The Evolution of Health Care and Timeline
Team B; Tammy, Alyssa, Felecia. Sherria, Tiffany
January 19, 2015
The Evolution of Health Care and Timeline
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...
References: 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.).
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Shu, L., & Singh, D. A. (2012). Delivering Health Care in America A Systems Approach (5th ed.). Burlington, MA: Jones & Bartlett Learning.
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