Publicly reported data on 636 552 clinicians working at outpatient clinics across the US were used to assess the association of the affiliation status of clinicians within the 609 health systems with their 2019 final MIPS performance score and value-based reimbursement (both based on clinician performance in 2017), adjusting for clinician, patient, and practice area characteristics. EXPOSURES Health system affiliation vs no affiliation. MAIN OUTCOMES AND MEASURES The primary outcome was final MIPS performance score (range, 0-100; higher scores intended to represent better performance). The secondary outcome was MIPS payment adjustment, including negative (penalty) payment adjustment, positive payment adjustment, and bonus payment adjustment. RESULTS The final sample included 636 552 clinicians (41% female, 83% physicians, 50% in primary care, 17% in rural areas), including 48.6% who were affiliated with a health system. Compared with unaffiliated clinicians, system-affiliated clinicians were significantly more likely to be female (46% vs 37%), primary care physicians (36% vs 30%), and classified as safety net clinicians (12% vs 10%) and significantly less likely to be specialists (44% vs 55%) (P < .001 for each). The mean final MIPS performance score for system-affiliated clinicians was 79.0 vs 60.3 for unaffiliated clinicians (absolute mean difference, 18.7 [95% CI, 18.5 to 18.8]). The percentage receiving a negative (penalty) payment adjustment was 2.8% for system-affiliated clinicians vs 13.7% for unaffiliated clinicians (absolute difference, -10.9% [95% CI, -11.0% to -10.7%]), 97.1% vs 82.6%, respectively, for those receiving a positive payment adjustment (absolute difference, 14.5% [95% CI, 14.3% to 14.6%]), and 73.9% vs 55.1% for those receiving a bonus payment adjustment (absolute difference, 18.9% [95% CI, 18.6% to 19.1%]). CONCLUSIONS AND RELEVANCE Clinician affiliation with a health system was associated with significantly better 2019 MIPS performance scores. Whether this represents differences in quality of care or other factors requires additional research.
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Affiliation(s)
- Kenton J. Johnston
- Department of Health Management and Policy, College for Public Health and Social Justice, St Louis University, St Louis, Missouri
- Department of Health and Clinical Outcomes Research, St Louis University, St Louis, Missouri
| | - Timothy L. Wiemken
- Department of Health and Clinical Outcomes Research, St Louis University, St Louis, Missouri
| | - Jason M. Hockenberry
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Jose F. Figueroa
- Department of Health Policy and Management, T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Karen E. Joynt Maddox
- Cardiovascular Division, School of Medicine, Washington University in St Louis, St Louis, Missouri
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Tan SY, Melendez-Torres GJ, Pang T. Implementation of provider payment system reforms in the age of universal health coverage: a realist review of evidence from Asian developing countries. J Health Serv Res Policy 2019; 24:279-287. [PMID: 31007065 DOI: 10.1177/1355819619842305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective Launched to assist in achieving universal health coverage, provider payment reform (PPR) is one of the most important policy tools deployed to transform incentives within a health system that is plagued with allocative inefficiency and high out-of-pocket payments to one that is able to deliver basic services and be cost-efficient. However, the black box of such reform – that is, the contexts in which reform operates, the mechanisms by which it changes health systems and behaviour within health systems, and the outcome patterns that arise from – remains unexplored. This review aims to examine the implementation mechanisms underlying PPR in Asian developing countries. Methods A realist synthesis approach was employed to tease out the configurative elements of PPR in developing countries. A multimethod and retrospective search was conducted to locate the evidence. A programme theory and data extraction framework were developed. Data were analysed using thematic synthesis to inform an overarching realist synthesis, expressed as a set of synthesized context-mechanism-outcome configurations. Results This review found that the policy design of PPR, policy capacity, willingness of policy adoption at the local government level and provider autonomy are critical contextual factors that could trigger different policy mechanisms leading to either intended theoretical outcomes or perverse incentives. Conclusions Our findings, demonstrating the PPR implementation contexts and mechanisms that have worked in Asian countries, have implications in terms of policy learning for most developing countries that are contemplating rolling out similar reforms in the future.
