An important development in Medicare reimbursement is toward pay-for-performance (P4P) and it is receiving attention in the public and private sectors. P4P aims to align provider payments with the quality of care that is provided to the consumer (Shu & Singh, 2012). P4P is a priority to the Centers for Medicare & Medicaid Services (CMS) and they believe that they should seek opportunities to encourage improvements in the quality of care of their beneficiaries (Centers for Medicare & Medicaid Services, 2005). As part of the Medicare Prescription Drug, improvement, and Modernization Act of 2003, the United States Congress asked the Institute of Medicine (IOM) to assess the need for implementing P4P in the Medicare program. During the implementation the IOM found that there was mixed evidence regarding the potential effectiveness of P4P payments; the Medicare program is not the only system considering P4P strategies (Shu & Singh, 2012). There are 12 states that are in the early stages of instituting P4P in their Medicaid programs and CMS is offering technical assistance to states for evaluating and implementing P4P. How Pay for Performance has changed the Quality of Care
Studies on the impact that pay for performance initiatives are having on the quality of health care being given have produced mixed results. When first initiated, positive results were noted in various studies, like the one conducted of the Premier Hospital Quality Incentive Demonstration (HQID). This study, serving as the model for the federal government, involved more than 250 hospitals and showed improvement in quality measures under financial incentives during the first two years (Epstein, 2012). However, as the study progressed, the increase in the measures for quality dwindled greatly. The reason for this is thought to be related to other changes in health care occurring at the same time as these pay for performance initiatives were introduced. According to Schatz, “even when the studies suggest positive effects, the designs often do not permit assurance that the effects are due to the incentives compared to other factors” ( Schatz, 2008, p. 220).
Some examples of other changes impacting the quality of care are the electronic medical record, public reporting of quality measures, and improved techniques in education of providers and patients. Although more studies are needed to determine the degree to which these pay for performance initiatives are influencing the quality of care measures, it is unlikely these financial incentives will be abandoned. Instead, the results obtained will be used to modify the initiatives already in place and expand on new quality measures to implement in pay for performance. The Centers for Medicare and Medicaid have already made changes by modifying the list of qualities measured and by greatly increasing the payment formula (Epstein, 2012). Societal Belief and Influence on Pay for Performance
P4P became of societal interest when the decline in health care was evident and a lack of incentive to do better could be identified. The IOM found numerous medical factors contributing to poor quality and included the payment system as part of the problem (Petersen, Woodard, Urech, Daw, & Sookanan, 2006). The IOM also found that the payment system contributed as disincentives to quality care and out of the interest of society, these findings could not be ignored.
Any actions to improve health care and offer incentives for quality care are of interest to society as health care consumers. Society is or will be recipients of care at some point and will prefer the best care that can be offered. When given the option, no person would choose lesser quality of care over high-quality care and so it can be assumed that valuing quality care is of interest to all. Another segment of society is the providers, who play a large role in P4P. The P4P idea has gained traction among providers due to concerns regarding costs, inefficiency, safety, and consumer engagement (Schmitt, 2012). Consumers are becoming rapidly aware of costs and quality of health care through information technology, and the result of the customers to get vested in P4P to improve care have forced providers to follow suit. Regardless of P4P effectiveness, it is evident that society values an effort to improve care and will be the driving force of change.
The Views That Affect Team B in Regards to the Delivery of Health Care
Positive results first initiated an effect on one team member, even though these pay for performance initiatives are influencing the quality of care measures and another team member is suggesting that more studies are needed to determine the degree to which P4P affects on the health care industry. One team member found with the implementation the IOM there was assorted evidence regarding the possible effectiveness of P4P payments which warrants some financial organizations to lean towards the P4P measures. Another team member found that P4P proposal has gained enormous attention among providers. Team B found out that expanding on new quality measures to implement in P4P could give the pay for performance proposal the results that will be used to modify the initiatives already in play (Miller, 2015).
2003:The Medicare Prescription Drug, Improvement, and Modernization Act, the US Congress asked the Institute of Medicine (IOM) to assess the potential for implementing P4P in the Medicare program.
January 1, 2010:Medicare Beneficiary Drug Rebate provides a $250 rebate to Medicare beneficiaries who reach the Part D coverage gap in 2010. Further subsidies and discounts that ultimately close the coverage gap begin in 2011.
July 1, 2010:Consumer Website requires the Department of Health and Human Services to develop an internet website to help residents identify health coverage options.
January 1, 2011:Medicare Payments for Primary Care provides a 10% Medicare bonus payment for primary care services; also, provides a 10% Medicare bonus payment to general surgeons practicing in health professional shortage areas. January 1, 2012:Accountable Care Organizations (ACOs) in Medicare allows providers organized as (ACOs) that voluntarily meet quality thresholds to share in the cost savings they achieve for the Medicare program. January 1, 2013:Flexible Spending Account limits the amount of contributions for medical expenses to $2,500 per year, increased annually by the cost of living adjustment. January 1, 2014:Health Insurance Exchanges created state-based American Health Benefit Exchanges and Small Business Health Options Program (SHOP) Exchanges, administered by a governmental agency or non-profit organization, through which individuals and small businesses with up to 100 employees can purchase qualified coverage. Exchanges will have a single form for applying for health programs, including coverage through the Exchanges and Medicaid and CHIP programs.
Centers for Medicare & Medicaid Services. (2005). Pay-for-Performance Quality Incentives. Retrieved from http://www.cms.gov/Regulations-and-Guidance/Guidance/FACA/downloads/tab_H.pdf Epstein, A. M. (2012, November 8). Will pay for performance improve quality of care? The New England Journal of Medicine, 367(19), 1852-1853. Petersen, L. A., Woodard, L. D., Urech, T., Daw, C., & Sookanan, S. (2006). Does pay-for-performance improve the quality of health care? Annuals Of Internal Medicine, 145(4), 265-272. Schatz, M. (2008). Does pay-for-performance influence the quality of care? Current Opinion Allergy Clinical Immunology, 8(3), 213-221. Retrieved from http://www.medscape.com/viewarticle/576573 Schmitt, C. (2012). Techniques in Gastrointestinal Endoscopy (14th ed.). Retrieved from http://ac.els-cdn.com/S1096288311001860/1-s2.0-S1096288311001860-main.pdf? _tid=2490795a-9f29-11e4-9349-00000aacb35d&acdnat=1421596158_72dfc87e72d4a4f4fdad3be3b54bb0a7. Shu, L., & Singh, D. A. (2012). Delivering Health Care in America A Systems Approach (5th ed.). Burlington, MA: Jones & Bartlett Learning.