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From page 241... ... Index A Ambulatory care Quality Alliance, 39, 179 Ambulatory payment classification, 146 Access to care American Health Information Community, performance measurement and, 6 126 potential adverse consequences of Anthem Blue Cross and Blue Shield, 22 payment incentives, 4�5, 29, 48�50 of New Hampshire, 41, 62 Accountability for coordination of care, 120�121, 123� 124 B goals of payment system reform, 8 public reporting for, 10�11, 103�104, Bridges to Excellence, 40�41, 62, 67 106 Physician Practice Connections, 41 Administrative data, 88, 103 Bundled payments, 4, 26, 33, 35, 145 Adverse consequences of pay-for performance system causes, 22, 28, 29 C inequitable or decreased access, 29, 48� Case management, 33 51 Centers for Medicare and Medicaid Services managing to measures, 29, 51 current payment incentive programs, 3, monitoring rationale, 4�5, 48, 53, 54 62 obstacles to knowledge transfer and leadership for health care improvement, innovation, 4�5, 29, 51�52 28, 137 potential scope of, 4�5, 48 performance reporting program, 11�12 provider attitudes and perceptions, 52� recommendations to improve 53 coordination of care, 13, 122 quality of care, 9, 29 See also Medicare Agency for Healthcare Research and Certification and licensure Quality, 126 Medicare provider qualifications, 25 Ambulatory care, 212�215 payment incentive programs and, 5 241 Read the entire page →
From page 242... ... 242 INDEX Certification Commission for Healthcare limitations of current efforts, 88�89 Information Technology, 128 Medicare data collection efforts, 43 Chart data, 88, 103 Medicare demonstration projects, 38�39 Chronic heart failure, 180 pay-for-performance implementation, 5, Clinical quality 13, 103 as basis for performance reward provider feedback, 103 distribution, 81�83, 95�96 for quality improvement, 13 goals of payment system reform, 3, 20, recommendations for, 14, 128�129 21�22, 44 See also Performance measurement; Collaborative efforts, 39 Public reporting Competition, in health care delivery system, Demonstration projects, 3, 14, 22, 38�39, 29, 52 139�140 Connecting for Health, 126 Department of Health and Human Services Consolidated Health Informatics, 126 current payment incentive programs, 3 Consumer Assessment of Healthcare information technology promotion, 14, Providers and Systems, 87, 109, 209� 126, 128�129 219 monitoring of pay-for-performance Coordination of care program, 14, 134 accountable source of care, 120�121, public reporting role, 10�11, 106 123�124 recommendations for, 6, 8, 10�11, 12, beneficiary role in, 123�124 14, 55, 78, 85, 106, 116�117, 128� goals of payment system reform, 3, 8, 45 129, 134 importance of, 124 Diabetes, 19, 180 performance measurement, 45 Diagnosis-related groups, 145�146 rationale, 13 Dialysis, 19 recommendations, 13, 122 Dialysis facilities rewards for, 123 Medicare prospective payment system, shortcomings of current delivery system, 148�149, 208 1, 4, 33, 45, 119�120 Medicare spending, 19 Coronary artery disease, 180 pay-for-performance implementation, Cost of care 110, 209�211 consumer spending, 18�19 performance measurement, 208�209 federal spending, 24 Diffusion of knowledge and best practices goals of payment system reform, 3, 21� health information technologies, 124�128 22 payment incentive program as obstacle health information technologies, 127 to, 29, 51�52 hospital management strategies, 145�146 Disease management models, 38�39 international comparisons, 19 Distribution of rewards Medicare spending, 4, 24 to ambulatory care settings, 215 quality of care and, 19 among Medicare parts, 97 Cost shifting behavior, 53�54 beneficiary rewards, 44�45 Crossing the Quality Chasm: A New Health by care settings, 118�119 System for the 21st Century, 1, 15, composite measures for, 89�90 71, 81 condition-based system, 89 data collection for, 88�89 defining comparison groups for, 94�95 D to dialysis facilities, 211 domains of care as basis for, 9, 81�83, Data collection and management 95�96, 100�101 data auditing, 103 existing funds model, 66�69 health information technologies, 124� generated savings model, 69�71 129 Read the entire page →
From page 243... ... INDEX 243 graduated vs. fixed reward amounts, 92� F 93 to high-performing providers, 41, 84, Fee-for-service system, 34 85, 101 Funding for payment incentives level of award necessary to affect budget-neutral approaches, 65 behavior, 46�47 challenges to establishing, 61�62 measure sets for, 85�88 criteria for assessing possible sources, penalty system, 93�94 60, 64�65 performance improvement as basis for, direct investment model, 71�74, 75 9�10, 83�85, 100�101 existing funds model, 66�69, 75, 77, 78 policy issues, 8, 80�81, 101 generated savings model, 69�71, 75, 78 private sector pay-for-performance geographic pools, 77, 95 programs, 40�41, 62 long-term, 77�78 provider payout case example, 97�100 performance reporting incentives, 106 to providers meeting performance potential sources, 7, 61 thresholds, 90�91 private sector models, 62 public reporting and timing of, 107 public sector models, 62 recommendations, 9, 82, 85 recommendations, 7�8, 75, 78 size of reward, 100 research needs, 75 structural measures for, 90 reward pool design, 60�61, 65, 67, 75, 78 tournament-style reward structure, 91 reward size and, 100 for treatment of high-risk patients, 50, short-term implementation, 65�66, 74� 129 75 significance of, for pay-for-performance implementation, 6, 60�61 E single source of, 8 United Kingdom program, 63�64 Educational interventions current payment system, 25 shortcomings of current payment system, H 4 shortcomings of Medicare Harvard Pilgrim Health Care, 62 reimbursement, 33 Hawaii Blue Cross and Blue Shield, 22 Effectiveness of care, 1, 81 Healthcare Information Technology See also Clinical quality Standards Panel, 126 Efficiency of care Health Insurance Portability and aims, 1, 81 Accountability Act, 13, 124 as basis for performance reward, 81�83, Health maintenance organizations, 41 95�96 HealthPartners, 73 goals of payment system reform, 21�22 Health plan care performance measurement, 6, 51, 209 pay-for-performance implementation for, recommendations for payment incentive 215�216 program design, 9, 82 Health Plan Employer Data and shortcomings of current payment system, Information Set, 39�40, 87 4 Heart/Stroke Physician Recognition Electronic health records, 6, 88, 124, 125, Program, 41 127�128 Hemodialysis. Read the entire page →