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Affiliation(s)
- Si Ying Tan
- Researcher, Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
| | - G J Melendez-Torres
- Senior Lecturer, Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, UK
| | - Tikki Pang
- Visiting Professor, Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
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Allen T, Whittaker W, Kontopantelis E, Sutton M. Influence of financial and reputational incentives on primary care performance: a longitudinal study. Br J Gen Pract 2018; 68:e811-e818. [PMID: 30397016 PMCID: PMC6255225 DOI: 10.3399/bjgp18x699797] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 07/25/2018] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The Quality and Outcomes Framework has generated reputational as well as financial rewards for general practices because the number of quality points a practice receives is publicly reported. These rewards vary across diseases and practices, and over time. AIM To determine the relative effects on performance of the financial and reputational rewards resulting from a pay-for-performance programme. DESIGN AND SETTING Observational study of the published performance on 42 indicators of 8929 practices in England between 2004 and 2013. METHOD The authors calculated the revenue offered (financial reward, measured in £100s) and the points offered (reputational reward) per additional patient treated for each indicator for each practice in each year. Fixed-effects multivariable regression models were used to estimate whether the percentage of eligible patients treated responded to changes in these financial and reputational rewards. RESULTS Both the offered financial rewards and reputational rewards had small but statistically significant associations with practice performance. The effect of the financial reward on performance decreased from 0.797 percentage points per £100 (95% confidence interval [CI] = 0.614 to 0.979) in 2004, to 0.092 (95% CI = 0.045 to 0.138) in 2013. The effect of the reputational reward increased from -0.121 percentage points per quality point (95% CI = -0.220 to -0.022) in 2004, to 0.209 (95% CI = 0.147 to 0.271) in 2013. CONCLUSION In the short term, general practices were more sensitive to revenue than reputational rewards. In the long term, general practices appeared to divert their focus towards the reputational reward, once benchmarks of performance became established.
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Affiliation(s)
| | | | | | - Matt Sutton
- School of Health Sciences, University of Manchester, Manchester
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Affiliation(s)
| | | | - Mark Minchin
- National Institute for Health and Care Excellence, Manchester, United Kingdom
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Early F, Wellwood I, Kuhn I, Deaton C, Fuld J. Interventions to increase referral and uptake to pulmonary rehabilitation in people with COPD: a systematic review. Int J Chron Obstruct Pulmon Dis 2018; 13:3571-3586. [PMID: 30464439 PMCID: PMC6214582 DOI: 10.2147/copd.s172239] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Pulmonary rehabilitation (PR) reduces the number and duration of hospital admissions and readmissions, and improves health-related quality of life in patients with COPD. Despite clinical guideline recommendations, under-referral and limited uptake to PR contribute to poor treatment access. We reviewed published literature on the effectiveness of interventions to improve referral to and uptake of PR in patients with COPD when compared to standard care, alternative interventions, or no intervention. The review followed recognized methods. Search terms included "pulmonary rehabilitation" AND "referral" OR "uptake" applied to MEDLINE, EMBASE, CINAHL, PsycINFO, ASSIA, BNI, Web of Science, and Cochrane Library up to January 2018. Titles, abstracts, and full papers were reviewed independently and quality appraised. The protocol was registered (PROSPERO # 2016:CRD42016043762). We screened 5,328 references. Fourteen papers met the inclusion criteria. Ten assessed referral and five assessed uptake (46,146 patients, 409 clinicians, 82 hospital departments, 122 general practices). One was a systematic review which assessed uptake. Designs, interventions, and scope of studies were diverse, often part of multifaceted evidence-based management of COPD. Examples included computer-based prompts at practice nurse review, patient information, clinician education, and financial incentives. Four studies reported statistically significant improvements in referral (range 3.5%-36%). Two studies reported statistically significant increases in uptake (range 18%-21.5%). Most studies had methodological and reporting limitations. Meta-analysis was not conducted due to heterogeneity of study designs. This review demonstrates the range of approaches aimed at increasing referral and uptake to PR but identifies limited evidence of effectiveness due to the heterogeneity and limitations of study designs. Research using robust methods with clear descriptions of intervention, setting, and target population is required to optimize access to PR across a range of settings.
