Pay-for-performance is an umbrella term used when referring to various initiatives aimed at improving the healthcare industry’s effectiveness, quality, and overall value of healthcare. Such arrangements are significant as they provide financial incentives to the physicians, hospitals, and enable other healthcare providers to carry out improvements in the industry and attain optimum outcomes for patients. Pay-for-performance is well-known amongst various policy makers, civic and private healthcare players. The Affordable Care Act (Obamacare) encourages the expansion and use of this approach in the healthcare sector and fosters research to point out programs and designs that are most efficient and operative.
Phenomena of interest
The phenomenon of interest for my dissertation topic is merging advanced technology with pay-for-performance programs to impact patient outcomes positively. Pay-for-Performance not only focuses on enhancing reduction of payments made through fee schedules, bonuses, and incentives, but it increases the quality of care and service patients receive. It has been demonstrated that “adoption of common performance measures and benchmarks across health plans and physician organizations helps harness collective market forces to drive improvements in patient care” (IHA.org, 2017). Pay-for-performance plays a significant role in the healthcare industry. It is not only designed to enhance reduction of payments made through fee schedules, bonuses, and incentives, but it increases the quality of care and service rendered to patients. The social change aspect of merging technology with preventive pay-for-performance improves the quality of care provided to patients. It reduces the amount of inpatient bed days by encouraging and increasing the use of outpatient ambulatory care facilities. Better patient outcomes are observed when pay-for-performance efforts and initiatives are applied.
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Problem Statement
Health spending in the United States of America is higher than most industrialized countries. However, the higher pricing does not make the health care services better than other developed countries and in some cases it is even worse. Due to this fact, the wave of payment has shifted over the years from using fee- for- service (rewarding for the amount of services provided) to pay for performance (rewarding for quality and efficiency). Pay for performance has widely been adopted by both private players in the health care industry and Medicare. Currently, advanced technology has been merged with pay- for- performance with the aim of improving patients’ outcome. However, little research has been done to ascertain that pay for performance has been effective in improving the quality of services provided and reducing the costs of health care (Ryan and Werner, 2013). This research paper will discuss the impact of integrating pay- for-performance with advanced technology on the patient’s outcome.
Purpose Statement
The main purpose of this topic is to study and understand how merging pay-for-performance with technology in health care has improved patient outcomes in the United States of America. For the study to identify how patients outcome in the country have been affected by the merge of technology and pay for performance, it is vital to first learn the roles played by pay for performance in the healthcare system. Secondly, it is important to find out how the integration of the two has led to an increase in the quality of care and the services rendered to patients. Lastly, this study is set to determine how pay for performed enhances reduction of payments in health care. Moreover, this research will encompass the identification of additional programs that can be integrated into or customized to fit existing pay-for-performance programs. The study will also include approaches that other medical institutions use to improve the quality of care and promote the patient’s outcomes.
Annotated Bibliography
Alshamsan, R., Majeed, A., Ashworth, M., Car, J., & Millett, C. (2010). The impact of pay for performance on inequalities in health care: a systematic review. Journal of Health Services Research & Policy,15 (3), 178-184. doi:10.1258/jhsrp.2010.009113.
The systematic review and objective of this article is to assess the impact of pay-for-performance programs on the inequalities in the healthcare quality about ethnicity, sex, and socioeconomic status. The authors used systemic search and appraisal of experimental and observational studies that evaluated the effect of monetary incentives on the inequalities present in healthcare quantitatively. The authors concluded that the disparities in the management of chronic illness management have substantially persisted after the introduction of the Quality Outcome Framework. It was also determined that the pay-for-performance programs should be structured in a way to ensure the reduction in inequalities and to improve the overall healthcare quality. As such, this is a reliable article as it offers comprehensive information on the research topic.
Cromwell, J., Trisolini, M. G., Pope, G. C., Mitchell, J. B., & Greenwald, L. M. (2011). Pay for performance in health care: methods and approaches. RTI Press Publication. NO. BK-002-1103. Retrieved February 15, 2014.
This book offers a very balanced approach and assessment of pay-for-performance or P4P. These programs, per the publication, have become far-reaching in the healthcare industry. This has resulted in the development and testing of new types of payment systems that are immensely featured in the current health reforms. The authors conduct a comprehensive review of the characteristics of pay-for-performance programs, analyzing its strengths and weaknesses. Led by by Jerry Cromwell, a Ph.D. holder, the authors have extensive experience in conducting funded evaluation and technical projects in the field of health economics. Their rigorous review and assessment of the research topic make this book a significant source of information on pay-for-performance programs.
Donev, D. (2005). Payment methods and regulation of providers. World, 119, 21.
This article examines the concerns about the nature of the standard that is used to earn and distribute the incentive payments. It further offers three alternatives, the first being the focus on the provision of healthcare that meets a consensus-based quality standard. Another option provided by the article is that the actual performance of the healthcare service providers could be utilized to set up an empirical benchmark. Therefore, competition among the providers would be used to determine the standard and distribution of the incentive payments. The third alternative, as discussed in the article, is to focus on quality improvement in the healthcare sector. As such, a provider whose performance is wanting could still earn an incentive payment provided it improves its performance. This is an informative source as it offers credible information concerning the Centers for Medicaid Services’ emphasis on the importance of quality healthcare and policies regarding pay-for-performance.
Hahn, J. (2006, November). Pay-for-performance in health care. In the Library of Congress: Washington, DC.
This journal is a report for the Congress Research Service, and it gives more information about pay-for-performance in health care. It describes the prerequisites for the success of pay-for-performance programs. It also outlines the elements of pay-for-performance starting with its objectives, measures and performance standards for establishing the target criteria, and the rewards that are at risk. The article gives detailed information on the program and how the government is involved in rolling it out to both public and private health care. Therefore, this is a rich source of knowledge on the pay-for-performance program when writing the dissertation.