From page 244... ... 244 INDEX recommendations for reward short-term funding models, 65�75 distribution, 9�10, 85 in skilled nursing facilities, 111�112, 219 relative comparisons, 91 specialist participation, 117�118 Hill Physicians Medical Group, 41 speed of, 112�117 Home health agencies steps involved in, 103�107 Medicare prospective payment system, timing, 101, 107�110 34�35, 147�148 variation across settings, 11�12, 27, Medicare public reporting efforts, 104, 110�112, 116�117 105 See also Funding for payment incentives pay-for-performance implementation, Infant mortality, 19 11, 110, 217�218 Innovation performance measurement, 148, 216� goals of payment incentives, 3 217 potential adverse consequences of Hospital Quality Alliance, 39 payment incentives, 4�5, 52 Hospitals Integrated Healthcare Association, 22, 39� health information technologies, 125 40, 62 Medicare prospective payment system, International comparisons, 19 34�35, 37, 145�146 See also United Kingdom Medicare public reporting efforts, 105 Medicare qualifications, 25 pay-for-performance implementation, L 11, 110, 211�212 Learning organizations, 135�137 performance measurement, 211 Learning system, 6, 14, 54, 55�56, 133� 134, 135�137 I Life expectancy, 19 Longitudinal measures of quality, 12, 18, 116 Implementation of payment incentives in ambulatory care settings, 213�215 benefits of collaboration, 39 M challenges, 23 delayed approach, 108�109 Massachusetts Blue Cross Blue Shield, 62 Medicare in dialysis facilities, 110, 209�211 funding pool considerations, 60�61, 65 current payment system, 4, 22, 23�26, health information technologies in, 13� 33�34, 55 current public reporting efforts, 104�105 14, 124�129 in home health care, 11, 110, 217�218 data collection, 43 in hospitals, 110, 211�212, 217�218 distribution of rewards among component parts, 97 Medicare restructuring to foster nationwide change, 27�28 expenditures, 4, 24, 35 monitoring, 12, 23, 44, 53, 54, 133�134 financing, 23 funding for payment incentives, 7�8 organization size as factor in, 115, 117 participation requirements, 112�116 future challenges, 20 performance measures, 6, 110�111 hemodialysis spending, 19 implementation of payment incentives, 6, phased approach, 5, 6, 28, 29, 55, 107, 110, 117 23, 27�28, 55 procedural and technical issues, 101, 102 influence of, in health care system, 26, 28, 43 public reporting of performance outcomes, 10�11, 103�106 model reward distribution using existing recommendations, 6, 12, 29�30, 32�33, funds, 67 pay-for-performance rationale, 5, 43 54�55, 75 research needs, 23 performance reporting requirements, 112�115 Read the entire page →
From page 245... ... INDEX 245 Physician Fee Schedule, 35 National Quality Coordination Board, 18, program assessment role, 136 140 prospective payment system, 34�35, 38, Nursing homes 145�151 Medicare payment system effects, 38 provider qualifications, 25 Medicare public reporting efforts, 105 Quality Improvement Organization, 18 See also Skilled nursing facilities recent pay-for-performance experiments, 38�39 recommendations for pay-for- P performance implementation, 6, 55 Pathways to Quality Health Care, 2, 17, 44, retrospective payment system, 34 scope of participation and benefits, 4, 116 23�24, 28, 147 Patient-centered care aims, 1, 81 utilization patterns and trends, 13, 19, 119 ambulatory care performance See also Centers for Medicare and assessment, 213 as basis for performance reward, 81�83, Medicaid Services Medicare Advantage program, 4, 11, 24, 95�96 33, 105, 110, 150�151 dialysis services assessment, 209 goals of payment system reform, 21�22 Medicare Management Performance Demonstration, 38�39 health plan performance assessment, 216 Medicare Payment Advisory Committee, 67, home health agency performance assessment, 217 110, 146, 180 Medicare Prescription Drug, Improvement, hospital performance assessment, 211 and Modernization Act (2003) , 2, 17, measurement, 20 performance measurement 39, 148 Medicare's Quality Improvement considerations, 6, 51 Organization Program: Maximizing recommendations for payment incentive program design, 9, 82 Potential, 2, 18, 135 Medicare Trust Funds, 7 shortcomings of current payment Monitoring of payment incentive programs system, 1 trends, 20 for distribution of rewards, 8 learning system approach, 6, 14, 54, 55� Pay for performance 56, 133�134, 135�137 barriers to provider participation, 11� 12, 116�117 payment incentive program implementation, 6, 12, 116�117 beneficiary rewards, 44�45 rationale, 4�5, 14, 23, 44, 48, 53, 54 common features of existing programs, 42�43 recommendations, 14, 134 scope of, 133 experiences outside of health care technology for, 6�7 sectors, 47 goals, 3, 29, 32, 44, 55 Mortality studies, 46 for high-performing providers, 9�10, 85 to improve coordination of care, 13, 122 N literature review, 154�167 performance improvement linkage, 2, 5, National Commitee for Quality Assurance 17, 22�23, 26, 29, 36�37, 46 Diabetes Physician Recognition Program, programs in United Kingdom, 42 41 quality improvement goals, 9, 20 Heart/Stroke Physician Recognition recent experiments, 3, 22�23, 38�42 Program, 41 research needs, 139�141 Physician Practice Connections, 41 research on program effects, 3, 36, 46� National Health Information Network, 126 48 Read the entire page →