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Affiliation(s)
- Frances Early
- Centre for Self-Management Support, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK,
| | - Ian Wellwood
- Clinical Nursing Research Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Isla Kuhn
- Medical Library, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Christi Deaton
- Clinical Nursing Research Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Jonathan Fuld
- Centre for Self-Management Support, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK,
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Affiliation(s)
- Amol S Navathe
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ezekiel J Emanuel
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Kevin G Volpp
- Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Meier R, Muheim L, Senn O, Rosemann T, Chmiel C. The impact of financial incentives to improve quality indicators in patients with diabetes in Swiss primary care: a protocol for a cluster randomised controlled trial. BMJ Open 2018; 8:e023788. [PMID: 29961043 PMCID: PMC6042619 DOI: 10.1136/bmjopen-2018-023788] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION There is only limited and conflicting evidence on the effectiveness of Pay-for-Performance (P4P) programmes, although they might have the potential to improve guideline adherence and quality of care. We therefore aim to test a P4P intervention in Swiss primary care practices focusing on quality indicators (QI) achievement in the treatment of patients with diabetes. METHODS AND ANALYSIS This is a cluster-randomised, two-armed intervention study with the primary care practice as unit of randomisation. The control group will receive bimonthly feedback reports containing last data of blood pressure and glycated haemoglobin (HbA1c) measurements. The intervention group will additionally be informed about a financial incentive for each percentage point improved in QI achievement. Primary outcomes are differences in process (measurement of HbA1c) and clinical QI (blood pressure control) between the two groups. Furthermore, we investigate the effect on non-incentivised QIs and on sustainability of the financial incentives. Swiss primary care practices participating in the FIRE (Family Medicine ICPC Research using Electronic Medical Record) research network are eligible for participation. The FIRE database consists of anonymised structured medical routine data from Swiss primary care practices. According to power calculations, 70 of the general practitioners contributing to the database will be randomised in either of the groups. ETHICS AND DISSEMINATION According to the Local Ethics Committee of the Canton of Zurich, the project does not fall under the scope of the law on human research and therefore no ethical consent is necessary. Results will be published in a peer-reviewed journal. TRIAL REGISTRATION NUMBER ISRCTN13305645; Pre-results.
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Affiliation(s)
- Rahel Meier
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Leander Muheim
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Corinne Chmiel
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
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Affiliation(s)
- Catherine H MacLean
- From the Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York (C.H.M.); the University of Michigan Department of Internal Medicine and Institute for Healthcare Policy and Innovation and the Veterans Affairs Ann Arbor Center for Clinical Management and Research, Ann Arbor (E.A.K.); and the American College of Physicians, Philadelphia (A.Q.); and the ACP Performance Measurement Committee (C.H.M., E.A.K.). The other members of the Performance Measurement Committee were J. Thomas Cross, Jr., Eileen Barrett, Robert Centor, Andrew Dunn, Nick Fitterman, Bruce Leff, Ana María López, Mark Metersky, Robert Pendleton, Stephen D. Persell, Edmondo J. Robinson, Sameer D. Saini, Paul Shekelle, and from the American College of Physicians, Sarah Dinwiddie
| | - Eve A Kerr
- From the Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York (C.H.M.); the University of Michigan Department of Internal Medicine and Institute for Healthcare Policy and Innovation and the Veterans Affairs Ann Arbor Center for Clinical Management and Research, Ann Arbor (E.A.K.); and the American College of Physicians, Philadelphia (A.Q.); and the ACP Performance Measurement Committee (C.H.M., E.A.K.). The other members of the Performance Measurement Committee were J. Thomas Cross, Jr., Eileen Barrett, Robert Centor, Andrew Dunn, Nick Fitterman, Bruce Leff, Ana María López, Mark Metersky, Robert Pendleton, Stephen D. Persell, Edmondo J. Robinson, Sameer D. Saini, Paul Shekelle, and from the American College of Physicians, Sarah Dinwiddie
| | - Amir Qaseem
- From the Center for the Advancement of Value in Musculoskeletal Care, Hospital for Special Surgery, New York (C.H.M.); the University of Michigan Department of Internal Medicine and Institute for Healthcare Policy and Innovation and the Veterans Affairs Ann Arbor Center for Clinical Management and Research, Ann Arbor (E.A.K.); and the American College of Physicians, Philadelphia (A.Q.); and the ACP Performance Measurement Committee (C.H.M., E.A.K.). The other members of the Performance Measurement Committee were J. Thomas Cross, Jr., Eileen Barrett, Robert Centor, Andrew Dunn, Nick Fitterman, Bruce Leff, Ana María López, Mark Metersky, Robert Pendleton, Stephen D. Persell, Edmondo J. Robinson, Sameer D. Saini, Paul Shekelle, and from the American College of Physicians, Sarah Dinwiddie
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Affiliation(s)
- Raphael Rush
- From the Department of Medicine, University of Toronto, and Toronto Grace Hospital - both in Toronto
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Abstract
In 2017, the Centers for Medicare and Medicaid Services began requiring all eligible providers to participate in the Quality Payment Program or face financial reimbursement penalty. The Quality Payment Program outlines two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. For the first performance period beginning in January of 2017, the Centers for Medicare and Medicaid Services estimates that approximately 83 to 90 percent of eligible providers will not qualify for participation in an Advanced Alternative Payment Model and therefore must participate in the Merit-Based Incentive Payment System program. The Merit-Based Incentive Payment System path replaces existing quality-reporting programs and adds several new measures to evaluate providers using four categories of data: (1) quality, (2) cost/resource use, (3) improvement activities, and (4) advancing care information. These categories will be combined to calculate a weighted composite score for each provider or provider group. Composite Merit-Based Incentive Payment System scores based on 2017 performance data will be used to adjust reimbursed payment in 2019. In this article, the authors provide relevant background for understanding value-based provider performance measurement. The authors also discuss Merit-Based Incentive Payment System reporting requirements and scoring methodology to provide plastic surgeons with the necessary information to critically evaluate their own practice capabilities in the context of current performance metrics under the Quality Payment Program.
