The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
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, 45, 29, 4850 of New Hampshire, 41, 62 Accountability for coordination of care, 120121, 123 124 B goals of payment system reform, 8 public reporting for, 1011, 103104, Bridges to Excellence, 4041, 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, 45, 48, 53, 54 62 obstacles to knowledge transfer and leadership for health care improvement, innovation, 45, 29, 5152 28, 137 potential scope of, 45, 48 performance reporting program, 1112 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, 212215 payment incentive programs and, 5 241
|
From page 242... ...
242 INDEX Certification Commission for Healthcare limitations of current efforts, 8889 Information Technology, 128 Medicare data collection efforts, 43 Chart data, 88, 103 Medicare demonstration projects, 3839 Chronic heart failure, 180 pay-for-performance implementation, 5, Clinical quality 13, 103 as basis for performance reward provider feedback, 103 distribution, 8183, 9596 for quality improvement, 13 goals of payment system reform, 3, 20, recommendations for, 14, 128129 2122, 44 See also Performance measurement; Collaborative efforts, 39 Public reporting Competition, in health care delivery system, Demonstration projects, 3, 14, 22, 3839, 29, 52 139140 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, 128129 219 monitoring of pay-for-performance Coordination of care program, 14, 134 accountable source of care, 120121, public reporting role, 1011, 106 123124 recommendations for, 6, 8, 1011, 12, beneficiary role in, 123124 14, 55, 78, 85, 106, 116117, 128 goals of payment system reform, 3, 8, 45 129, 134 importance of, 124 Diabetes, 19, 180 performance measurement, 45 Diagnosis-related groups, 145146 rationale, 13 Dialysis, 19 recommendations, 13, 122 Dialysis facilities rewards for, 123 Medicare prospective payment system, shortcomings of current delivery system, 148149, 208 1, 4, 33, 45, 119120 Medicare spending, 19 Coronary artery disease, 180 pay-for-performance implementation, Cost of care 110, 209211 consumer spending, 1819 performance measurement, 208209 federal spending, 24 Diffusion of knowledge and best practices goals of payment system reform, 3, 21 health information technologies, 124128 22 payment incentive program as obstacle health information technologies, 127 to, 29, 5152 hospital management strategies, 145146 Disease management models, 3839 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, 5354 beneficiary rewards, 4445 Crossing the Quality Chasm: A New Health by care settings, 118119 System for the 21st Century, 1, 15, composite measures for, 8990 71, 81 condition-based system, 89 data collection for, 8889 defining comparison groups for, 9495 D to dialysis facilities, 211 domains of care as basis for, 9, 8183, Data collection and management 9596, 100101 data auditing, 103 existing funds model, 6669 health information technologies, 124 generated savings model, 6971 129
|
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, 4647 challenges to establishing, 6162 measure sets for, 8588 criteria for assessing possible sources, penalty system, 9394 60, 6465 performance improvement as basis for, direct investment model, 7174, 75 910, 8385, 100101 existing funds model, 6669, 75, 77, 78 policy issues, 8, 8081, 101 generated savings model, 6971, 75, 78 private sector pay-for-performance geographic pools, 77, 95 programs, 4041, 62 long-term, 7778 provider payout case example, 97100 performance reporting incentives, 106 to providers meeting performance potential sources, 7, 61 thresholds, 9091 private sector models, 62 public reporting and timing of, 107 public sector models, 62 recommendations, 9, 82, 85 recommendations, 78, 75, 78 size of reward, 100 research needs, 75 structural measures for, 90 reward pool design, 6061, 65, 67, 75, 78 tournament-style reward structure, 91 reward size and, 100 for treatment of high-risk patients, 50, short-term implementation, 6566, 74 129 75 significance of, for pay-for-performance implementation, 6, 6061 E single source of, 8 United Kingdom program, 6364 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, 8183, Health maintenance organizations, 41 9596 HealthPartners, 73 goals of payment system reform, 2122 Health plan care performance measurement, 6, 51, 209 pay-for-performance implementation for, recommendations for payment incentive 215216 program design, 9, 82 Health Plan Employer Data and shortcomings of current payment system, Information Set, 3940, 87 4 Heart/Stroke Physician Recognition Electronic health records, 6, 88, 124, 125, Program, 41 127128 Hemodialysis.
|
From page 244... ...