From page 246... ... 246 INDEX stakeholder position statements data limitations, 88�89 nonspecialist groups, 170�172 dialysis services, 208�211 purchaser and consumer groups, domains of quality, 9, 21, 51, 81�83 177�178 in home health agencies, 216�217 specialist groups, 173�176 in hospitals, 211 in systemic approach to health care ideal characteristics, 134�135 reform, 5�6, 20, 27, 28, 44, 55 improving provider participation, 11�12, See also Adverse consequences of pay- 116�117 for-performance system; Distribution longitudinal measures, 12, 18, 116 of rewards; Funding for payment pay-for-performance implementation, 6, incentives; Implementation of 11, 103, 107, 108�109, 110�111 payment incentives for payment system assessment, 2, 17, 23 Payment systems in post-acute care settings, 148 current Medicare, 23�26, 33�34 potential adverse consequences of, 6, 29, current shortcomings, 1, 4, 19�20, 25� 51 26, 32, 33�34, 55, 80 provider participation requirements, 112 effects on provider behavior, 37�38, 46� provider resources for, 114 47 recent efforts, 20 excessive focus on, in health system recommendations for implementation, reform, 53 17�18 reform goals, 1�2 recommendations for improvement, 2, retrospective, 34 12 See also Prospective payment research needs, 137�139 Penalties for lack of improvement, 93�94 selection of measures, 85�86 Performance improvement shortcomings of current system, 18, 20� absolute thresholds, 90�91 21, 110 comparison groups, 94�95 in skilled nursing facilities, 219 defining, for distribution of incentive specialty care, 117�118 rewards, 83�85 stakeholder collaborations for, 14 payment incentive distribution starter set, 86�88 methodology, 9�10 statistical issues, 112, 129�130 payment incentive goals, 44 structural measures, 90 payment system linkage, 2, 17, 22�23, threshold setting, 91�92 29, 36�38, 46 Performance Measurement: Accelerating penalties for lack of, 93�94 Improvement, 2, 17�18, 51, 137�138 recommendations for public reporting, Physician Group Practice Demonstration, 10�11 38, 69 relative comparisons, 91 Physician�patient relationship, 29 research needs, 6�7 Physician Practice Connections, 41 rules for health care process redesign for, Physicians 15 distribution of rewards, 118�119 strategies for, 18 Medicare prospective payment system, technical assistance for, 18 34�35, 149�150 Performance measurement Medicare qualifications, 25 case mix considerations, 129�130 negative perceptions of payment system common features of existing pay-for- reform, 52�53 performance programs, 42�43 pay-for-performance implementation in composite measures, 89�90 private practice, 110 of coordination of care, 45 payment incentives as barrier to costs, 112, 130 performance improvement, 29 current measurement sets, 86 virtual groups, 119 Read the entire page →
From page 247... ... INDEX 247 Population health Quality of care international comparison, 19 ambulatory care performance patterns and trends, 19 assessment, 213 significance of Medicare practices, 26 consumer spending and, 19 Preferred provider organizations, 41 current Medicare payment system and, Premier Hospital Quality Incentive 4, 25�26, 33�34 Demonstration, 38 current shortcomings, 1, 15 Preventive care dialysis services assessment, 208�209 shortcomings of current payment system, domains of quality, 9, 21, 51, 95�96 1, 4 health plan performance assessment, 215 shortcomings of Medicare home health agency performance reimbursement, 33 assessment, 217 Primary care, 4, 27, 43, 52�53, 73, 120 hospital performance assessment, 211 Priority Areas for National Action: information technology to improve, 13 Transforming Health Care Quality, Medicare Advantage program, 150�151 71 Medicare provider qualifications, 25 Private sector payment system linkage, 3, 5 in collaborations for performance prospective payment system and, 146 measurement, 14, 23 public reporting of provider performance cost-shifting outcomes of payment and, 26 system reform, 53�54 recommendations for payment incentive pay-for-performance funding models in, program design, 9, 21�22, 82 62 See also Performance improvement; pay-for-performance in executive Clinical quality compensations, 47 recent pay-for-performance experiments, 39�41 R Prospective payment, 34�35, 37, 38 Regional Health Information Organizations, for home health care, 147�148 for inpatient hospital care, 145�146 126 Medicare programs, 145�151 Relative value of medical services, 1, 25�26 Research for outpatient dialysis services, 148�149 outpatient hospital care, 145�146 long-term funding for payment for physician services, 149�150 incentives program, 75 needs of pay-for-performance program, shortcomings of current system, 4, 26 for skilled nursing facilities, 146�147 139�141 Public reporting oversight, 140 pay-for-performance studies, 3, 36, 46�48 access to care decreased by, 50 costs, 105�106 payment incentive implementation, 23 current Medicare efforts, 104�105 payment system effects on provider behavior, 37�38 distribution of rewards and, 107 pay-for-performance implementation, 5, performance measurement, 137�139 10�11, 12, 103�106 performance monitoring, 6�7 Retrospective payment system, 34 quality of care and, 26 rationale, 103�104 Risk adjustment, 48�50, 129�130 Q S Quality Improvement Organizations, 18, 52, Safety of care aims, 1, 81 94, 128 as basis for performance reward, 81 Read the entire page →
From page 248... ... 248 INDEX Settings for care performance measurement, 117�118 defining comparison groups for reward shortcomings of current payment distribution, 94�95 system, 4 distribution of rewards, 118�119 Sustainable growth rate, 8, 35, 66, 68, 75, funding sources for payment incentive 149 programs, 7, 8 health information technologies for, 125 implementation of pay-for-performance, T 11�12, 27, 110�112, 116�117 Medicare prospective payment system, Technical assistance for quality improvement, 18 145�151 Medicare spending, 35 Timeliness of care, 1, 81 performance measurement and, 11�12, To Err Is Human: Building a Safer Health System, 15 116�117 size of organizations, 115 Size of reward, 100 U Skilled nursing facilities Medicare payment system effects, 38 United Kingdom, 42, 63�64 Medicare prospective payment system, Utilization 34�35, 146�147 consumer spending, 18�19 pay-for-performance implementation, Medicare patterns and trends, 13, 19, 111�112, 219 37, 119 performance measurement, 219 shortcomings of current Medicare Social Security Act, 2, 17 payment system, 25�26, 80 Specialization specialty care, 117 implementation of pay-for-performance, 118 patterns, 117 V pay-for-performance programs, 43 Virtual groups, 119, 122�123 Read the entire page →