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Affiliation(s)
- Lee Squitieri
- Robert Wood Johnson Clinical Scholars Program, David Geffen School of Medicine, University of California Los Angeles, Los Angeles CA
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles CA
- U.S. Department of Veterans Affairs Greater Los Angeles Health System, Los Angeles CA
| | - Kevin C. Chung
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor MI
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Barnato AE, Moore R, Moore CG, Kohatsu ND, Sudore RL. Financial Incentives to Increase Advance Care Planning Among Medicaid Beneficiaries: Lessons Learned From Two Pragmatic Randomized Trials. J Pain Symptom Manage 2017; 54:85-95.e1. [PMID: 28450218 DOI: 10.1016/j.jpainsymman.2017.02.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 02/10/2017] [Accepted: 02/20/2017] [Indexed: 12/26/2022]
Abstract
CONTEXT Medicaid populations have low rates of advance care planning (ACP). Potential policy interventions include financial incentives. OBJECTIVE To test the effectiveness of patient plus provider financial incentive compared with provider financial incentive alone for increasing ACP discussions among Medicaid patients. METHODS Between April 2014 and July 2015, we conducted two sequential assessor-blinded pragmatic randomized trials in a health plan that pays primary care providers (PCPs) $100 to discuss ACP: 1) a parallel cluster trial (provider-delivered patient incentive) and 2) an individual-level trial (mail-delivered patient incentive). Control and intervention arms included encouragement to complete ACP, instructions for using an online ACP tool, and (in the intervention arm) $50 for completing the online ACP tool and a small probability of $1000 (i.e., lottery) for discussing ACP with their PCP. The primary outcome was provider-reported ACP discussion within three months. RESULTS In the provider-delivered patient incentive study, 38 PCPs were randomized to the intervention (n = 18) or control (n = 20) and given 10 patient packets each to distribute. Using an intention-to-treat analysis, there were 27 of 180 ACP discussions (15%) in the intervention group and 5 of 200 (2.5%) in the control group (P = .0391). In the mail-delivered patient incentive study, there were 5 of 187 ACP discussions (2.7%) in the intervention group and 5 of 189 (2.6%) in the control group (P = .99). CONCLUSION ACP rates were low despite an existing provider financial incentive. Adding a provider-delivered patient financial incentive, but not a mail-delivered patient incentive, modestly increased ACP discussions. PCP encouragement combined with a patient incentive may be more powerful than either encouragement or incentive alone.
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Affiliation(s)
- Amber E Barnato
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Lebanon, New Hampshire, USA
| | - Robert Moore
- Partnership Health Plan of California, Fairfield, California, USA
| | - Charity G Moore
- Dickson Advanced Analytics, Carolinas Healthcare System, Charlotte, North Carolina, USA
| | - Neal D Kohatsu
- Department of Health Care Services, State of California, Sacramento, California, USA
| | - Rebecca L Sudore
- San Francisco Veterans Medical Center, San Francisco, California, USA; Division of Geriatrics, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Marron-Stearns M. Embrace the MIPS Additional Payment Adjustment for Exceptional Performance. J AHIMA 2017; 88:30-33. [PMID: 29424520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Connole P. Finding a Path Through the Acronym Maze. Provider 2017; 43:14-22. [PMID: 29601715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Providers must deal with new payment models governed by multiple statutes.
