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Buy-Right for Health Care Quality: Evidence and Indicators: Paying for Performance
Slide Presentation by Meredith Rosenthal, Ph.D.
On October 21, 2004, Dr. Rosenthal made a presentation in a Web conference entitled Buy-Right for Health Care Quality: Evidence and Indicators: Paying for Performance.
This is the text version of Dr. Rosenthal's slide presentation. Select to access the PowerPoint® Slides (72 KB).
Paying for Quality
Meredith Rosenthal, Ph.D.
Department of Health Policy and Management
School of Public Health
October 21, 2004
New Programs to Reward Physicians and Hospitals
- Quality of care in the U.S. is poor and not improving quickly enough.
- More than 50 new pay-for-performance programs put in place this decade by health plans, purchasers.
- Both physicians and hospitals to receive bonuses.
Reference: Health Affairs, Vol 23, Issue 2, 127-141
Targeted Areas of Performance
- Physicians rewarded based on care in 5-10 domains of evidence-based medicine
- Structure (e.g., development of Information Technology infrastructure) and process measures typical.
- Patient experience/satisfaction often included.
- Hospitals rewarded on broader set of structure, process, and outcome measures (including staffing, complications, readmissions).
- Quality improvement almost never targeted explicitly.
- Programs reward top performers (e.g., top 20% in market) or all providers reaching a fixed goal (e.g., 75% compliance with a benchmark).
- Thus rewards pay for past achievements, may widen performance gap.
Strength of Incentives
- Typical payments for best performers set to roughly 5% of revenues from the sponsoring plan or purchaser.
- Incentive sponsors usually represent minority share of provider revenues.
- Will this be enough to spur necessary changes?.
- Pay-for-performance targeting broad set of domains has been widely adopted.
- Current programs may not be well positioned to result in dramatic quality improvements
- No rewards for improvement.
- Relatively small dollar amounts.
Current as of March 2005
Paying for Quality. Text version of a slide presentation at a Web conference. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/buyright/rosenthaltxt.htm
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