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Suggested Citation:"Index." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
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Index

A

Access to care

performance measurement and, 6

potential adverse consequences of payment incentives, 45, 29, 4850

Accountability

for coordination of care, 120121, 123124

goals of payment system reform, 8

public reporting for, 1011, 103104, 106

Administrative data, 88, 103

Adverse consequences of pay-for-performance system

causes, 22, 28, 29

inequitable or decreased access, 29, 4851

managing to measures, 29, 51

monitoring rationale, 45, 48, 53, 54

obstacles to knowledge transfer and innovation, 45, 29, 5152

potential scope of, 45, 48

provider attitudes and perceptions, 5253

quality of care, 9, 29

Agency for Healthcare Research and Quality, 126

Ambulatory care, 212215

Ambulatory care Quality Alliance, 39, 179

Ambulatory payment classification, 146

American Health Information Community, 126

Anthem Blue Cross and Blue Shield, 22

of New Hampshire, 41, 62

B

Bridges to Excellence, 4041, 62, 67

Physician Practice Connections, 41

Bundled payments, 4, 26, 33, 35, 145

C

Case management, 33

Centers for Medicare and Medicaid Services

current payment incentive programs, 3, 62

leadership for health care improvement, 28, 137

performance reporting program, 1112

recommendations to improve coordination of care, 13, 122

See also Medicare

Certification and licensure

Medicare provider qualifications, 25

payment incentive programs and, 5

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

Certification Commission for Healthcare Information Technology, 128

Chart data, 88, 103

Chronic heart failure, 180

Clinical quality

as basis for performance reward distribution, 8183, 9596

goals of payment system reform, 3, 20, 2122, 44

Collaborative efforts, 39

Competition, in health care delivery system, 29, 52

Connecting for Health, 126

Consolidated Health Informatics, 126

Consumer Assessment of Healthcare Providers and Systems, 87, 109, 209219

Coordination of care

accountable source of care, 120121, 123124

beneficiary role in, 123124

goals of payment system reform, 3, 8, 45

importance of, 124

performance measurement, 45

rationale, 13

recommendations, 13, 122

rewards for, 123

shortcomings of current delivery system, 1, 4, 33, 45, 119120

Coronary artery disease, 180

Cost of care

consumer spending, 1819

federal spending, 24

goals of payment system reform, 3, 2122

health information technologies, 127

hospital management strategies, 145146

international comparisons, 19

Medicare spending, 4, 24

quality of care and, 19

Cost shifting behavior, 5354

Crossing the Quality Chasm: A New Health System for the 21st Century, 1, 15, 71, 81

D

Data collection and management

data auditing, 103

health information technologies, 124129

limitations of current efforts, 8889

Medicare data collection efforts, 43

Medicare demonstration projects, 3839

pay-for-performance implementation, 5, 13, 103

provider feedback, 103

for quality improvement, 13

recommendations for, 14, 128129

See also Performance measurement;