244 INDEX recommendations for reward short-term funding models, 6575 distribution, 910, 85 in skilled nursing facilities, 111112, 219 relative comparisons, 91 specialist participation, 117118 Hill Physicians Medical Group, 41 speed of, 112117 Home health agencies steps involved in, 103107 Medicare prospective payment system, timing, 101, 107110 3435, 147148 variation across settings, 1112, 27, Medicare public reporting efforts, 104, 110112, 116117 105 See also Funding for payment incentives pay-for-performance implementation, Infant mortality, 19 11, 110, 217218 Innovation performance measurement, 148, 216 goals of payment incentives, 3 217 potential adverse consequences of Hospital Quality Alliance, 39 payment incentives, 45, 52 Hospitals Integrated Healthcare Association, 22, 39 health information technologies, 125 40, 62 Medicare prospective payment system, International comparisons, 19 3435, 37, 145146 See also United Kingdom Medicare public reporting efforts, 105 Medicare qualifications, 25 pay-for-performance implementation, L 11, 110, 211212 Learning organizations, 135137 performance measurement, 211 Learning system, 6, 14, 54, 5556, 133 134, 135137 I Life expectancy, 19 Longitudinal measures of quality, 12, 18, 116 Implementation of payment incentives in ambulatory care settings, 213215 benefits of collaboration, 39 M challenges, 23 delayed approach, 108109 Massachusetts Blue Cross Blue Shield, 62 Medicare in dialysis facilities, 110, 209211 funding pool considerations, 6061, 65 current payment system, 4, 22, 2326, health information technologies in, 13 3334, 55 current public reporting efforts, 104105 14, 124129 in home health care, 11, 110, 217218 data collection, 43 in hospitals, 110, 211212, 217218 distribution of rewards among component parts, 97 Medicare restructuring to foster nationwide change, 2728 expenditures, 4, 24, 35 monitoring, 12, 23, 44, 53, 54, 133134 financing, 23 funding for payment incentives, 78 organization size as factor in, 115, 117 participation requirements, 112116 future challenges, 20 performance measures, 6, 110111 hemodialysis spending, 19 implementation of payment incentives, 6, phased approach, 5, 6, 28, 29, 55, 107, 110, 117 23, 2728, 55 procedural and technical issues, 101, 102 influence of, in health care system, 26, 28, 43 public reporting of performance outcomes, 1011, 103106 model reward distribution using existing recommendations, 6, 12, 2930, 3233, funds, 67 pay-for-performance rationale, 5, 43 5455, 75 research needs, 23 performance reporting requirements, 112115
|
From page 245... ...
INDEX 245 Physician Fee Schedule, 35 National Quality Coordination Board, 18, program assessment role, 136 140 prospective payment system, 3435, 38, Nursing homes 145151 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, 3839 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 2324, 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, 8183, Medicaid Services Medicare Advantage program, 4, 11, 24, 9596 33, 105, 110, 150151 dialysis services assessment, 209 goals of payment system reform, 2122 Medicare Management Performance Demonstration, 3839 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, 133134, 135137 barriers to provider participation, 11 12, 116117 payment incentive program implementation, 6, 12, 116117 beneficiary rewards, 4445 rationale, 45, 14, 23, 44, 48, 53, 54 common features of existing programs, 4243 recommendations, 14, 134 scope of, 133 experiences outside of health care technology for, 67 sectors, 47 goals, 3, 29, 32, 44, 55 Mortality studies, 46 for high-performing providers, 910, 85 to improve coordination of care, 13, 122 N literature review, 154167 performance improvement linkage, 2, 5, National Commitee for Quality Assurance 17, 2223, 26, 29, 3637, 46 Diabetes Physician Recognition Program, programs in United Kingdom, 42 41 quality improvement goals, 9, 20 Heart/Stroke Physician Recognition recent experiments, 3, 2223, 3842 Program, 41 research needs, 139141 Physician Practice Connections, 41 research on program effects, 3, 36, 46 National Health Information Network, 126 48
|
From page 246... ...
