Article

Pay for Performance in Emergency Medicine

Department of Emergency Medicine, Boston University School of Medicine, Boston, MA, USA. <>
Annals of emergency medicine (Impact Factor: 4.33). 07/2007; 49(6):756-61. DOI: 10.1016/j.annemergmed.2006.06.032
Source: PubMed

ABSTRACT One of the latest market-based solutions to the rising costs and quality gaps in health care is pay for performance. Pay for performance is the use of financial incentives to promote the delivery of designated standards of care. Pay for performance represents a dramatic change in the reimbursement of providers, from fixed rates or fees, to variable compensation based on the quality of care. This article serves as an introduction to pay for performance. I discuss the goals and structure of pay for performance plans and their limitations and potential consequences in the health care arena. A particular focus is provided on pay-for-performance initiatives affecting the emergency department either directly by contracting at the group level or indirectly through hospital reward programs. I also provide a strategy to guide constructive engagement by emergency physicians in the pay-for-performance movement.

0 Followers
 · 
134 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Restricted government budgets are forcing countries to implement more efficient health measures. Unlike in somatic medicine, the process of evaluating payment systems in psychiatry in Switzerland is ongoing. A pilot approach in one psychiatric hospital, here called "new remuneration system (NRS)", was introduced to better control length of stay (LOS) by combining a lump sum with degressive daily rates. This is a first evaluation of the NRS in terms of a reduction of the LOS, and the prevention of early readmissions by analysing meaningful outcome categories.
    Swiss medical weekly: official journal of the Swiss Society of Infectious Diseases, the Swiss Society of Internal Medicine, the Swiss Society of Pneumology 08/2014; 144:w13991. DOI:10.4414/smw.2014.13991 · 1.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Nursing home quality threatens the well-being of residents. Pay for performance pays organizations for meeting performance targets and is required in Medicare hospitals under the 2010 Patient Protection and Affordable Care Act, where it is called “value-based purchasing.” It is not yet required of nursing homes. This article asks whether pay for performance could mitigate nursing home quality problems. A total of 159 health care studies were reviewed. “Effect sizes” (the percentage improvement or decline in care) were gleaned from 22 selected studies measuring 150 health outcomes ranging from more frequent foot exams to a measure of heart function. The median improvement was a modest 2.9 percent. Nursing home studies were a minority of those reviewed. Yet one large randomized trial proved successful. Pay for performance may be well suited to nursing homes given their routine care, chronic population, and low wage rates. However, design and implementation lessons must be applied to avoid failure.
    Public Administration Review 09/2013; 73(s1). DOI:10.1111/puar.12074 · 0.84 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: We investigate the effect of institutions on the delivery of services funded by the Constituencies Development Fund (CDF) in meeting constituents' needs in Kenya. Using household survey data collected by the Kenya Institute for Public Policy Research and Analysis (KIPPRA) in 2006 from a sample of constituencies, we construct indices of voice and client power using principal component analysis. We then estimate ordered probit models regarding the rating of the performance of CDF funded projects in meeting the constituents' needs. The estimation strategy we adopt controls for potential endogeneity of the institutional measures, potential sample selection-bias and potential unobserved heterogeneity. The results indicate that higher quality institutions are associated with better service delivery outcomes.