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• W2334123755 abstract "In the decades-old debate over how best to finance and deliver health care in the United States, a nearly ubiquitous complaint about most systems of physician and hospital reimbursement is that payments are made based on the services delivered regardless of the quality of care delivered, providing no incentive—some say a disincentive—for quality improvement. Advocates of “pay-for-performance” (P4P) systems of health care reimbursement argue that the concept of paying more to those who produce better outcomes, a “bedrock principle” in efforts to “reduce error and reinforce best practices” in other industries, should become “a top national priority” in “the campaign to rally our underperforming health care system.” In proposals to improve health care systems, high-level enthusiasm is not necessarily an indicator of high-quality evidence, and P4P is no exception. Editorialists George Diamond and Sanjay Kaul, both cardiologists and keen observers of quality of evidence in health care decision making, wrote in 2009 that rapid proliferation of P4P systems “is occurring despite a paucity of empirical evidence that [they] actually deliver on their promise to improve the quality and reduce the cost of health care. There are essentially no randomized controlled trials (RCTs) demonstrating the effectiveness of [P4P] programs and very few reports in the literature that analyze the existing programs.” The point made by Diamond and Kaul is welltaken. As we have observed previously, the health care research literature is replete with examples of schemes that were widely (sometimes wildly) supported based on weak observational evidence but refuted and ultimately abandoned after being tested with more rigorous research designs. When considering implementation of a P4P program, managed care organization (MCO) decision makers should be mindful both of quantitative research findings about the degree to which P4P and similar interventions improve quality and of the limitations of the evidence base at the present time. Key issues are (a) whether improvements associated with P4P would have taken place anyway, that is, without the financial incentives and (b) what factors “drive” changes in provider behavior." @default.
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• W2334123755 date "2010-06-01" @default.
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• W2334123755 title "Clinical Quality Indicators and Provider Financial Incentives: Does Money Matter?" @default.
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• W2334123755 doi "https://doi.org/10.18553/jmcp.2010.16.5.360" @default.
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