Rewarding Provider Performance Aligning Incentives in Medicare (2007) / Chapter Skim
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Appendix E: Pay for Performance in Various Care Settings
Appendix E: Pay for Performance in Various Care Settings
Pages 208-219
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E Pay for Performance in Various Care Settings Each care setting -- dialysis facilities, hospitals, ambulatory physicians, health plans, home health agencies, and skilled nursing facilities -- has specific characteristics that need to be considered when planning a pay-forperformance program. This appendix briefly describes each care setting and discusses how rewards could be distributed.
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APPENDIX E 209 prevalence of ESRD and acts to drive the ESRD research agenda.) Five of these measures are currently collected for the Agency for Healthcare Research and Quality's (AHRQ)
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210 APPENDIX E TABLE E-1 Dialysis Facility Phasing Year 1 (2008)
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APPENDIX E 211 ized costs for Medicare Parts A and B) for all patients at a given dialysis facility.
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212 APPENDIX E TABLE E-2 Hospital Phasing Year 1 Year 2 Year 3 Clinical quality Hospital Quality Hospital Quality Hospital Quality Alliance measures -- Alliance measures -- Alliance measures- pay for public pay for performance pay for performance reporting Patient- Hospital CAHPS -- Hospital CAHPS -- Hospital CAHPS-centeredness pay for public pay for performance pay for performance reporting Efficiency Additional payout to Additional payout to the most efficient 1/3 the most efficient 1/3 of hospitals meeting of hospitals meeting thresholds for both thresholds for both clinical quality and clinical quality and patient-centeredness patient-centeredness measures 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)
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APPENDIX E 213 rative initiative launched in January 2006 by CMS -- the Physician Voluntary Reporting Program. No portion of physician reimbursements has been linked to this initiative (physicians are paid out of Medicare Part B)
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214 APPENDIX E TABLE E-3 Ambulatory Phasing Year 1 (2008)
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APPENDIX E 215 Acute Myocardial Infarction Measures · Quality: A composite score for AMI in each care setting could be formulated to determine whether patients had received all the care they should have received. Each measure could be equally weighted, and a straight average could be taken -- one for HQA measures and one for AQA measures.
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216 APPENDIX E TABLE E-4 Health Plan Phasing Year 1 Year 2 Year 3 Clinical quality HEDIS measures -- pay HEDIS measures -- HEDIS measures- for public reporting pay for performance pay for performance Patient- CAHPS Health Plan CAHPS Health Plan CAHPS Health Plan centeredness Survey -- pay for public Survey -- pay for Survey -- pay for reporting performance performance Efficiency Additional payout to Additional payout to Additional payout to the most efficient 1/3 the most efficient 1/3 the most efficient 1/3 of health plans meet- of health plans meet- of health plans meet ing thresholds for both ing thresholds for both ing thresholds for both clinical quality and clinical quality and clinical quality and patient-centeredness patient-centeredness patient-centeredness measures measures measures · Patient-centeredness: Health plans have been collecting patientsatisfaction data for years through use of the original CAHPS survey. A more specific survey, the CAHPS health plan survey, is part of the group of Ambulatory CAHPS surveys.
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APPENDIX E 217 performance data through CMS since 2003. Federal support for home health care is provided through Medicare, paid out of Part A
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218 APPENDIX E Example of Pay for Performance for Home Health Care Measurement of the performance of the physicians treating home health care patients would be based on clinical quality, patient-centeredness, and efficiency. The clinical quality measures would include the following: · Quality: A composite score for home health care in each care setting would be formulated to determine whether patients had received all the care they should have received.
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APPENDIX E 219 REWARDING SKILLED NURSING FACILITY CARE Background The majority of nursing home care is paid for by Medicaid and private payers. Medicare pays for a specific type of nursing home care, called skilled nursing care, through Medicare Part A
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