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Shortell SM. Increasing Value: A Research Agenda for Addressing the Managerial and Organizational Challenges Facing Health Care Delivery in the United States. Med Care Res Rev 2016; 61:12S-30S. [PMID: 15375281 DOI: 10.1177/1077558704266768] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is growing consensus that the U.S. health care system is not producing value relative to the resources invested. Unwarranted variation exists in quality and outcomes of care and underutilization of both evidence-based medicine and evidence-management practices. To address these issues, this article calls for a broad-based social science approach focused on obtaining a greater understanding of change at the individual, group, organizational, and environmental levels as they influence each other. Specific examples and questions for research are suggested with regard to the redesign of care systems, enhancing learning and transferring knowledge, and creating effective financial incentives. The specific measurement, analysis, and study design issues involved in under-taking such a research agenda are discussed.
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Affiliation(s)
- José J Escarce
- University of California at Los Angeles and RAND Health, USA
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Abstract
This article evaluates the impact of the Centers for Medicare & Medicaid Services/Premier pay-for-performance demonstration project on performance improvement in three clinical areas in a multihospital health care system. The study compares a group of hospitals participating in this project against a control group of similar hospitals that did not participate. Although the incentives are extremely small, the findings show that participation in the pay-for-performance initiative had a significant impact on the rate and magnitude of performance improvement. The project led to marked improvement in the quality of clinical process delivery and accelerated the adoption of evidence-based practices.
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Affiliation(s)
- Stephen R Grossbart
- Quality Management, Catholic Healthcare Partners, 615 Elsinore Pl., Cincinnati, OH 45202, USA.
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Shalgian C, Bailey PV. The new Medicare physician reimbursement system: Building the Quality Payment Program. Bull Am Coll Surg 2016; 101:20-22. [PMID: 28937710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
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Abstract
Pay-for-performance is being applied at the physician level to stimulate improvements in quality of care and cost efficiency; however, little is known about how physicians will respond. We interviewed physicians exposed to a financial incentive program in California to identify possible barriers to the successful application of financial incentives by exploring physicians' opinions of and experiences with pay-for-performance programs. Reasons physicians cited for quality deficiencies included insurance coverage limitations and lack of patient compliance, time, and proper physician oversight. Physicians believe that they play a significant role and have a moderate to high degree of control over quality of care and that it is important to self-monitor. Physicians expressed the need for accurate and timely data, peer comparisons, and more patient time, staff support, and consultations with colleagues to successfully monitor and deliver quality care. Many support increased pay for delivering high-quality care but question measurement accuracy, bonus payment financing, and health plan involvement.
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Affiliation(s)
- Stephanie S Teleki
- RAND Health, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138, USA.
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Navathe AS, Sen AP, Rosenthal MB, Pearl RM, Ubel PA, Emanuel EJ, Volpp KG. New strategies for aligning physicians with health system incentives. Am J Manag Care 2016; 22:610-612. [PMID: 27662223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- Amol S Navathe
- University of Pennsylvania, Department of Medical Ethics and Health Policy, 1108 Blockley Hall, University of Pennsylvania, Philadelphia, PA 19104. E-mail:
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Abstract
Not-for-profit hospitals are complex organizations and, therefore, may face unique challenges in responding to financial incentives for quality. In this research, we explore the types of behavioural changes made by not-for-profit Michigan hospitals in response to a pay-for-performance system for quality. We also identify factors that motivate or facilitate changes in effort. We apply a conceptual framework based on agency theory to motivate our research questions. Using data derived from structured interviews and surveys administered to 86 hospitals participating in a pay-for-performance system, we compare hospitals reporting and not reporting behavioural changes. Separate analyses are performed for hospitals reporting structure-related changes and hospitals reporting process-related changes. Our findings confirm that hospitals respond to incentive payments; however, our findings also reveal that hospital responses are not universal. Rather, involvement by boards of trustees, willingness to exert leverage with physicians, and financial and competitive motivations are all associated with hospitals' behavioural responses to incentives. Results of this research will help inform payers and hospital managers considering the use of incentives about the nature of hospitals' responses.
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Affiliation(s)
- Kristin L Reiter
- Department of Health Policy and Administration, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7411, USA.
