Pay-for-performance programs (P4P) are programs that help in providing financial rewards to physicians and other health care providers–in the order of meeting understandable quality of care and proficiency. The programs, themselves, are good in supporting the quality and improvement of care in the United States. P4P incentive programs differentiate payment among providers based on performance of quality and efficiency measures. This will ensure that desired outcomes transpire through different behavior. Pay-for-Performance programs come in different levels, including pay-For-Quality, Pay-For-Reporting, Pay-For-Efficiency, and Pay-For-Value, et cetera.
I was not sure what she was implying when talking about the side effect of using P4P. She provided a concern of multiple factors outside of health care system that can affect outcome measures; a problem that is commonly cited as she said. “As a result, physicians and other clinicians may not consider it fair to be held accountable for outcome performance.” She provided an example that many different physicians and other health professionals may treat patients with cardiovascular disease, and patient factors regarding diet, exercise, and adherence to medications may play a large role in mortality rates.
Pay-For-Performance:-
- Pay for quality. These programs can assess quality in several ways, using structure, process, outcome, or coordination of care measures. Such programs may also use composite measures to quantitatively combine multiple quality indicators into a single metric.
- Pay for reporting. Often termed P4R, focuses on provider reporting of quality-related data. These programs usually intend to develop into pay for quality once providers become more comfortable with the validity and reliability of the quality measures and data collection procedures.
- Pay for efficiency. Paying for efficiency generally means rewarding cost reduction or cost containment. Cost measures may include annual expenditures for patients with chronic diseases or episode-based spending measures for patients with acute illnesses. Alternately, efficiency-based programs may use health care utilization measures that focus on the number of physician visits or hospital days per patient per year. Some payers have also developed composite measures or indexes of efficiency to profile and compare provider performance.
- Pay for value. In this method, payers may give providers simultaneous incentives for increasing quality and containing costs and then allow the providers to sort out the best approaches for responding to both incentives. The Affordable Care Act health reform legislation took this approach with hospital P4P in its Hospital Value-Based Purchasing Program (HVBPP), in which cost savings are guaranteed through across-the-board reductions in hospital reimbursement; hospitals are then able to earn back a portion of the lost reimbursement through performance on quality measures. As a result, both cost and quality factors are included in the HVBPP.
