TABLE E-2 Hospital Phasing

 

Year 1

Year 2

Year 3

Clinical quality

Hospital Quality Alliance measures— pay for public reporting

Hospital Quality Alliance measures— pay for performance

Hospital Quality Alliance measures— pay for performance

Patient-centeredness

Hospital CAHPS— pay for public reporting

Hospital CAHPS— pay for performance

Hospital CAHPS— pay for performance

Efficiency

 

Additional payout to the most efficient 1/3 of hospitals meeting thresholds for both clinical quality and patient-centeredness measures

Additional payout to the most efficient 1/3 of hospitals meeting thresholds for both clinical quality and patient-centeredness measures

quality measures as discussed above, the committee believes rewards could be provided for meeting performance criteria for these measures beginning in year 2 (2009). As Hospital CAHPS would just have gotten off the ground, hospitals could be rewarded for publicly reporting these data through Hospital Compare. Beginning in year 2, patient-centeredness could be rewarded based on performance. Efficiency measures could thus begin to be rewarded only beginning in year 2. As more measures for each dimension were developed, they could be considered for payment based first on public reporting and then on performance. Rewards for public reporting would be smaller than those for performance (see Table E-2).

Example of Hospital Pay for Performance

See the example of AMI at the end of the section on ambulatory physicians below.

REWARDING AMBULATORY CARE

Background

Efforts to hold individual physicians accountable for the care they provide are in their early stages because of the basic difficulties involved and the fact that such efforts have never been undertaken on a large scale. There have, however, been some successful smaller-scale examples. An important step toward being able to attribute care in ambulatory settings is a collabo-



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