Kirchner, J. (2015). Statin in patients with diabetes. Patient Care, 38(11), 70-71.
Based on the contents of this journal, there seems to be a lot of confusion surrounding the proper administration of statin medications to patients with diabetes. The use of a statin for these patients is dependent on the patient’s risk of developing cardiovascular problems. This article seeks to clarify the confusion of the new Standards of Medical Care in Diabetes dispensed by the American Diabetes Association in 2015, which differs with the recommendation for statin use outlined by the American College of Cardiology in 2013. The relevance of this article to the research topic is that it seeks to include the diabetes health care issue to the pay-for-performance programs. Diabetes is a life-threatening ailment and the patients suffering from it should be given access to affordable and high-quality health care.
Mendelson, A., Kondo, K., Damberg, C., Low, A., Motúapuaka, M., Freeman, M., Kansagara, D. (2017). The Effects of Pay-for-Performance Programs on Health, Health Care Use, and Processes of Care. Annals of Internal Medicine, 166(5), 341. doi:10.7326/m16-1881
This peer-reviewed journal is a study that sought to examine the benefits of pay-for-performance. The objective of the study was to expand and update previous systematic reviews that scrutinized the impact of pay-for-performance programs focused on the physician, managerial, group, or institutional levels on the process of care and patient results in inpatient and ambulatory contexts. The authors concluded that pay-for-performance programs might be related to improved processes of care in ambulatory contexts, but consistently impressive associations with improved patient health outcomes have not been proven in any setting. This article is relevant to the research topic as it provides previous studies on pay-for-performance programs’ effectiveness in ambulatory and health outcomes setting.
Miller, R. H., & Sim, I. (2004). Physicians’ use of electronic medical records: barriers and solutions. Health Affairs, 23(2), 116-126.
The author conducted a survey on the physician who uses the electronic medical record (EMR) technology. EMR is an emergent technology that enable doctors to pursue more robust quality improvement programs such as the pay-for-performance programs. Using this technology, according to the author, is time saving and effective. Based on the survey carried out, the author discovered that quality improvement in healthcare is heavily dependent on the physician’s use of an electronic medical record for their daily work. This journal is significant to the topic of research since it focuses on how the quality of healthcare can be improved using technological advancements since such technologies facilitate the success of programs such as pay-for-performance.
Nix, K. (2013). What Obamacare's Pay-For-Performance Programs Mean for Health Care Quality. The HeritageFoundation, Leadership for America, 1-9.
This journal gives a detailed explanation of the Patient Protection and Affordable Care Act of 2010 or just known as Obamacare. The author elaborates that the Obamacare Act created several new medical programs that intend to enhance the quality of healthcare in the United States using pay-for-performance strategies to exert pressure on the medical providers. The author talks about how these programs’ payment plans are based on performance metrics founded on the adherence to particular care processes, patient satisfaction surveys, and patient outcomes. However, the author argues that the incentives offered by the government do not necessarily guarantee value or benefit to the patients. This is a credible source of information on government’s role in the pay-for-performance programs and what it means to the quality of healthcare.
Petersen, L. A., Woodard, L. D., Urech, T., Daw, C., & Sookanan, S. (2006). Does pay-for-performance improve the quality of health care? Annals of internal medicine, 145(4), 265-272.
This systematic review attempts to answer the question on whether pay-for-performance improves the quality of healthcare. It is a relevant peer reviewed article since the authors seek to address the question by conducting various studies and analyses of whether explicit financial incentives are responsible for enhancing the quality of the healthcare industry. The authors accomplish their research by examining various measures of care process, most of which are aimed at preventive services. Most of the surveys conducted by the authors of this article found a positive correlation between pay-for-performance and access to healthcare, while another study presented proof of gaming behavior – signifying an undesirable effect on access to healthcare. This article is significant to the topic of research as it divulges credible literature review and studies.
Scott Endsley, M. D., Kirkegaard, M., Baker, G., & Murcko, A. C. (2004). Getting rewards for your results: pay-for-performance programs. Family Practice Manager, 11(3), 45-48.
The authors of this article are renowned professionals in the field of healthcare. The article attempts to give an elaboration of the basics of pay-for-performance programs. The authors indicate that even amongst the healthcare professionals who are motivated to offer the best care to the patients, the payment structure and incentives may not enable the necessary actions required to improve the quality of healthcare systematically. This publication is essential to the research topic as it provides the necessary knowledge about the relationship between pay-for-performance plans and the performance of the physicians in the provision of quality healthcare.
Research Questions
What role does ‘pay for performance’ play in the healthcare industry?
How does merging of ‘pay for performance’ with technology increase quality of care and services rendered to patients?
How does pay for performance enhance reduction of payments?
What additional programs can be integrated into existing pay for performance programs?
References
Bruno, L. F., (2017). Pay-for-Performance Incentives in Healthcare: Purpose, Politics and
Pitfalls. Retrieved March 26, 2017, from https://physiciansnews.com/2012/05/03/pay-for-performance-incentives-in-healthcare-purpose-politics-and-pitfalls/
IHA.org (2017). California’s Value Based Pay-for-Performance Program . Retrieved March 2, 2017 from http://www.iha.org/our-work/accountability/value-based-p4p
Torgan, C. (2013). Patient Outcomes Improved by Pay-For-Performance. Retrieved March
16, 2017, from https://www.nih.gov/news-events/nih-research-matters/patient-outcomes-improved-pay-performance
Ryan A. M., And Werner, R. M. (2013). Doubts About Pay For Performance In Health Care. Harvard business review . www.HBR.org
