pay for performance

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[1][2][3][4][5][6][7][8]

Management

  • pay for performance did not lead to better quality of care or outcomes in patients with hypertension [1]
  • hospital-based pay for performance did not improve 30-day mortality in the US[3]
  • hospital-based pay for performance did improve 30-day pneumonia-related mortality in the United Kingdom[4]; no improvement in 30-day mortality related to heart failure or myocardial infarction
  • pay for performance does not extend life span or diminish mortality in the U.K.[5]

Notes

  • Checklist part A: Is a financial incentive appropriate?[2]
    • does the desired clinical action improve patient outcomes?
    • will the desired clinical behavior persist without intervention?
    • are there valid, reliable & practical measures of the desired clinical behavior?
    • have the barriers & enablers to improving clinical behavior been assessed?
    • will the financial incentives work, & better than other interventions to change behavior, & why?
    • will the benefits clearly outweigh any unintended harmful effects, & at an acceptable cost?
  • Checklist part B: Implementation[2]
    • are systems & structures needed for the change in place?
    • how much should be paid, to whom, & for how long?
    • how will the financial incentives be delivered?
  • Comment from editorial[2] "despite a dearth of robust evidence that [pay-for-performance] is clinically effective in healthcare, payers charge ahead with implementing everywhere an intervention that has not been proven to work anywhere."[2]
  • no evidence after 10 years that pay-for-performance results in better process scores or diminished mortality[6]
  • Medicare Merit-Based Incentive Payment System (MIPS) affects reimbursement via penalties & bonuses for performance across several cost & quality measures, but does not affect clinical outcomes[7]

References

  1. ↑ 1.0 1.1 Serumaga B et al. Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: Interrupted time series study. BMJ 2011 Jan 25; 342:d108 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21266440
  2. ↑ 2.0 2.1 2.2 2.3 2.4 Physician's First Watch Massachusetts Medical Society jwatch@mms.org
    Glasziou PP et al When financial incentives do more good than harm: a checklist BMJ 2012;345:e5047 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22893568 <Internet> http://www.bmj.com/content/345/bmj.e5047
    Woolhandler S and Ariely D Why pay for performance may be incompatible with quality improvement BMJ 2012;345:e5015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22893567 <Internet> http://www.bmj.com/content/345/bmj.e5015
  3. ↑ 3.0 3.1 Jha AK et al. The long-term effect of premier pay for performance on patient outcomes. N Engl J Med 2012 Mar 28 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22455751 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMsa1112351
  4. ↑ 4.0 4.1 Sutton M et al Reduced Mortality with Hospital Pay for Performance in England. N Engl J Med 2012; 367:1821-1828 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23134382 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMsa1114951
    Epstein AM Will Pay for Performance Improve Quality of Care? The Answer Is in the Details. N Engl J Med 2012; 367:1852-1853 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23134388 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1212133
  5. ↑ 5.0 5.1 Ryan AM et al. Long-term evidence for the effect of pay-for-performance in primary care on mortality in the UK: A population study. Lancet 2016 May 17; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27207746
    Roland M. Does pay-for-performance in primary care save lives? Lancet 2016 May 17 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27207745
  6. ↑ 6.0 6.1 Bonfrer I et al Impact of Financial Incentives on Early and Late Adopters among US Hospitals: observational study. BMJ 2018;360:j5622 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29298765 Free full text <Internet> http://www.bmj.com/content/360/bmj.j5622
  7. ↑ 7.0 7.1 Bond AM et al. Association between individual primary care physician merit-based incentive payment system score and measures of process and patient outcomes. JAMA 2022 Dec 6; 328:2136-2146. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36472595 https://jamanetwork.com/journals/jama/fullarticle/2799153
    McWilliams JM. Pay for performance: When slogans overtake science in health policy. JAMA 2022 Dec 6; 328:2114-2116. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36472613 https://jamanetwork.com/journals/jama/fullarticle/2799177
  8. ↑ http://www.ahqr/gov/qual/pay4per.htm
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