National Academies Press: OpenBook

Rewarding Provider Performance: Aligning Incentives in Medicare (2007)

Chapter: Appendix B: Review of the Evidence

« Previous: Appendix A: Selected Medicare Prospective Payment Systems
Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×

B
Review of the Evidence

Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×

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 1980 to April 1983; 36 SNFs (18 study facilities; 18 control facilities)

Level: payment system

Type: bonus

Duration: admission incentive up to 4 y; outcome and discharge incentives 1 to 2 y

Admission incentive: per diem bonus for type D ($5) and E ($3 to $28) patients (vs. $36 reimbursement)

Outcome incentive: improved health status within 90 d (measured by ADL classification); $126 to $370 per case (range of bonus)

Discharge incentive: timely discharge and resident did not return within 90 d; $60 to $230 (range of bonus); type A patients not eligible

Payment frequency: NS

Shen, 2003

CBA; FY 1991 to 1995; 5552 clients (2367 OSA clients; 3185 Medicaid clients)

Level: payment system

Type: PBC

Duration: FY 1993 to 1995

Description: additional funds based on efficiency, effectiveness, and service to special populations

Efficiency: minimum service delivery (% of contracted amount); minimum service to primary clients (% of units delivered)

Effectiveness: abstinence/drug-free 30 d before termination; reduction of use of primary substance abuse problem; maintaining employment; employability; employment improvement; reduction in number of problems with employer; reduction in absenteeism; not arrested; participation in self-help during treatment; reduction of problems with spouse/family members

Special populations: female; age 0 to 19 y; age ≥50 y; corrections; homeless; concurrent psychological problems; history of IV drug use; polydrug use

Payment frequency: yearly

Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×

Domains of Quality

Analysis and Results

Overall Effectb

Methodologic Strengthc

Access; outcome

Markov model

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 admission or death (P < 0.001)

Positive

3

Access

Probit specification (regression)

Significant decrease in the likelihood that an OSA patient was a “most severe user” after PBC implementation compared with the likelihood of a Medicaid (control) patient; coefficient = −0.74; t-value = 3.26; P ≤ 0.01

Negative

2

Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×

Reference

Study Design

Incentives

Clark et al., 1995

CBA; July 1992; 7

CMHCs; 185 clients (95 in TCM and 90 in CTT)

Level: provider group

Type: enhanced FFS

Duration: NA

Description: CMHCs received $15.75 per 15 min spent in community settings delivering MIMS

Payment frequency: FFS

Hillman et al., 1998

RCT (2 arms); 1993 to 1995; 52 PC sites (26 intervention; 26 control)

Level: provider group

Type: bonus

Duration: 18 mo

Description: compliance with cancer screening for women age ≥50 y; aggregate compliance scores and improvement in scores over time; full and partial bonuses (20%; 10% of capitation); range of bonus per site, $570 to $1260

Payment frequency: every 6 mo

Kouides et al., 1998

RCT (2 arms); September to December 1991; 54 solo/group practices (27 intervention; 27 control)

Level: provider group

Type: bonus

Duration: 4 mo

Description: influenza immunization rate ($8 standard fee); if rate >70%, bonus of $0.80 per immunization; if rate >85%, bonus of $1.60

Payment frequency: one time (end of study)

Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×

Domains of Quality

Analysis and Results

Overall Effectb

Methodologic Strengthc

Access

Student t-test for paired comparisons; MANOVA

Student t-test: average weekly time spent in community treatment per client increased after the payment change (30.71 min vs. 38.61 min; P < 0.05)

Office-based case management weekly time per client decreased (32.96 min vs. 23.31 min; P < 0.001)

Total case manager average weekly time per client was not significantly different (63.68 min vs. 61.93 min)

MANOVA: after the payment change, center-based treatment time decreased (F-value = 10.41; P = 0.001). The increase in community minutes had an F-value of 3.72 (P = 0.055). Program type and Medicaid status were not associated with change in time in community vs. mental health center

Partial effect

2

Process

Repeated-measures ANOVA

Absolute increase in total mean compliance scores for intervention group from baseline was 26.3%; control group was 26.4%. No significant differences between the groups

No effect

3

Process

Linear regression

Absolute increase in immunization rates (from 1990 [baseline] to 1991) was 6.8%; P = 0.03

