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pay for performance

Management: - pay for performance did not lead to better quality of care or outcomes in patients with hypertension [1] - hospital-based pay for performance did not improve 30-day mortality in the US [3] - hospital-based pay for performance did improve 30-day pneumonia-related mortality in the United Kingdom [4]; no improvement in 30-day mortality related to heart failure or myocardial infarction - pay for performance does not extend life span or diminish mortality in the U.K. [5] Notes: - Checklist part A: Is a financial incentive appropriate? [2] - does the desired clinical action improve patient outcomes? - will the desired clinical behavior persist without intervention? - are there valid, reliable & practical measures of the desired clinical behavior? - have the barriers & enablers to improving clinical behavior been assessed? - will the financial incentives work, & better than other interventions to change behavior, & why? - will the benefits clearly outweigh any unintended harmful effects, & at an acceptable cost? - Checklist part B: Implementation [2] - are systems & structures needed for the change in place? - how much should be paid, to whom, & for how long? - how will the financial incentives be delivered? - Comment from editorial [2] "despite a dearth of robust evidence that [pay-for-performance] is clinically effective in healthcare, payers charge ahead with implementing everywhere an intervention that has not been proven to work anywhere." [2] - no evidence after 10 years that pay-for-performance results in better process scores or diminished mortality [6] - Medicare Merit-Based Incentive Payment System (MIPS) affects reimbursement via penalties & bonuses for performance across several cost & quality measures, but does not affect clinical outcomes [7]

References

  1. Serumaga B et al. Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: Interrupted time series study. BMJ 2011 Jan 25; 342:d108 PMID: 21266440
  2. Physician's First Watch Massachusetts Medical Society jwatch@mms.org - Glasziou PP et al When financial incentives do more good than harm: a checklist BMJ 2012;345:e5047 PMID: 22893568 http://www.bmj.com/content/345/bmj.e5047 - Woolhandler S and Ariely D Why pay for performance may be incompatible with quality improvement BMJ 2012;345:e5015 PMID: 22893567 http://www.bmj.com/content/345/bmj.e5015
  3. Jha AK et al. The long-term effect of premier pay for performance on patient outcomes. N Engl J Med 2012 Mar 28 PMID: 22455751 http://www.nejm.org/doi/full/10.1056/NEJMsa1112351
  4. Sutton M et al Reduced Mortality with Hospital Pay for Performance in England. N Engl J Med 2012; 367:1821-1828 PMID: 23134382 http://www.nejm.org/doi/full/10.1056/NEJMsa1114951 - Epstein AM Will Pay for Performance Improve Quality of Care? The Answer Is in the Details. N Engl J Med 2012; 367:1852-1853 PMID: 23134388 http://www.nejm.org/doi/full/10.1056/NEJMe1212133
  5. Ryan AM et al. Long-term evidence for the effect of pay-for-performance in primary care on mortality in the UK: A population study. Lancet 2016 May 17; PMID: 27207746 - Roland M. Does pay-for-performance in primary care save lives? Lancet 2016 May 17 PMID: 27207745
  6. Bonfrer I et al Impact of Financial Incentives on Early and Late Adopters among US Hospitals: observational study. BMJ 2018;360:j5622 PMID: 29298765 Free full text http://www.bmj.com/content/360/bmj.j5622
  7. Bond AM et al. Association between individual primary care physician merit-based incentive payment system score and measures of process and patient outcomes. JAMA 2022 Dec 6; 328:2136-2146. PMID: 36472595 https://jamanetwork.com/journals/jama/fullarticle/2799153 - McWilliams JM. Pay for performance: When slogans overtake science in health policy. JAMA 2022 Dec 6; 328:2114-2116. PMID: 36472613 https://jamanetwork.com/journals/jama/fullarticle/2799177
  8. http://www.ahqr/gov/qual/pay4per.htm