Public Reporting and Pay for Performance in Hospital Quality Improvement

Abstract

Hospitals engaged in both public reporting and pay for performance achieved modestly greater improvements in quality than did hospitals engaged only in public reporting. Additional research is required to determine whether different incentives would stimulate more improvement and whether the benefits of these programs outweigh their costs.

Improving Outcomes in Colorectal Surgery by Sequential Implementation of Multiple Standardized Care Programs

“…1,2 Furthermore, public reporting of hospital and surgeon outcomes data and pay-for-performance reimbursement schemes have added to the impetus to improve health care quality. [3][4][5] In colorectal surgery (CRS), engaged surgeons have focused on implementing systems of care designed to reliably provide evidence-supported practices as a mechanism to improve postoperative outcomes. 6 Two prominent systems of care are the enhanced recovery pathway (ERP) 7,8 and the preventive surgical site infection bundle (SSIB).…”

Hospital quality measurement— Perplexing for professionals, let alone for patients

“…Hospitals engaged in both public reporting and pay-for-performance achieved modestly greater improvements in quality compared with those that only did public reporting. 7 It is notable that this demonstration project generally produced modest financial rewards to those hospitals that improved performance. 8 The optimal model to reward performance remains to be determined.…”

“…8 The optimal model to reward performance remains to be determined. 7,9,10 There are a number of potentially harmful unintended consequences of poorly designed quality measures and associated transparency and incentive programs. The most obvious is opportunity cost.…”

The Use of Three Strategies to Improve Quality of Care at a National Level

“…Stakeholder involvement in design and evaluation of measures, and strong dissemination, further enhanced improvement [16,72]. Pay-forperformance had the greatest effect on low rather than high performers [3,9,16,33,44,64,72]. Approaches with purely positive incentives (versus winners and losers) [12,16,34,35,48] and paying clinicians rather than hospitals were more effective [16,61].…”

“…However, the overall effect was small and highly context-specific [16,28,49,61,66,67,72]. Three of four studies of physician-level financial incentives, one study of financial incentives directed toward health administrators, and four of five studies of provider-level financial incentives showed positive improvement in quality [3,9,12,28,33,44,48,64]. All but one study of pay-for-performance was conducted in the United States [15].…”