Positive

3

Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×

Reference

Study Design

Incentives

Hillman et al., 1999

RCT (3 arms); 1993 to 1995; 49 PC sites (19 FB+I; 15 FBO; 15 control)

Level: provider group

Type: bonus

Duration: 18 mo

Description: pediatric immunizations; well-child visits; bonuses based on total compliance score for quality indicators; full and partial bonuses (20%; 10% of site’s total 6-mo capitation for pediatric members ≤age 6 y); 3 highest-scoring sites received full bonus; next 3 received partial bonus; most improved sites received partial bonus; average bonus, $2,000 (range, $772 to $4682)

Payment frequency: every 6 mo

Christensen et al., 2000

RCT (2 arms); February 1994 to September 1995; 200 pharmacies (110 intervention; 90 control)

Level: provider group

Type: enhanced FFS

Duration: 20 mo

Description: $4 for cognitive services interventions (< 6 min); $6 for ≥ 6 min; cognitive services are judgmental or educational services provided by the pharmacist to the patient, such as consulting the prescriber about a suboptimal dose

Payment frequency: FFS

Casalino et al., 2003

Cross-sectional survey; September 2000 to September 2001; 1040 physician organizations (no patient-level data included)

Level: provider group

Type: better contracts with health plans; bonuses

Duration: not ascertained in survey

Description: not ascertained in survey

Payment frequency: not ascertained in survey

Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×

Domains of Quality

Analysis and Results

Overall Effectb

Methodologic Strengthc

Process

Repeated-measures ANOVA

Absolute increase in total mean compliance scores from baseline: FB+I, 17.2%; FBO, 22.6%; control, 22.6%

Differences in compliance score improvement between groups: FB+I vs. control, 5.9%; FBO vs. control, 11.3%

No significant differences between the groups

No effect

3

Process

Student t-test

Mean rate, 1.59 interventions per 100

Medicaid prescriptions (study pharmacies) vs. 0.67 (controls); P < 0.001

Positive

2

Process

Multivariate linear regression

Receiving better contracts for quality was associated with an increase of 0.74 CMP implemented (P = 0.007).

Receiving a bonus for scoring well on quality measures was not associated with CMP implementation (P = 0.08)

Partial effect

1

Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×

Reference

Study Design

Incentives

McMenamin et al., 2003

Cross-sectional survey; September 2000 to September 2001; 1104 physician organizations

Level: provider group

Type: financial incentives; additional income; better contracts with health plans

Duration: not ascertained in survey

Description: not ascertained in survey

Payment frequency: not ascertained in survey

Roski et al., 2003

RCT (3 arms); May 1999 to June 2000; 37 PC sites (13 incentive; 9 incentive + registry; 15 control)

Level: provider group

Type: bonus

Duration: 12 mo

Description: 75% of patients with smoking status identified/documented at the last visit; 65% of patients with quitting advice documented at the last visit (targets set at approximately 15% above the average from 2 y before study); bonuses, $5000 for sites with 1–7 providers and $10,000 for sites with ≥8 providers

Outcome measured: 7-d sustained abstinence from smoking (not associated with financial incentive)

Payment frequency: one time (end of study)

Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×

Domains of Quality

Analysis and Results

Overall Effectb

Methodologic Strengthc

Process

Multivariate logistic regression

Receiving financial incentives from HMOs increased the adjusted odds of having a smoking cessation intervention for 6 of the 7 organizational supports (OR, 2.13 to 14.46; P < 0.038)

Receiving additional income from health plans for performance on quality measures: 2 of 7 organizational supports (OR, 1.49, 1.90; P < 0.033)

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

Partial effect

1

Process

Logistic regression, clustering at the practice level

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) was 22.4% for the incentive group; 21.7% for the incentive + registry group; 19.2% for the control group. No significant difference across the study groups

Partial effect

2

Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×

Reference

Study Design

Incentives

Rosenthal et al., 2005

CBA; October 2001 to April 2004; 163 provider groups contracted with PacifiCare Health Systems in California (provider groups in the Pacific Northwest were the comparison group)

Level: provider group

Type: bonus

Duration: July 2003 to April 2004 (10 mo)