From page 241...

... Index A Ambulatory care Quality Alliance, 39, 179 Ambulatory payment classification, 146 Access to care American Health Information Community, performance measurement and, 6 126 potential adverse consequences of Anthem Blue Cross and Blue Shield, 22 payment incentives, 4�5, 29, 48�50 of New Hampshire, 41, 62 Accountability for coordination of care, 120�121, 123� 124 B goals of payment system reform, 8 public reporting for, 10�11, 103�104, Bridges to Excellence, 40�41, 62, 67 106 Physician Practice Connections, 41 Administrative data, 88, 103 Bundled payments, 4, 26, 33, 35, 145 Adverse consequences of pay-for performance system causes, 22, 28, 29 C inequitable or decreased access, 29, 48� Case management, 33 51 Centers for Medicare and Medicaid Services managing to measures, 29, 51 current payment incentive programs, 3, monitoring rationale, 4�5, 48, 53, 54 62 obstacles to knowledge transfer and leadership for health care improvement, innovation, 4�5, 29, 51�52 28, 137 potential scope of, 4�5, 48 performance reporting program, 11�12 provider attitudes and perceptions, 52� recommendations to improve 53 coordination of care, 13, 122 quality of care, 9, 29 See also Medicare Agency for Healthcare Research and Certification and licensure Quality, 126 Medicare provider qualifications, 25 Ambulatory care, 212�215 payment incentive programs and, 5 241

