Long-Term Effect of Hospital Pay for Performance on Mortality in England

Kristensen, Søren Rud; Meacock, Rachel; Turner, Alexander; Boaden, Ruth; McDonald, Ruth; Roland, Martin; Sutton, Matt

doi:10.1056/nejmsa1400962

Cited by 24 publications

(21 citation statements)

References 17 publications

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“…There is some evidence from the United Kingdom's P4P program that improvements in quality for incentivized indicators were at the expense of some detriment in quality for unincentivized conditions (Doran et al 2008a). On the positive side, Kristensen et al (2014) found some evidence that when the initial effect of reduced hospital mortality from the introduction of an HQID program in the United Kingdom was lost in the longer term, this might have been the result of positive spillover effects into nonincentivized conditions. The possibility of negative spillover effects is particularly important because P4P often targets aspects of care that can be measured relatively easily (e.g., blood sugar control in diabetes) and therefore Financial and Reputational Incentives risks neglecting aspects of medical care in which processes and outcomes may be more difficult to measure (e.g., mental health care).…”

Section: Variation Among Individuals In Response To Incentivesmentioning

confidence: 99%

How Financial and Reputational Incentives Can Be Used to Improve Medical Care

Roland

Dudley

2015

Health Services Research

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ObjectivesNarrative review of the impact of pay‐for‐performance (P4P) and public reporting (PR) on health care outcomes, including spillover effects and impact on disparities.Principal FindingsThe impact of P4P and PR is dependent on the underlying payment system (fee‐for‐service, salary, capitation) into which these schemes are introduced. Both have the potential to improve care, but they can also have substantial unintended consequences. Evidence from the behavioral economics literature suggests that individual physicians will vary in how they respond to incentives. We also discuss issues to be considered when including patient‐reported outcome measures (PROMs) or patient‐reported experience measures into P4P and PR schemes.ConclusionWe provide guidance to payers and policy makers on the design of P4P and PR programs so as to maximize their benefits and minimize their unintended consequences. These include involving clinicians in the design of the program, taking into account the payment system into which new incentives are introduced, designing the structure of reward programs to maximize the likelihood of intended outcomes and minimize the likelihood of unintended consequences, designing schemes that minimize the risk of increasing disparities, providing stability of incentives over some years, and including outcomes that are relevant to patients' priorities. In addition, because of the limitations of PR and P4P as effective interventions in their own right, it is important that they are combined with other policies and interventions intended to improve quality to maximize their likely impact.

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Section: Variation Among Individuals In Response To Incentivesmentioning

confidence: 99%

How Financial and Reputational Incentives Can Be Used to Improve Medical Care

Roland

Dudley

2015

Health Services Research

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“…In the United States, both Medicare's Hospital Compare public reporting scheme (87) and Premier's Hospital Quality Incentive Demonstration (HQID) (55,80) appear to have had no impact on mortality rates. When HQID was transferred to England, there was an apparent short-term reduction in mortality for patients admitted with one of the three targeted conditions (pneumonia) (94), but this result was not sustained after the second year (63). Furthermore, reanalysis of the data suggested not only that the initial reduction was not statistically significant but also that mortality rates for nonincentivized conditions increased (62).…”

Section: Introductionmentioning

confidence: 99%

Impact of Provider Incentives on Quality and Value of Health Care

Doran

Maurer

Ryan

2017

Annu. Rev. Public Health

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The use of financial incentives to improve quality in health care has become widespread. Yet evidence on the effectiveness of incentives suggests that they have generally had limited impact on the value of care and have not led to better patient outcomes. Lessons from social psychology and behavioral economics indicate that incentive programs in health care have not been effectively designed to achieve their intended impact. In the United States, Medicare's Hospital Readmission Reduction Program and Hospital ValueBased Purchasing Program, created under the Affordable Care Act (ACA), provide evidence on how variations in the design of incentive programs correspond with differences in effect. As financial incentives continue to be used as a tool to increase the value and quality of health care, improving the design of programs will be crucial to ensure their success.

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“…[60][61][62] How well these CMS programs work to improve patient safety in the long run remains unclear. Recent data on payfor-performance programs in general have shown mixed results, 22,[63][64][65] and 1 analysis found no early benefits from the Medicare Value-Based Purchasing program. 66 However, the federal government professes confidence in the approach and is quick to highlight even modest evidence of such positive effects.…”

Section: Performance-based Payment Incentivesmentioning

confidence: 99%