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Bloor K, Maynard A, Freemantle N. Variation in activity rates of consultant surgeons and the influence of reward structures in the English NHS. J Health Serv Res Policy 2016; 9:76-84. [PMID: 15099454 DOI: 10.1258/135581904322987481] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives: To explore variation in the National Health Service (NHS) activity rates of consultant surgeons, and examine whether activity is dependent upon the type of contract held and/or bonus payments, after accounting for age and other consultant and hospital characteristics. Methods: NHS Hospital Episode Statistics (HES) for England were used in combination with workforce data in five surgical specialties in 1998/99 and 1999/2000. Descriptive statistics were used to explore variation in activity rates. A multi-level model was used to analyse the relationship between NHS contract and bonus payments, and activity. Results: There is considerable variation in activity rates of English NHS consultant surgeons, with and without adjustment for casemix. Interquartile variation shows that the top 25% of consultants have activity rates 60 to 85% higher than the bottom 25%. A multi-level model indicates that consultant surgeons with a 'maximum part-time' contract have significantly higher activity rates than those with a full time contract (129 more finished consultant episodes (FCEs) per year, 95% CI 97-160). Consultant surgeons who hold discretionary salary points undertake significantly more activity than those without (95 FCEs, 95% CI 62-128). Those with a distinction award (a type of bonus payment) have a tendency towards higher activity rates, but this does not reach statistical significance (48 FCEs, 95% CI -4 to 103). Conclusions: 'Maximum part-time contract' status is associated with higher absolute activity rates among NHS surgeons. Rich data sources like HES merit careful exploration and increased use as an essential first step in measuring and managing variations in specialists' performance.
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Affiliation(s)
- Karen Bloor
- Department of Health Sciences, Alcuin College, University of York, York, UK
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Dyer C. GP struck off for making false claims under quality and outcomes framework. BMJ 2016; 353:i3334. [PMID: 27302317 DOI: 10.1136/bmj.i3334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mooney H. Incentives paid to GPs to improve healthcare have no effect on mortality, study finds. BMJ 2016; 353:i2882. [PMID: 27197664 DOI: 10.1136/bmj.i2882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kristensen SR, Bech M, Lauridsen JT. Who to pay for performance? The choice of organisational level for hospital performance incentives. Eur J Health Econ 2016; 17:435-442. [PMID: 25860814 DOI: 10.1007/s10198-015-0690-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Accepted: 03/25/2015] [Indexed: 06/04/2023]
Abstract
Financial incentives for quality improvement in hospital care [known as pay for performance (P4P)] can be directed to either the hospital level or redistributed to the department level. Theoretically, performance payments distributed to lower organisational levels are more effective in increasing performance than payments directed to the hospital level, but the empirical evidence for this expectation is scarce. This paper compares the performance of hospital departments at hospitals that do and do not redistribute performance payments to the department level. We study a Danish P4P scheme to provide patients with case managers. Applying difference in differences analysis, we estimate a 5 percentage points higher performance at hospital departments that are subject to a direct financial incentive. Our results suggest that payers can improve the effectiveness of P4P payments by distributing payments to the department level rather than the hospital level.
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Affiliation(s)
- Søren Rud Kristensen
- Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Oxford Road, Manchester, M13 9PL, UK.
- COHERE - Centre of Health Economics Research, Department of Business and Economics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.
| | - Mickael Bech
- COHERE - Centre of Health Economics Research, Department of Business and Economics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Jørgen T Lauridsen
- COHERE - Centre of Health Economics Research, Department of Business and Economics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
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Self R, Coffin J. Modified Stage 2 and Stage 3 Meaningful Use for Eligible Providers: Performance Metrics, Reporting Period Lengths, and Hardship Exemptions. J Med Pract Manage 2016; 31:332-335. [PMID: 27443051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In October 2015, the Centers for Medicare & Medicaid Services released its final rule on the new guidelines for alterations to the long-standing EHR Incentive Program. These Modified Stage 2 and upcoming Stage 3 Meaningful Use Rules were developed in response to provider and organizational feedback during the last few years. This article provides a comprehensive overview for the new rules as they relate to Medicare and Medicaid Eligible Providers. Reporting deadlines for previous calendar year compliance and the basic criteria for automatic provider hardship exemptions to avoid reimbursement penalties also are discussed.