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From page 242...

... 242 INDEX Certification Commission for Healthcare limitations of current efforts, 88�89 Information Technology, 128 Medicare data collection efforts, 43 Chart data, 88, 103 Medicare demonstration projects, 38�39 Chronic heart failure, 180 pay-for-performance implementation, 5, Clinical quality 13, 103 as basis for performance reward provider feedback, 103 distribution, 81�83, 95�96 for quality improvement, 13 goals of payment system reform, 3, 20, recommendations for, 14, 128�129 21�22, 44 See also Performance measurement; Collaborative efforts, 39 Public reporting Competition, in health care delivery system, Demonstration projects, 3, 14, 22, 38�39, 29, 52 139�140 Connecting for Health, 126 Department of Health and Human Services Consolidated Health Informatics, 126 current payment incentive programs, 3 Consumer Assessment of Healthcare information technology promotion, 14, Providers and Systems, 87, 109, 209� 126, 128�129 219 monitoring of pay-for-performance Coordination of care program, 14, 134 accountable source of care, 120�121, public reporting role, 10�11, 106 123�124 recommendations for, 6, 8, 10�11, 12, beneficiary role in, 123�124 14, 55, 78, 85, 106, 116�117, 128� goals of payment system reform, 3, 8, 45 129, 134 importance of, 124 Diabetes, 19, 180 performance measurement, 45 Diagnosis-related groups, 145�146 rationale, 13 Dialysis, 19 recommendations, 13, 122 Dialysis facilities rewards for, 123 Medicare prospective payment system, shortcomings of current delivery system, 148�149, 208 1, 4, 33, 45, 119�120 Medicare spending, 19 Coronary artery disease, 180 pay-for-performance implementation, Cost of care 110, 209�211 consumer spending, 18�19 performance measurement, 208�209 federal spending, 24 Diffusion of knowledge and best practices goals of payment system reform, 3, 21� health information technologies, 124�128 22 payment incentive program as obstacle health information technologies, 127 to, 29, 51�52 hospital management strategies, 145�146 Disease management models, 38�39 international comparisons, 19 Distribution of rewards Medicare spending, 4, 24 to ambulatory care settings, 215 quality of care and, 19 among Medicare parts, 97 Cost shifting behavior, 53�54 beneficiary rewards, 44�45 Crossing the Quality Chasm: A New Health by care settings, 118�119 System for the 21st Century, 1, 15, composite measures for, 89�90 71, 81 condition-based system, 89 data collection for, 88�89 defining comparison groups for, 94�95 D to dialysis facilities, 211 domains of care as basis for, 9, 81�83, Data collection and management 95�96, 100�101 data auditing, 103 existing funds model, 66�69 health information technologies, 124� generated savings model, 69�71 129

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From page 243...