Description: incentive payout based on provider’s groups ability to reach or exceed target rates for cervical cancer screening, mammography, and hemoglobin A1c testing for diabetic patients

Incentive reward: $0.23 PMPM

Payment frequency: quarterly

Grady et al., 1997

RCT (3 arms); 1 year (NS); 61 community-based primary care practices (20 cue and reward; 18 cue; 23 control [total of 95 physicians]); cues were posters in waiting rooms and chart reminder stickers

Level: physician

Type: bonus ($50 for a 50% referral rate)

Duration: 6 mo

Description: “token” reward, based on the percentage referred for mammography during quarterly audit

Payment frequency: 1 per quarterly audit; rewards given last 2 quarters

Fairbrother et al., 1999

RCT (4 arms); July 1995 to July 1996; 60 physicians (15 bonus; 15 enhanced FFS; 15 feedback only; 15 control)

Level: physician

Type: bonus and FFS

Duration: 12 mo

Description: patients’ up-to-date coverage for pediatric immunizations

Bonuses: $1000 (20% improvement from baseline); $2500 (40% improvement); $5000 (80% up-to-date)

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., 2000

Cross-sectional survey; January to April, October 1996; physicians in 8 IPA/ network HMOs (2761 patients)

Level: physician

Type: not ascertained in survey

Duration: not ascertained in survey

Description: survey of health plan executives elicited information about use of financial incentives regarding patient satisfaction

Payment frequency: not ascertained in survey

Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×

Domains of Quality

Analysis and Results

Overall Effectb

Methodologic Strengthc

Process

Differences-in-differences analysis using generalized estimating equations

Improvement in cervical cancer screening rates before and after the quality incentive program was statistically significant between the intervention and comparison groups (difference, 3.6%; P = 0.02). Improvements in mammography screening rates and hemoglobin A1c testing were not statistically significant

Partial effect

2

Process

Repeated-measures ANOVA

The financial incentive arm was not significantly different from the control arm

No effect

2

Process

Linear and logistic regression

Bonus group improved significantly in documented up-to-date immunization status, with an overall change of 25.3% (P < 0.01), but none of the other groups improved significantly compared with controls

Partial effect

3

Patient experience

Linear regression

Financial incentives concerning patient satisfaction were related to increase in score on primary care scale completed by patients on 2 of the 4 aspects of primary care assessed (access, physicians’ knowledge of patients, clinician–patient communication, and interpersonal treatment)

Access to care (β = 2.57; P < 0.01) and dimensions of comprehensiveness of care (β = 2.00 for knowledge of patient; P < 0.05) and preventive counseling (β = 3.50; P < 0.05)

Partial effect

1

Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×

Reference

Study Design

Incentives

Fairbrother et al., 2001

RCT (3 arms); July 1997 to July 1998; 57 physicians (24 bonus; 12 FFS; 21 control)

Level: physician

Type: bonus and FFS

Duration: 16 mo

Description: patients’ up-to-date coverage for pediatric immunizations

Bonuses: $1000 (30% improvement from baseline); $2500 (45% improvement); $5000 (80% up-to-date); $7500 (90% up-to-date)

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

Beaulieu and Horrigan, 2005

CBA; April 2001 to January 2002; 21 PCPs contracted with Independent Health in upstate New York (476 diabetic patients); 600 Independent Health diabetic patients were the comparison group

Level: physician

Type: bonus

Duration: 8 mo

Description: meeting target CS of ≥6.23; CS of ≥6.86; or overall 50% improvement in composite score. CS based on PCP’s performance of process and outcome measures for diabetes care (e.g., LDL test, dilated retinal examination, LDL cholesterol level <2.59 mmol/L (<100 mg/dL))

Incentive rewards: CS >6.86, $3.00 PMPM (Medicare), $0.75 PMPM (commercial); CS >6.23, $1.50 PMPM (Medicare), $0.37 PMPM (commercial); 50% improvement and CS <6.23, $0.75 PMPM (Medicare), $0.18 PMPM (commercial)

Payment frequency: at the conclusion of the study

Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×

Domains of Quality

Analysis and Results

Overall Effectb

Methodologic Strengthc

Process

Linear and logistic regression

Both the bonus and the enhanced FFS groups improved significantly in documented up-to-date immunization status, with an overall change of 5.9% (P < 0.05) and 7.4% (P < 0.01), respectively, compared with the control group