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Abstract
OBJECTIVE To assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives. DATA SOURCES/STUDY SETTING Existing literature (gray and peer-reviewed) on measuring patient experience and patient-reported outcomes, identified from Medline and Cochrane databases; evaluations of pay-for-performance programs in the United States, Europe, and the Commonwealth countries. STUDY DESIGN/DATA COLLECTION We analyzed (1) studies of pay-for-performance, to identify those including metrics for patient experience, and (2) studies of patient experience and of patient-reported outcomes to identify evidence of influence on clinical practice, whether through public reporting or private reporting to clinicians. PRINCIPAL FINDINGS First, we identify four forms of "patient-reported information" (PRI), each with distinctive roles shaping clinical practice: (1) patient-reported outcomes measuring self-assessed physical and mental well-being, (2) surveys of patient experience with clinicians and staff, (3) narrative accounts describing encounters with clinicians in patients' own words, and (4) complaints/grievances signaling patients' distress when treatment or outcomes fall short of expectations. Because these forms vary in crucial ways, each must be distinctively measured, deployed, and linked with financial incentives. Second, although the literature linking incentives to patients experience is limited, implementing pay-for-performance systems appears to threaten certain patient-valued aspects of health care. But incentives can be made compatible with the outcomes patients value if: (a) a sufficient portion of incentives is tied to patient-reported outcomes and experiences, (b) incentivized forms of PRI are complemented by other forms of patient feedback, and (c) health care organizations assist clinicians to interpret and respond to PRI. Finally, we identify roles for the public and private sectors in financing PRI and orchestrating an appropriate balance among its four forms. CONCLUSIONS Unless public policies are attentive to patients' perspectives, stronger financial incentives for clinicians can threaten aspects of care that patients most value. Certain policy parameters are already clear, but additional research is required to clarify how best to collect patient narratives in varied settings, how to report narratives to consumers in conjunction with quantified metrics, and how to promote a "culture of learning" at the practice level that incorporates patient feedback.
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Affiliation(s)
- Mark Schlesinger
- Department of Health Policy and ManagementYale University School of Public HealthRoom 304 LEPH 60 College StNew HavenCT 06520
| | - Rachel Grob
- Center for Patient PartnershipsUW Law SchoolUniversity of Wisconsin‐MadisonMadisonWI
- Department of Family MedicineUW Medical SchoolUniversity of Wisconsin‐MadisonMadisonWI
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Affiliation(s)
| | - Kevin G Volpp
- LDI Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia3Center for Health Equity and Promotion, Cresencz VA Medical Center, Philadelphia, Pennsylvania
| | - Allan S Detsky
- Institute of Health Policy Management and Evaluation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada5Department of Medicine, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
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Affiliation(s)
- Miles B Mack
- Royal College of General Practitioners Scotland, Edinburgh EH2 1JX, UK
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Sorrel AL. SGR Is Gone. Now What? Tex Med 2015; 111:57-62. [PMID: 26360341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Physicians will have to prepare to participate in one of the new payment systems that will replace Medicare's Sustainable Growth Rate formula, which Congress eliminated in April via the Medicare and CHIP Reauthorization Act. Come 2019, physicians can participate in one of two major payment tracks: the fee-for-service Merit-Based Incentive Payment System, which boosts or docks physician pay based on their quality and cost performance; or one or more alternative payment models, such as accountable care organizations, medical homes, bundled payments, or other initiatives.