... INDEX 243 graduated vs. fixed reward amounts, 92� F 93 to high-performing providers, 41, 84, Fee-for-service system, 34 85, 101 Funding for payment incentives level of award necessary to affect budget-neutral approaches, 65 behavior, 46�47 challenges to establishing, 61�62 measure sets for, 85�88 criteria for assessing possible sources, penalty system, 93�94 60, 64�65 performance improvement as basis for, direct investment model, 71�74, 75 9�10, 83�85, 100�101 existing funds model, 66�69, 75, 77, 78 policy issues, 8, 80�81, 101 generated savings model, 69�71, 75, 78 private sector pay-for-performance geographic pools, 77, 95 programs, 40�41, 62 long-term, 77�78 provider payout case example, 97�100 performance reporting incentives, 106 to providers meeting performance potential sources, 7, 61 thresholds, 90�91 private sector models, 62 public reporting and timing of, 107 public sector models, 62 recommendations, 9, 82, 85 recommendations, 7�8, 75, 78 size of reward, 100 research needs, 75 structural measures for, 90 reward pool design, 60�61, 65, 67, 75, 78 tournament-style reward structure, 91 reward size and, 100 for treatment of high-risk patients, 50, short-term implementation, 65�66, 74� 129 75 significance of, for pay-for-performance implementation, 6, 60�61 E single source of, 8 United Kingdom program, 63�64 Educational interventions current payment system, 25 shortcomings of current payment system, H 4 shortcomings of Medicare Harvard Pilgrim Health Care, 62 reimbursement, 33 Hawaii Blue Cross and Blue Shield, 22 Effectiveness of care, 1, 81 Healthcare Information Technology See also Clinical quality Standards Panel, 126 Efficiency of care Health Insurance Portability and aims, 1, 81 Accountability Act, 13, 124 as basis for performance reward, 81�83, Health maintenance organizations, 41 95�96 HealthPartners, 73 goals of payment system reform, 21�22 Health plan care performance measurement, 6, 51, 209 pay-for-performance implementation for, recommendations for payment incentive 215�216 program design, 9, 82 Health Plan Employer Data and shortcomings of current payment system, Information Set, 39�40, 87 4 Heart/Stroke Physician Recognition Electronic health records, 6, 88, 124, 125, Program, 41 127�128 Hemodialysis.

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From page 244...

... 244 INDEX recommendations for reward short-term funding models, 65�75 distribution, 9�10, 85 in skilled nursing facilities, 111�112, 219 relative comparisons, 91 specialist participation, 117�118 Hill Physicians Medical Group, 41 speed of, 112�117 Home health agencies steps involved in, 103�107 Medicare prospective payment system, timing, 101, 107�110 34�35, 147�148 variation across settings, 11�12, 27, Medicare public reporting efforts, 104, 110�112, 116�117 105 See also Funding for payment incentives pay-for-performance implementation, Infant mortality, 19 11, 110, 217�218 Innovation performance measurement, 148, 216� goals of payment incentives, 3 217 potential adverse consequences of Hospital Quality Alliance, 39 payment incentives, 4�5, 52 Hospitals Integrated Healthcare Association, 22, 39� health information technologies, 125 40, 62 Medicare prospective payment system, International comparisons, 19 34�35, 37, 145�146 See also United Kingdom Medicare public reporting efforts, 105 Medicare qualifications, 25 pay-for-performance implementation, L 11, 110, 211�212 Learning organizations, 135�137 performance measurement, 211 Learning system, 6, 14, 54, 55�56, 133� 134, 135�137 I Life expectancy, 19 Longitudinal measures of quality, 12, 18, 116 Implementation of payment incentives in ambulatory care settings, 213�215 benefits of collaboration, 39 M challenges, 23 delayed approach, 108�109 Massachusetts Blue Cross Blue Shield, 62 Medicare in dialysis facilities, 110, 209�211 funding pool considerations, 60�61, 65 current payment system, 4, 22, 23�26, health information technologies in, 13� 33�34, 55 current public reporting efforts, 104�105 14, 124�129 in home health care, 11, 110, 217�218 data collection, 43 in hospitals, 110, 211�212, 217�218 distribution of rewards among component parts, 97 Medicare restructuring to foster nationwide change, 27�28 expenditures, 4, 24, 35 monitoring, 12, 23, 44, 53, 54, 133�134 financing, 23 funding for payment incentives, 7�8 organization size as factor in, 115, 117 participation requirements, 112�116 future challenges, 20 performance measures, 6, 110�111 hemodialysis spending, 19 implementation of payment incentives, 6, phased approach, 5, 6, 28, 29, 55, 107, 110, 117 23, 27�28, 55 procedural and technical issues, 101, 102 influence of, in health care system, 26, 28, 43 public reporting of performance outcomes, 10�11, 103�106 model reward distribution using existing recommendations, 6, 12, 29�30, 32�33, funds, 67 pay-for-performance rationale, 5, 43 54�55, 75 research needs, 23 performance reporting requirements, 112�115

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From page 245...