Positive

3

Process; intermediate outcome

Before and after comparison, specific test not described

Patients treated by physicians in the demonstration project had statistically significant improvement (final – baseline performance) on the following process and outcomes measures (P < 0.001 unless otherwise noted): second hemoglobin A1c test (25.5% difference); LDL cholesterol test (18.3% difference); diabetic retinal examination (25.6% difference); nephropathy test (37.0% difference); foot examination (45.4% difference); hemoglobin A1c level <9.5% (13.9% difference); LDL cholesterol level <2.59 mmol/L (<100 mg/dL) (10.5% difference); LDL cholesterol level <3.37 mmol/L (< 130 mg/dL) (23.5% difference); BP < 130/80 mm Hg (6.3% difference; P < 0.05). No significant improvement on performing 1 hemoglobin A1c test

Partial effect

1

Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×

Reference

Study Design

Incentives

Pourat et al., 2005

Cross-sectional survey; January to May 2002; PCPs contracted with Medicaid HMOs in 8 California counties with the highest rates of Chlamydia trachomatis infection and Medicaid HMO enrollment

Level: physician

Type: better contracts with health plans

Duration: not ascertained in survey

Description: HMO contracts included reimbursements for quality of care dimensions, including patient satisfaction or peer review

Payment frequency: not ascertained in survey

aStudy inclusion criteria were that the article must be an original report providing empirical results and the study must assess the relationship between an explicit financial incentive and a quantitative measure of health care quality. Articles were excluded if there was no concurrent comparison group, or if there was no baseline, pre-intervention analysis of the groups on the quality measure. 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. Partial effect studies showed improved performance on some measures of quality but not others. Negative studies were those for which all measures of quality demonstrated a statistically significant decrease with the financial incentive.

cGraded on a scale of 1 (poor) to 4 (excellent).

SOURCE: Petersen LA, Woodard LD, Urech T, Daw C, Sookanan S. 2006. Does pay-for-performance improve the quality of health care? Annals of Internal Medicine 145(4): 265–272.

Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×

Domains of Quality

Analysis and Results

Overall Effectb

Methodologic Strengthc

Process

Chi-square, logistic regression

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 performance, 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 Chlamydia trachomatis infection annually compared with physicians reimbursed using other payment mechanisms (P < 0.05)

Positive

1

Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×

REFERENCES

Beaulieu ND, Horrigan DR. 2005. Putting smart money to work for quality improvement. Health Services Research 40:1318–1334.

Casalino L, Gillies RR, Shortell SM, Schmittdiel JA, Bodenheimer T, Robinson JC, et al. 2003. External incentives, information technology, and organized processes to improve health care quality for patients with chronic diseases. Journal of the American Medical Association 289:434–441.

Christensen DB, Neil N, Fassett WE, Smith DH, Holmes G, Stergachis A. 2000. Frequency and characteristics of cognitive services provided in response to a financial incentive. Journal of the American Pharmaceutical Association 40:609–617.

Clark RE, Drake RE, McHugo GJ, Ackerson TH. 1995. Incentives for community treatment: Mental illness management services. Medical Care 33:729–738.

Fairbrother G, Hanson KL, Friedman S, Butts GC. 1999. The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates. American Journal of Public Health 89:171–175.

Fairbrother G, Siegel MJ, Friedman S, Kory PD, Butts GC. 2001. Impact of financial incentives on documented immunization rates in the inner city: Results of a randomized controlled trial. Ambulatory Pediatrics 1:206–212.

Grady KE, Lemkau JP, Lee NR, Caddell C. 1997. Enhancing mammography referral in primary care. American Journal of Preventive Medicine 26:791–800.

Hillman AL, Ripley K, Goldfarb N, Nuamah I, Weiner J, Lusk E. 1998. Physician financial incentives and feedback: Failure to increase cancer screening in Medicaid managed care. American Journal of Public Health 88:1699–1701.

Hillman AL, Ripley K, Goldfarb N, Weiner J, Nuamah I, Lusk E. 1999. The use of physician financial incentives and feedback to improve pediatric preventive care in Medicaid managed care. Pediatrics 104:931–995.

