Pay-for-Performance in Nursing Homes

University of Massachusetts Medical School and Meyers Primary Care Institute, Worcester, Massachusetts 01605, USA.
Health care financing review (Impact Factor: 2.06). 02/2009; 30(3):1-13.
Source: PubMed

ABSTRACT Information on the impact of pay-for-performance programs is lacking in the nursing home setting. This literature review (1980-2007) identified 13 prior examples of pay-for-performance programs in the nursing home setting: 7 programs were active as of 2007, while 6 had been terminated. The programs were mostly short-lived, varied considerably in the choice of performance measures and pay incentives, and evaluations of the impact were rare.

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    • "Regarding resource use, 1 study found a greater reduction in resource use when directed at individuals whose contracts include withhold than when directed at groups. 1 study: lack of association between bonuses/withholds and change in resource use may have been result of a delayed rewards. 1 study: null effect possibly a result of limited physician awareness, and limited time frame of study. Briesacher et al. (2009) [28] "
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    ABSTRACT: BACKGROUND: A vast amount of literature on effects of pay-for-performance (P4P) in health care has been published. However, the evidence has become fragmented and it has become challenging to grasp the information included in it. OBJECTIVES: To provide a comprehensive overview of effects of P4P in a broad sense by synthesizing findings from published systematic reviews. METHODS: Systematic literature search in five electronic databases for English, Spanish, and German language literature published between January 2000 and June 2011, supplemented by reference tracking and Internet searches. Two authors independently reviewed all titles, assessed articles' eligibility for inclusion, determined a methodological quality score for each included article, and extracted relevant data. RESULTS: Twenty-two reviews contain evidence on a wide variety of effects. Findings suggest that P4P can potentially be (cost-)effective, but the evidence is not convincing; many studies failed to find an effect and there are still few studies that convincingly disentangled the P4P effect from the effect of other improvement initiatives. Inequalities among socioeconomic groups have been attenuated, but other inequalities have largely persisted. There is some evidence of unintended consequences, including spillover effects on unincentivized care. Several design features appear important in reaching desired effects. CONCLUSION: Although data is available on a wide variety of effects, strong conclusions cannot be drawn due to a limited number of studies with strong designs. In addition, relevant evidence on particular effects may have been missed because no review has explicitly focused on these effects. More research is necessary on the relative merits of P4P and other types of incentives, as well as on the long-term impact on patient health and costs.
    Health Policy 02/2013; 110(2-3). DOI:10.1016/j.healthpol.2013.01.008 · 1.73 Impact Factor
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    • "Nursing facility pay for performance has received only limited research ( Arling et al., 2009 ; Briesacher et al., 2009 ). Studies of pay for performance in other settings such as health plans, hospitals , physician practices, or individual providers have yielded generally disappointing results ( Christianson , Leatherman, & Sutherland, 2007 ; Dudley, Robinowitz, Talavera, Broadhead, & Luft, 2004 ; Petersen, Woodard, Urech, Daw, & Sookanan, 2006 ; Rosenthal & Frank, 2006 ; Town, Kane, Johnson, & Butler, 2005 ). "
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    ABSTRACT: Minnesota's Nursing Facility Performance-Based Incentive Payment Program (PIPP) supports provider-initiated projects aimed at improving care quality and efficiency. PIPP moves beyond conventional pay for performance. It seeks to promote implementation of evidence-based practices, encourage innovation and risk taking, foster collaboration and shared learning, and establish a solid case for investing in better quality from the perspective of the state, providers, and consumers. We explain PIPP rationale and design, describe projects and participating facilities, and present findings from interviews with project leaders. Provider-initiated projects lasting from 1 to 3 years are selected through a competitive process and are funded for up to 5% of the daily operating per diem rate. Providers are at risk of losing up to 20% of their project funding if they fail to achieve targets on state nursing facility performance measures. Minnesota has made a major investment in the PIPP by supporting 45 individual or collaborative projects, representing approximately 160 facilities and annual funding of approximately $18 million. Projects involve a wide range of interventions, such as fall reduction, wound prevention, exercise, improved continence, pain management, resident-centered care and culture change, and transitions to the community. The PIPP can serve as a model for other states seeking to promote nursing facility quality either in combination or in place of conventional pay-for-performance efforts.
    The Gerontologist 10/2009; 50(4):556-63. DOI:10.1093/geront/gnp140 · 3.21 Impact Factor
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    ABSTRACT: Concerns about the quality of long-term care have resulted in an extensive array of regulations governing provider behavior. This article reports the results of a survey of 1,147 long-term care specialists on issues related to the government's performance in assuring quality and improving care. With the exception of providers, more than half of specialists ranked the quality of the average nursing home as fair or poor; home health agencies and even assisted-living facilities fared only somewhat better. Yet despite the perceived ineffectiveness of the current regime, the majority of specialists expressed a general willingness to continue pursuing more stringent and enhanced enforcement and to proceed down the same path with assisted-living facilities. Furthermore, while most were not sanguine about public reporting, the majority favored pay-for-performance, even though both rely on the same information. In addition to constituency group affiliation, differences in views derived largely from respondents' ideological predispositions.
    Medical Care Research and Review 05/2010; 67(4 Suppl):38S-64S. DOI:10.1177/1077558710367655 · 2.57 Impact Factor
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