Rewarding Provider Performance Aligning Incentives in Medicare (2007) / Chapter Skim
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Appendix B: Review of the Evidence
Appendix B: Review of the Evidence
Pages 153-168
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From page 153... ...
B Review of the Evidence 153
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154 APPENDIX B TABLE B-1 Articles Identified as Assessing Explicit Financial Incentives and Health Care Quality from a Systematic Review of the Literature After Applying Study Inclusion and Exclusion Criteriaa Reference Study Design Incentives Norton, 1992 RCT (2 arms) ; November Level: payment system 1980 to April 1983; 36 Type: bonus SNFs (18 study facilities; Duration: admission incentive up to 4 y; 18 control facilities)
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APPENDIX B 155 MethodDomains Overall ologic of Quality Analysis and Results Effectb Strengthc Access; outcome Markov model Positive 3 Experimental homes admitted more type D and E patients (sicker patients) than control homes Patients in experimental homes were more likely to be discharged to home or to an ICF and had less likelihood of hospital admis sion or death (P < 0.001)
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156 APPENDIX B TABLE B-1 Continued Reference Study Design Incentives Clark et al., CBA; July 1992; 7 Level: provider group 1995 CMHCs; 185 clients (95 in Type: enhanced FFS TCM and 90 in CTT) Duration: NA Description: CMHCs received $15.75 per 15 min spent in community settings delivering MIMS Payment frequency: FFS Hillman et al., RCT (2 arms)
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APPENDIX B 157 MethodDomains Overall ologic of Quality Analysis and Results Effectb Strengthc Access Student t-test for paired comparisons; Partial 2 MANOVA effect Student t-test: average weekly time spent in community treatment per client increased after the payment change (30.71 min vs.
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Description: $4 for cognitive services interventions (< 6 min) ; $6 for 6 min; cognitive services are judgmental or educa tional services provided by the pharmacist to the patient, such as consulting the prescriber about a suboptimal dose Payment frequency: FFS Casalino et al., Cross-sectional survey; Level: provider group 2003 September 2000 to Septem- Type: better contracts with health plans; ber 2001; 1040 physician bonuses organizations (no patient- Duration: not ascertained in survey level data included)
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. Receiving a bonus for scoring well on quality measures was not associated with CMP implementation (P = 0.08)
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160 APPENDIX B TABLE B-1 Continued Reference Study Design Incentives McMenamin et Cross-sectional survey; Level: provider group al., 2003 September 2000 to Septem- Type: financial incentives; additional ber 2001; 1104 physician income; better contracts with health plans organizations Duration: not ascertained in survey Description: not ascertained in survey Payment frequency: not ascertained in survey Roski et al., RCT (3 arms) ; May 1999 Level: provider group 2003 to June 2000; 37 PC sites Type: bonus (13 incentive; 9 incentive + Duration: 12 mo registry; 15 control)
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Receiving better contracts with health plans was not associated with supporting smoking cessation interventions Examples of organizational supports include offering smoking cessation health promotion programs and giving providers nicotine replacement starter kits to distribute to patients Process Logistic regression, clustering at the practice Partial 2 level effect Change in tobacco use status identification: incentive group had increased 14.1%; incentive + registry group increased 8.1%; control group increased 6.2%; P = 0.009 Change in providing quitting advice to patients: incentive group increased 24.2%; incentive + registry increased 18.3%; control increased 18.3%. No significant difference across the study groups The quitting rate (7-d sustained abstinence)
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Enhanced FFS: $5 per vaccine given within 30 d of its coming due; $15 for each visit at which >1 vaccine was due and all were given Payment frequency: every 4 mo Safran et al., Cross-sectional survey; Level: physician 2000 January to April, October Type: not ascertained in survey 1996; physicians in 8 IPA/ Duration: not ascertained in survey network HMOs (2761 Description: survey of health plan patients) executives elicited information about use of financial incentives regarding patient satisfaction Payment frequency: not ascertained in survey
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APPENDIX B 163 MethodDomains Overall ologic of Quality Analysis and Results Effectb Strengthc Process Differences-in-differences analysis using Partial 2 generalized estimating equations effect Improvement in cervical cancer screening rates before and after the quality incentive program was statistically significant be tween the intervention and comparison groups (difference, 3.6%; P = 0.02)
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CS based on Health diabetic patients PCP's performance of process and were the comparison group outcome measures for diabetes care (e.g., LDL test, dilated retinal examination, LDL cholesterol level <2.59 mmol/L (<100 mg/dL)
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(10.5% difference) ; LDL cholesterol level <3.37 mmol/L (< 130 mg/dL)
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ADL = activities of daily living; ANOVA = analysis of variance; BP= blood pressure; CBA = controlled before and after; CMHC = community mental health center; CMP = care management process; CS= composite score; CTT = continuous treatment team; FB+I = feedback and incentive; FBO = feedback only; FFS = fee for service; FY = fiscal year; HMO = health maintenance organization; ICF = intermediate care facility; IPA = independent practice association; IV= intravenous; LDL = low-density lipoprotein; MANOVA = multivariate analysis of variance; MIMS = mental illness management services; NA= not applicable; NS= not specified; OR = odds ratio; OSA = Office of Substance Abuse; PBC = performance-based contracting; PC = primary care; PCP = primary care physicians; PMPM = per member per month; RCT = randomized, controlled trial; SNF = skilled nursing facility; TCM = traditional case managers. bPositive studies were those for which all measures of quality demonstrated a statistically significant improvement with the financial incentive.
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From page 167... ...
APPENDIX B 167 MethodDomains Overall ologic of Quality Analysis and Results Effectb Strengthc Process Chi-square, logistic regression Positive 1 Primary care physicians reimbursed under salary and quality of care more often adhered to annual screening of sexually active females age 15 to 19 y, compared with physicians compensated by capitation and financial performance, salary and productivity, salary and financial perfor mance, or FFS (P < 0.05) The physicians with salary and quality of care incentive also more often consistently screened women age 20 to 25 y for Chlamy dia trachomatis infection annually com pared with physicians reimbursed using other payment mechanisms (P < 0.05)
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From page 168... ...
2000. Organiza tional and financial characteristics of health plans: Are they related to primary care per formance?
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