Kouides RW, Bennett NM, Lewis B, Cappuccio JD, Barker WH, LaForce FM. 1998. Performance-based physician reimbursement and influenza immunization rates in the elderly. American Journal of Preventive Medicine 14:89–95.

McMenamin SB, Schauffler HH, Shortell SM, Rundall TG, Gillies RR. 2003. Support for smoking cessation interventions in physician organizations: Results from a national study. Medical Care 41:1396–1406.

Norton EC. 1992. Incentive regulation of nursing homes. Journal of Health Economics 11:105–128.

Pourat N, Rice T, Tai-Seale M, Bolan G, Nihalani J. 2005. Association between physician compensation methods and delivery of guideline-concordant STD care: Is there a link? American Journal of Managed Care 11:426–432.

Rosenthal MB, Frank RG, Li Z, Epstein AM. 2005. Early experience with pay-for-performance: From concept to practice. Journal of the American Medical Association 294:1788–1793.

Roski J, Jeddeloh R, An L, Lando H, Hannan P, Hall C, et al. 2003. The impact of financial incentives and a patient registry on preventive care quality: Increasing provider adherence to evidence-based smoking cessation practice guidelines. American Journal of Preventive Medicine 36:291–299.

Safran DG, Rogers WH, Tarlov AR, Inui T, Taira DA, Montgomery JE, et al. 2000. Organizational and financial characteristics of health plans: Are they related to primary care performance? Archives of Internal Medicine 160:69–76.

Shen Y. 2003. Selection incentives in a performance-based contracting system. Health Services Research 38:535–552.

Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×
Page 153
Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×
Page 154
Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×
Page 155
Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×
Page 156
Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×
Page 157
Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×
Page 158
Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×
Page 159
Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×
Page 160
Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×
Page 161
Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×
Page 162
Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×
Page 163
Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×
Page 164
Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×
Page 165
Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×
Page 166
Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×
Page 167
Suggested Citation:"Appendix B: Review of the Evidence." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
×
Page 168
Next: Appendix C: Comparison of Various Professional Groups' Pay-for-Performance Position Statements »
Rewarding Provider Performance: Aligning Incentives in Medicare Get This Book
×
Buy Hardback | $60.00
MyNAP members save 10% online.
Login or Register to save!
Download Free PDF

The third installment in the Pathways to Quality Health Care series, Rewarding Provider Performance: Aligning Incentives in Medicare, continues to address the timely topic of the quality of health care in America. Each volume in the series effectively evaluates specific policy approaches within the context of improving the current operational framework of the health care system. The theme of this particular book is the staged introduction of pay for performance into Medicare. Pay for performance is a strategy that financially rewards health care providers for delivering high-quality care. Building on the findings and recommendations described in the two companion editions, Performance Measurement and Medicare's Quality Improvement Organization Program, this book offers options for implementing payment incentives to provide better value for America’s health care investments.

This book features conclusions and recommendations that will be useful to all stakeholders concerned with improving the quality and performance of the nation’s health care system in both the public and private sectors.

  1. ×

    Welcome to OpenBook!

    You're looking at OpenBook, NAP.edu's online reading room since 1999. Based on feedback from you, our users, we've made some improvements that make it easier than ever to read thousands of publications on our website.

    Do you want to take a quick tour of the OpenBook's features?

    No Thanks Take a Tour »
  2. ×

    Show this book's table of contents, where you can jump to any chapter by name.

    « Back Next »
  3. ×

    ...or use these buttons to go back to the previous chapter or skip to the next one.

    « Back Next »
  4. ×

    Jump up to the previous page or down to the next one. Also, you can type in a page number and press Enter to go directly to that page in the book.

    « Back Next »
  5. ×

    Switch between the Original Pages, where you can read the report as it appeared in print, and Text Pages for the web version, where you can highlight and search the text.

    « Back Next »
  6. ×

    To search the entire text of this book, type in your search term here and press Enter.

    « Back Next »
  7. ×

    Share a link to this book page on your preferred social network or via email.

    « Back Next »
  8. ×

    View our suggested citation for this chapter.

    « Back Next »
  9. ×

    Ready to take your reading offline? Click here to buy this book in print or download it as a free PDF, if available.

    « Back Next »
Stay Connected!