Pay-for-performance-Pay-for-performance

Pay-for-performance

Pdf Summary

The "Pay-for-Performance" (P4P) system introduces a new healthcare payment structure designed to enhance the quality of patient care by providing financial incentives to medical offices that meet or exceed established care standards. According to Dr. Meredith B. Rosenthal from the Harvard School of Public Health, P4P was created in response to the 2001 Institute of Medicine report that highlighted inadequacies in the U.S healthcare system.<br /><br />P4P evaluates physician practices based on quality performance measures, such as recommended tests for diabetic patients. These programs, though voluntary in some instances, are mandatory for Medicare. Each P4P plan includes performance measures, data collection, target settings, and compensation for exceeding targets. Key measures cover cost management, clinical effectiveness, patient satisfaction, administrative technology, and patient safety.<br /><br />California's Integrated Healthcare Association (IHA) manages one of the largest state-wide P4P programs, involving eight major health plans and 10.5 million insured persons. This initiative allows for uniform performance standards, simplifying data collection and reporting for physicians.<br /><br />A study by Ruth McDonald and Martin Roland highlighted unintended consequences of P4P, such as frustration among California physicians due to inability to exclude noncompliant patients and performance data collected by third parties. Overall, satisfaction with P4P varied significantly based on program design and implementation, independent of financial rewards.<br /><br />Challenges in compensation include understanding how health plans determine performance data and the formulae used, which can result in varied P4P payments. For some practices, especially smaller ones, the cost of necessary technology to participate can negate the benefits.<br /><br />The adoption of Electronic Medical Records (EMRs) is vital for tracking patients and meeting quality targets, though its initial setup may be challenging. Overall, while P4P encourages longer-term improvements in clinical results and shifts the focus of physician groups towards quality care, it also comes with complexities and potential downsides, such as exacerbating healthcare disparities and incentivizing patient discrimination.

Keywords

Pay-for-Performance

P4P

healthcare payment

quality of care

financial incentives

performance measures

Medicare

Electronic Medical Records

patient satisfaction

Integrated Healthcare Association