246 INDEX stakeholder position statements data limitations, 8889 nonspecialist groups, 170172 dialysis services, 208211 purchaser and consumer groups, domains of quality, 9, 21, 51, 8183 177178 in home health agencies, 216217 specialist groups, 173176 in hospitals, 211 in systemic approach to health care ideal characteristics, 134135 reform, 56, 20, 27, 28, 44, 55 improving provider participation, 1112, See also Adverse consequences of pay- 116117 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, 108109, 110111 payment incentives for payment system assessment, 2, 17, 23 Payment systems in post-acute care settings, 148 current Medicare, 2326, 3334 potential adverse consequences of, 6, 29, current shortcomings, 1, 4, 1920, 25 51 26, 32, 3334, 55, 80 provider participation requirements, 112 effects on provider behavior, 3738, 46 provider resources for, 114 47 recent efforts, 20 excessive focus on, in health system recommendations for implementation, reform, 53 1718 reform goals, 12 recommendations for improvement, 2, retrospective, 34 12 See also Prospective payment research needs, 137139 Penalties for lack of improvement, 9394 selection of measures, 8586 Performance improvement shortcomings of current system, 18, 20 absolute thresholds, 9091 21, 110 comparison groups, 9495 in skilled nursing facilities, 219 defining, for distribution of incentive specialty care, 117118 rewards, 8385 stakeholder collaborations for, 14 payment incentive distribution starter set, 8688 methodology, 910 statistical issues, 112, 129130 payment incentive goals, 44 structural measures, 90 payment system linkage, 2, 17, 2223, threshold setting, 9192 29, 3638, 46 Performance Measurement: Accelerating penalties for lack of, 9394 Improvement, 2, 1718, 51, 137138 recommendations for public reporting, Physician Group Practice Demonstration, 1011 38, 69 relative comparisons, 91 Physicianpatient relationship, 29 research needs, 67 Physician Practice Connections, 41 rules for health care process redesign for, Physicians 15 distribution of rewards, 118119 strategies for, 18 Medicare prospective payment system, technical assistance for, 18 3435, 149150 Performance measurement Medicare qualifications, 25 case mix considerations, 129130 negative perceptions of payment system common features of existing pay-for- reform, 5253 performance programs, 4243 pay-for-performance implementation in composite measures, 8990 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
|
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, 2526, 3334 Demonstration, 38 current shortcomings, 1, 15 Preventive care dialysis services assessment, 208209 shortcomings of current payment system, domains of quality, 9, 21, 51, 9596 1, 4 health plan performance assessment, 215 shortcomings of Medicare home health agency performance reimbursement, 33 assessment, 217 Primary care, 4, 27, 43, 5253, 73, 120 hospital performance assessment, 211 Priority Areas for National Action: information technology to improve, 13 Transforming Health Care Quality, Medicare Advantage program, 150151 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, 5354 recommendations for payment incentive pay-for-performance funding models in, program design, 9, 2122, 82 62 See also Performance improvement; pay-for-performance in executive Clinical quality compensations, 47 recent pay-for-performance experiments, 3941 R Prospective payment, 3435, 37, 38 Regional Health Information Organizations, for home health care, 147148 for inpatient hospital care, 145146 126 Medicare programs, 145151 Relative value of medical services, 1, 2526 Research for outpatient dialysis services, 148149 outpatient hospital care, 145146 long-term funding for payment for physician services, 149150 incentives program, 75 needs of pay-for-performance program, shortcomings of current system, 4, 26 for skilled nursing facilities, 146147 139141 Public reporting oversight, 140 pay-for-performance studies, 3, 36, 4648 access to care decreased by, 50 costs, 105106 payment incentive implementation, 23 current Medicare efforts, 104105 payment system effects on provider behavior, 3738 distribution of rewards and, 107 pay-for-performance implementation, 5, performance measurement, 137139 1011, 12, 103106 performance monitoring, 67 Retrospective payment system, 34 quality of care and, 26 rationale, 103104 Risk adjustment, 4850, 129130 Q S Quality Improvement Organizations, 18, 52, Safety of care aims, 1, 81 94, 128 as basis for performance reward, 81
|
From page 248... ...
248 INDEX Settings for care performance measurement, 117118 defining comparison groups for reward shortcomings of current payment distribution, 9495 system, 4 distribution of rewards, 118119 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 1112, 27, 110112, 116117 Medicare prospective payment system, Technical assistance for quality improvement, 18 145151 Medicare spending, 35 Timeliness of care, 1, 81 performance measurement and, 1112, To Err Is Human: Building a Safer Health System, 15 116117 size of organizations, 115 Size of reward, 100 U Skilled nursing facilities Medicare payment system effects, 38 United Kingdom, 42, 6364 Medicare prospective payment system, Utilization 3435, 146147 consumer spending, 1819 pay-for-performance implementation, Medicare patterns and trends, 13, 19, 111112, 219 37, 119 performance measurement, 219 shortcomings of current Medicare Social Security Act, 2, 17 payment system, 2526, 80 Specialization specialty care, 117 implementation of pay-for-performance, 118 patterns, 117 V pay-for-performance programs, 43 Virtual groups, 119, 122123
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.