Although there is a lot of debate about the effectiveness of pay-for-performance (P4P) plans, I think the plans are only going to increase in the foreseeable future.
We need more research to tell us the relative impact of public reporting of performance data and P4P programs. Most importantly, the details of how these plans are set up, how and what they measure, and the dollar amount involved will have everything to do with whether they are successful in improving the value of care we provide.
SHM’S Practice Management Committee conducted a mini-survey of hospitalist group leaders in 2006. Here are some of the key findings.
P4P Prevalence
Forty-one percent (60 out of 146) of hospital medicine group (HMG) leaders reported their groups have a quality-incentive program. Of those HMG leaders more likely to report participation in a quality-incentive program:
- 60% were at hospitals participating in a P4P program;
- 50% were at multispecialty/PCP medical groups; and
- 50% were in the Southern region.
Of those HMG leaders less likely to report participation in P4P programs, 28% were at academic programs and 31% were at local hospitalist-only groups.
Group vs. Individual Incentives
Of the HMG leaders participating in a quality-incentive program:
- 43% reported it was an individual incentive;
- 35% reported it was a group incentive;
- 10% reported the plan had elements of both individual and group incentives; and
- 12% were not sure if their plans had individual or group incentives.
Basis of Quality Targets
Of the HMG leaders reporting that they participate in a quality-incentive program (respondents could indicate one or more answers):
- 60% of the programs have targets based on national benchmarks;
- 23% have targets based on local or regional benchmarks;
- 37% have targets based on their hospital’s previous experience; and
- 47% have targets based on improvement over a baseline.
Maximum Impact of Incentives
Of the HMG leaders reporting that they participate in a quality-incentive program:
- 16% report the maximum impact is less than 3%;
- 24% report the maximum impact is from 3% to 7%;
- 35% report the maximum impact is from 8% to 10%;
- 17% report the maximum impact is from 11% to 20%;
- 3% report the maximum impact is more than 20%; and
- 5% report they do not know the maximum impact.
Group vs. Individual Incentives
Of the HMG leaders reporting that they participate in a quality-incentive program:
- 61% said they have received an incentive payment;
- 37% have not received an incentive payment; and
- 2% were unsure if they have received an incentive payment.
Quality Metrics
The most common metrics used in P4P programs, based on 29 responses to the SHM survey:
- 93% of HM programs have metrics based on The Joint Commission’s (JCAHO) heart failure measures;
- 86% have metrics based on JCAHO pneumonia measures;
- 79% have metrics based on JCAHO myocardial infarction measures;
- 28% have metrics based on a measure of medication reconciliation;
- 24% have metrics based on avoidance of unapproved abbreviations;
- 24% have metrics based on 100,000 Lives Campaign measures;
- 21% have metrics based on patient satisfaction measures;
- 17% have metrics based on transitions-of-care measures;
- 10% have metrics based on throughput measures;
- 7% have metrics based on end-of-life measures;
- 7% have metrics based on “good citizenship” measures;
- 7% have metrics based on mortality rate measures; and
- 7% have metrics based on readmission rate measures.