Public reporting

Demonstration projects, 3, 14, 22, 3839, 139140

Department of Health and Human Services

current payment incentive programs, 3

information technology promotion, 14, 126, 128129

monitoring of pay-for-performance program, 14, 134

public reporting role, 1011, 106

recommendations for, 6, 8, 1011, 12, 14, 55, 78, 85, 106, 116117, 128129, 134

Diabetes, 19, 180

Diagnosis-related groups, 145146

Dialysis, 19

Dialysis facilities

Medicare prospective payment system, 148149, 208

Medicare spending, 19

pay-for-performance implementation, 110, 209211

performance measurement, 208209

Diffusion of knowledge and best practices

health information technologies, 124128

payment incentive program as obstacle to, 29, 5152

Disease management models, 3839

Distribution of rewards

to ambulatory care settings, 215

among Medicare parts, 97

beneficiary rewards, 4445

by care settings, 118119

composite measures for, 8990

condition-based system, 89

data collection for, 8889

defining comparison groups for, 9495

to dialysis facilities, 211

domains of care as basis for, 9, 8183, 9596, 100101

existing funds model, 6669

generated savings model, 6971

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

graduated vs. fixed reward amounts, 9293

to high-performing providers, 41, 84, 85, 101

level of award necessary to affect behavior, 4647

measure sets for, 8588

penalty system, 9394

performance improvement as basis for, 910, 8385, 100101

policy issues, 8, 8081, 101

private sector pay-for-performance programs, 4041, 62

provider payout case example, 97100

to providers meeting performance thresholds, 9091

public reporting and timing of, 107

recommendations, 9, 82, 85

size of reward, 100

structural measures for, 90

tournament-style reward structure, 91

for treatment of high-risk patients, 50, 129

E

Educational interventions

current payment system, 25

shortcomings of current payment system, 4

shortcomings of Medicare reimbursement, 33

Effectiveness of care, 1, 81

See also Clinical quality

Efficiency of care

aims, 1, 81

as basis for performance reward, 8183, 9596

goals of payment system reform, 2122

performance measurement, 6, 51, 209

recommendations for payment incentive program design, 9, 82

shortcomings of current payment system, 4

Electronic health records, 6, 88, 124, 125, 127128

Equitable care

aims, 1, 81

potential adverse consequences of payment incentives, 45, 5051

Excellus Blue Cross Blue Shield, 72

F

Fee-for-service system, 34

Funding for payment incentives

budget-neutral approaches, 65

challenges to establishing, 6162

criteria for assessing possible sources, 60, 6465

direct investment model, 7174, 75

existing funds model, 6669, 75, 77, 78

generated savings model, 6971, 75, 78

geographic pools, 77, 95

long-term, 7778

performance reporting incentives, 106

potential sources, 7, 61

private sector models, 62

public sector models, 62

recommendations, 78, 75, 78

research needs, 75

reward pool design, 6061, 65, 67, 75, 78

reward size and, 100

short-term implementation, 6566, 7475

significance of, for pay-for-performance implementation, 6, 6061

single source of, 8

United Kingdom program, 6364

H

Harvard Pilgrim Health Care, 62

Hawaii Blue Cross and Blue Shield, 22

Healthcare Information Technology Standards Panel, 126

Health Insurance Portability and Accountability Act, 13, 124

Health maintenance organizations, 41

HealthPartners, 73

Health plan care

pay-for-performance implementation for, 215216

Health Plan Employer Data and Information Set, 3940, 87

Heart/Stroke Physician Recognition Program, 41

Hemodialysis. See Dialysis

High-performing providers

basis for distribution of incentive rewards, 84

recommendations for monitoring, 14, 134

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

recommendations for reward distribution, 910, 85

relative comparisons, 91

Hill Physicians Medical Group, 41

Home health agencies

Medicare prospective payment system, 3435, 147148

Medicare public reporting efforts, 104, 105

pay-for-performance implementation, 11, 110, 217218

performance measurement, 148, 216217

Hospital Quality Alliance, 39

Hospitals

health information technologies, 125

Medicare prospective payment system, 3435, 37, 145146

Medicare public reporting efforts, 105

Medicare qualifications, 25

pay-for-performance implementation, 11, 110, 211212

performance measurement, 211

I

Implementation of payment incentives

in ambulatory care settings, 213215

benefits of collaboration, 39

challenges, 23

delayed approach, 108109

in dialysis facilities, 110, 209211

funding pool considerations, 6061, 65

health information technologies in, 1314, 124129

in home health care, 11, 110, 217218

in hospitals, 110, 211212, 217218

Medicare restructuring to foster nationwide change, 2728

monitoring, 12, 23, 44, 53, 54, 133134

organization size as factor in, 115, 117

participation requirements, 112116

performance measures, 6, 110111

phased approach, 5, 6, 28, 29, 55, 107, 110, 117

procedural and technical issues, 101, 102

public reporting of performance outcomes, 1011, 103106

recommendations, 6, 12, 2930, 3233, 5455, 75

research needs, 23

short-term funding models, 6575

in skilled nursing facilities, 111112, 219

specialist participation, 117118

speed of, 112117

steps involved in, 103107

timing, 101, 107110

variation across settings, 1112, 27, 110112, 116117

See also Funding for payment incentives

Infant mortality, 19

Innovation

goals of payment incentives, 3

potential adverse consequences of payment incentives, 45, 52

Integrated Healthcare Association, 22, 3940, 62

International comparisons, 19

See also United Kingdom

L

Learning organizations, 135137

Learning system, 6, 14, 54, 5556, 133134, 135137

Life expectancy, 19

Longitudinal measures of quality, 12, 18, 116

M

Massachusetts Blue Cross Blue Shield, 62

Medicare

current payment system, 4, 22, 2326, 3334, 55

current public reporting efforts, 104105

data collection, 43

distribution of rewards among component parts, 97

expenditures, 4, 24, 35

financing, 23

funding for payment incentives, 78

future challenges, 20

hemodialysis spending, 19

implementation of payment incentives, 6, 23, 2728, 55

influence of, in health care system, 26, 28, 43

model reward distribution using existing funds, 67

pay-for-performance rationale, 5, 43

performance reporting requirements, 112115

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

Physician Fee Schedule, 35

program assessment role, 136

prospective payment system, 3435, 38, 145151

provider qualifications, 25

Quality Improvement Organization, 18

recent pay-for-performance experiments, 3839

recommendations for pay-for-performance implementation, 6, 55

retrospective payment system, 34

scope of participation and benefits, 4, 2324, 28, 147

utilization patterns and trends, 13, 19, 119

See also Centers for Medicare and Medicaid Services

Medicare Advantage program, 4, 11, 24, 33, 105, 110, 150151

Medicare Management Performance Demonstration, 3839

Medicare Payment Advisory Committee, 67, 110, 146, 180

Medicare Prescription Drug, Improvement, and Modernization Act (2003), 2, 17, 39, 148