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Russell T, Petterson SM, Klink K, Bazemore AW. Primary Care Physicians Are More Likely to Participate in Medicare EHR Incentives than Other Eligible Physicians. Am Fam Physician 2015; 92:182. [PMID: 26280137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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McCartney M. Margaret McCartney: Forever indebted to pharma--doctors must take control of our own education. BMJ 2015; 350:h1965. [PMID: 25869648 DOI: 10.1136/bmj.h1965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Iacobucci G. NHS is "withering away" as result of government policies, open letter from 140 senior doctors says. BMJ 2015; 350:h1893. [PMID: 25858433 DOI: 10.1136/bmj.h1893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Chen IT, Aung T, Thant HNN, Sudhinaraset M, Kahn JG. Cost-effectiveness analysis of malaria rapid diagnostic test incentive schemes for informal private healthcare providers in Myanmar. Malar J 2015; 14:55. [PMID: 25653121 PMCID: PMC4334415 DOI: 10.1186/s12936-015-0569-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 01/16/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The emergence of artemisinin-resistant Plasmodium falciparum parasites in Southeast Asia threatens global malaria control efforts. One strategy to counter this problem is a subsidy of malaria rapid diagnostic tests (RDTs) and artemisinin-based combination therapy (ACT) within the informal private sector, where the majority of malaria care in Myanmar is provided. A study in Myanmar evaluated the effectiveness of financial incentives vs information, education and counselling (IEC) in driving the proper use of subsidized malaria RDTs among informal private providers. This cost-effectiveness analysis compares intervention options. METHODS A decision tree was constructed in a spreadsheet to estimate the incremental cost-effectiveness ratios (ICERs) among four strategies: no intervention, simple subsidy, subsidy with financial incentives, and subsidy with IEC. Model inputs included programmatic costs (in dollars), malaria epidemiology and observed study outcomes. Data sources included expenditure records, study data and scientific literature. Model outcomes included the proportion of properly and improperly treated individuals with and without P. falciparum malaria, and associated disability-adjusted life years (DALYs). Results are reported as ICERs in US dollars per DALY averted. One-way sensitivity analysis assessed how outcomes depend on uncertainty in inputs. RESULTS ICERs from the least to most expensive intervention are: $1,169/DALY averted for simple subsidy vs no intervention, $185/DALY averted for subsidy with financial incentives vs simple subsidy, and $200/DALY averted for a subsidy with IEC vs subsidy with financial incentives. Due to decreasing ICERs, each strategy was also compared to no intervention. The subsidy with IEC was the most favourable, costing $639/DALY averted compared with no intervention. One-way sensitivity analysis shows that ICERs are most affected by programme costs, RDT uptake, treatment-seeking behaviour, and the prevalence and virulence of non-malarial fevers. In conclusion, private provider subsidies with IEC or a combination of IEC and financial incentives may be a good investment for malaria control.
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Affiliation(s)
- Ingrid T Chen
- Global Health Sciences, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA.
| | - Tin Aung
- Population Services International Myanmar, No 16, Shwe Gon Taing Street 4, Yangon, Myanmar.
| | - Hnin Nwe Nwe Thant
- Population Services International Myanmar, No 16, Shwe Gon Taing Street 4, Yangon, Myanmar.
| | - May Sudhinaraset
- Global Health Sciences, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA.
| | - James G Kahn
- Global Health Sciences, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94158, USA.
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Weeks DL, Keeney BJ, Evans PC, Moore QD, Conrad DA. Provider perceptions of the electronic health record incentive programs: a survey of eligible professionals who have and have not attested to meaningful use. J Gen Intern Med 2015; 30:123-30. [PMID: 25164087 PMCID: PMC4284265 DOI: 10.1007/s11606-014-3008-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The HITECH Act of 2009 enabled the Centers for Medicare & Medicaid Services (CMS) to provide financial incentives to health care providers who demonstrate "meaningful use" (MU) of their electronic health records (EHRs). Despite stakeholder involvement in the rule-making phase, formal input about the MU program from a cross section of providers has not been reported since incentive payments began. OBJECTIVE To examine the perspectives and experiences of a random sample of health care professionals eligible for financial incentives (eligible professionals or EPs) for demonstrating meaningful use of their EHRs. It was hypothesized that EPs actively participating in the MU program would generally view the purported benefits of MU more positively than EPs not yet participating in the incentive program. DESIGN Survey data were collected by mail from a random sample of EPs in Washington State and Idaho. Two follow-up mailings were made to non-respondents. PARTICIPANTS The sample included EPs who had registered for incentive payments or attested to MU (MU-Active) and EPs not yet participating in the incentive program (MU-Inactive). MAIN MEASURES The survey assessed perceptions of general realities and influences of MU on health care; views on the influence of MU on clinics; and personal views about MU. EP opinions were assessed with close- and open-ended items. KEY RESULTS Close-ended responses indicated that MU-Active providers were generally more positive about the program than MU-Inactive providers. However, the majority of respondents in both groups felt that MU would not reduce care disparities or improve the accuracy of patient information. The additional workload on EPs and their staff was viewed as too great a burden on productivity relative to the level of reimbursement for achieving MU goals. The majority of open-ended responses in each group reinforced the general perception that the MU program diverted attention from treating patients by imposing greater reporting requirements. CONCLUSIONS Survey results indicate the need by CMS to step up engagement with EPs in future planning for the MU program, while also providing support for achieving MU standards.
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Affiliation(s)
- Douglas L Weeks
- Inland Northwest Health Services, 711 S. Cowley St., Spokane, WA, 99202, USA,
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Lee A. Quality of healthcare. Issue Brief Health Policy Track Serv 2014:1-93. [PMID: 25775717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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