... INDEX 245 Physician Fee Schedule, 35 National Quality Coordination Board, 18, program assessment role, 136 140 prospective payment system, 34�35, 38, Nursing homes 145�151 Medicare payment system effects, 38 provider qualifications, 25 Medicare public reporting efforts, 105 Quality Improvement Organization, 18 See also Skilled nursing facilities recent pay-for-performance experiments, 38�39 recommendations for pay-for- P performance implementation, 6, 55 Pathways to Quality Health Care, 2, 17, 44, retrospective payment system, 34 scope of participation and benefits, 4, 116 23�24, 28, 147 Patient-centered care aims, 1, 81 utilization patterns and trends, 13, 19, 119 ambulatory care performance See also Centers for Medicare and assessment, 213 as basis for performance reward, 81�83, Medicaid Services Medicare Advantage program, 4, 11, 24, 95�96 33, 105, 110, 150�151 dialysis services assessment, 209 goals of payment system reform, 21�22 Medicare Management Performance Demonstration, 38�39 health plan performance assessment, 216 Medicare Payment Advisory Committee, 67, home health agency performance assessment, 217 110, 146, 180 Medicare Prescription Drug, Improvement, hospital performance assessment, 211 and Modernization Act (2003) , 2, 17, measurement, 20 performance measurement 39, 148 Medicare's Quality Improvement considerations, 6, 51 Organization Program: Maximizing recommendations for payment incentive program design, 9, 82 Potential, 2, 18, 135 Medicare Trust Funds, 7 shortcomings of current payment Monitoring of payment incentive programs system, 1 trends, 20 for distribution of rewards, 8 learning system approach, 6, 14, 54, 55� Pay for performance 56, 133�134, 135�137 barriers to provider participation, 11� 12, 116�117 payment incentive program implementation, 6, 12, 116�117 beneficiary rewards, 44�45 rationale, 4�5, 14, 23, 44, 48, 53, 54 common features of existing programs, 42�43 recommendations, 14, 134 scope of, 133 experiences outside of health care technology for, 6�7 sectors, 47 goals, 3, 29, 32, 44, 55 Mortality studies, 46 for high-performing providers, 9�10, 85 to improve coordination of care, 13, 122 N literature review, 154�167 performance improvement linkage, 2, 5, National Commitee for Quality Assurance 17, 22�23, 26, 29, 36�37, 46 Diabetes Physician Recognition Program, programs in United Kingdom, 42 41 quality improvement goals, 9, 20 Heart/Stroke Physician Recognition recent experiments, 3, 22�23, 38�42 Program, 41 research needs, 139�141 Physician Practice Connections, 41 research on program effects, 3, 36, 46� National Health Information Network, 126 48

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From page 246...

... 246 INDEX stakeholder position statements data limitations, 88�89 nonspecialist groups, 170�172 dialysis services, 208�211 purchaser and consumer groups, domains of quality, 9, 21, 51, 81�83 177�178 in home health agencies, 216�217 specialist groups, 173�176 in hospitals, 211 in systemic approach to health care ideal characteristics, 134�135 reform, 5�6, 20, 27, 28, 44, 55 improving provider participation, 11�12, See also Adverse consequences of pay- 116�117 for-performance system; Distribution longitudinal measures, 12, 18, 116 of rewards; Funding for payment pay-for-performance implementation, 6, incentives; Implementation of 11, 103, 107, 108�109, 110�111 payment incentives for payment system assessment, 2, 17, 23 Payment systems in post-acute care settings, 148 current Medicare, 23�26, 33�34 potential adverse consequences of, 6, 29, current shortcomings, 1, 4, 19�20, 25� 51 26, 32, 33�34, 55, 80 provider participation requirements, 112 effects on provider behavior, 37�38, 46� provider resources for, 114 47 recent efforts, 20 excessive focus on, in health system recommendations for implementation, reform, 53 17�18 reform goals, 1�2 recommendations for improvement, 2, retrospective, 34 12 See also Prospective payment research needs, 137�139 Penalties for lack of improvement, 93�94 selection of measures, 85�86 Performance improvement shortcomings of current system, 18, 20� absolute thresholds, 90�91 21, 110 comparison groups, 94�95 in skilled nursing facilities, 219 defining, for distribution of incentive specialty care, 117�118 rewards, 83�85 stakeholder collaborations for, 14 payment incentive distribution starter set, 86�88 methodology, 9�10 statistical issues, 112, 129�130 payment incentive goals, 44 structural measures, 90 payment system linkage, 2, 17, 22�23, threshold setting, 91�92 29, 36�38, 46 Performance Measurement: Accelerating penalties for lack of, 93�94 Improvement, 2, 17�18, 51, 137�138 recommendations for public reporting, Physician Group Practice Demonstration, 10�11 38, 69 relative comparisons, 91 Physician�patient relationship, 29 research needs, 6�7 Physician Practice Connections, 41 rules for health care process redesign for, Physicians 15 distribution of rewards, 118�119 strategies for, 18 Medicare prospective payment system, technical assistance for, 18 34�35, 149�150 Performance measurement Medicare qualifications, 25 case mix considerations, 129�130 negative perceptions of payment system common features of existing pay-for- reform, 52�53 performance programs, 42�43 pay-for-performance implementation in composite measures, 89�90 private practice, 110 of coordination of care, 45 payment incentives as barrier to costs, 112, 130 performance improvement, 29 current measurement sets, 86 virtual groups, 119

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From page 247...

... INDEX 247 Population health Quality of care international comparison, 19 ambulatory care performance patterns and trends, 19 assessment, 213 significance of Medicare practices, 26 consumer spending and, 19 Preferred provider organizations, 41 current Medicare payment system and, Premier Hospital Quality Incentive 4, 25�26, 33�34 Demonstration, 38 current shortcomings, 1, 15 Preventive care dialysis services assessment, 208�209 shortcomings of current payment system, domains of quality, 9, 21, 51, 95�96 1, 4 health plan performance assessment, 215 shortcomings of Medicare home health agency performance reimbursement, 33 assessment, 217 Primary care, 4, 27, 43, 52�53, 73, 120 hospital performance assessment, 211 Priority Areas for National Action: information technology to improve, 13 Transforming Health Care Quality, Medicare Advantage program, 150�151 71 Medicare provider qualifications, 25 Private sector payment system linkage, 3, 5 in collaborations for performance prospective payment system and, 146 measurement, 14, 23 public reporting of provider performance cost-shifting outcomes of payment and, 26 system reform, 53�54 recommendations for payment incentive pay-for-performance funding models in, program design, 9, 21�22, 82 62 See also Performance improvement; pay-for-performance in executive Clinical quality compensations, 47 recent pay-for-performance experiments, 39�41 R Prospective payment, 34�35, 37, 38 Regional Health Information Organizations, for home health care, 147�148 for inpatient hospital care, 145�146 126 Medicare programs, 145�151 Relative value of medical services, 1, 25�26 Research for outpatient dialysis services, 148�149 outpatient hospital care, 145�146 long-term funding for payment for physician services, 149�150 incentives program, 75 needs of pay-for-performance program, shortcomings of current system, 4, 26 for skilled nursing facilities, 146�147 139�141 Public reporting oversight, 140 pay-for-performance studies, 3, 36, 46�48 access to care decreased by, 50 costs, 105�106 payment incentive implementation, 23 current Medicare efforts, 104�105 payment system effects on provider behavior, 37�38 distribution of rewards and, 107 pay-for-performance implementation, 5, performance measurement, 137�139 10�11, 12, 103�106 performance monitoring, 6�7 Retrospective payment system, 34 quality of care and, 26 rationale, 103�104 Risk adjustment, 48�50, 129�130 Q S Quality Improvement Organizations, 18, 52, Safety of care aims, 1, 81 94, 128 as basis for performance reward, 81

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... 248 INDEX Settings for care performance measurement, 117�118 defining comparison groups for reward shortcomings of current payment distribution, 94�95 system, 4 distribution of rewards, 118�119 Sustainable growth rate, 8, 35, 66, 68, 75, funding sources for payment incentive 149 programs, 7, 8 health information technologies for, 125 implementation of pay-for-performance, T 11�12, 27, 110�112, 116�117 Medicare prospective payment system, Technical assistance for quality improvement, 18 145�151 Medicare spending, 35 Timeliness of care, 1, 81 performance measurement and, 11�12, To Err Is Human: Building a Safer Health System, 15 116�117 size of organizations, 115 Size of reward, 100 U Skilled nursing facilities Medicare payment system effects, 38 United Kingdom, 42, 63�64 Medicare prospective payment system, Utilization 34�35, 146�147 consumer spending, 18�19 pay-for-performance implementation, Medicare patterns and trends, 13, 19, 111�112, 219 37, 119 performance measurement, 219 shortcomings of current Medicare Social Security Act, 2, 17 payment system, 25�26, 80 Specialization specialty care, 117 implementation of pay-for-performance, 118 patterns, 117 V pay-for-performance programs, 43 Virtual groups, 119, 122�123

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Index Pages 241-248

Index
Pages 241-248