Medicare’s Quality Improvement Organization Program: Maximizing Potential, 2, 18, 135

Medicare Trust Funds, 7

Monitoring of payment incentive programs

for distribution of rewards, 8

learning system approach, 6, 14, 54, 5556, 133134, 135137

payment incentive program implementation, 6, 12, 116117

rationale, 45, 14, 23, 44, 48, 53, 54

recommendations, 14, 134

scope of, 133

technology for, 67

Mortality studies, 46

N

National Commitee for Quality Assurance

Diabetes Physician Recognition Program, 41

Heart/Stroke Physician Recognition Program, 41

Physician Practice Connections, 41

National Health Information Network, 126

National Quality Coordination Board, 18, 140

Nursing homes

Medicare payment system effects, 38

Medicare public reporting efforts, 105

See also Skilled nursing facilities

P

Pathways to Quality Health Care, 2, 17, 44, 116

Patient-centered care

aims, 1, 81

ambulatory care performance assessment, 213

as basis for performance reward, 8183, 9596

dialysis services assessment, 209

goals of payment system reform, 2122

health plan performance assessment, 216

home health agency performance assessment, 217

hospital performance assessment, 211

measurement, 20

performance measurement considerations, 6, 51

recommendations for payment incentive program design, 9, 82

shortcomings of current payment system, 1

trends, 20

Pay for performance

barriers to provider participation, 1112, 116117

beneficiary rewards, 4445

common features of existing programs, 4243

experiences outside of health care sectors, 47

goals, 3, 29, 32, 44, 55

for high-performing providers, 910, 85

to improve coordination of care, 13, 122

literature review, 154167

performance improvement linkage, 2, 5, 17, 2223, 26, 29, 3637, 46

programs in United Kingdom, 42

quality improvement goals, 9, 20

recent experiments, 3, 2223, 3842

research needs, 139141

research on program effects, 3, 36, 4648

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

stakeholder position statements

nonspecialist groups, 170172

purchaser and consumer groups, 177178

specialist groups, 173176

in systemic approach to health care reform, 56, 20, 27, 28, 44, 55

See also Adverse consequences of pay-for-performance system;

Distribution of rewards;

Funding for payment incentives;

Implementation of payment incentives

Payment systems

current Medicare, 2326, 3334

current shortcomings, 1, 4, 1920, 2526, 32, 3334, 55, 80

effects on provider behavior, 3738, 4647

excessive focus on, in health system reform, 53

reform goals, 12

retrospective, 34

See also Prospective payment

Penalties for lack of improvement, 9394

Performance improvement

absolute thresholds, 9091

comparison groups, 9495

defining, for distribution of incentive rewards, 8385

payment incentive distribution methodology, 910

payment incentive goals, 44

payment system linkage, 2, 17, 2223, 29, 3638, 46

penalties for lack of, 9394

recommendations for public reporting, 1011

relative comparisons, 91

research needs, 67

rules for health care process redesign for, 15

strategies for, 18

technical assistance for, 18

Performance measurement

case mix considerations, 129130

common features of existing pay-for-performance programs, 4243

composite measures, 8990

of coordination of care, 45

costs, 112, 130

current measurement sets, 86

data limitations, 8889

dialysis services, 208211

domains of quality, 9, 21, 51, 8183

in home health agencies, 216217

in hospitals, 211

ideal characteristics, 134135

improving provider participation, 1112, 116117

longitudinal measures, 12, 18, 116

pay-for-performance implementation, 6, 11, 103, 107, 108109, 110111

for payment system assessment, 2, 17, 23

in post-acute care settings, 148

potential adverse consequences of, 6, 29, 51

provider participation requirements, 112

provider resources for, 114

recent efforts, 20

recommendations for implementation, 1718

recommendations for improvement, 2, 12

research needs, 137139

selection of measures, 8586

shortcomings of current system, 18, 2021, 110

in skilled nursing facilities, 219

specialty care, 117118

stakeholder collaborations for, 14

starter set, 8688

statistical issues, 112, 129130

structural measures, 90

threshold setting, 9192

Performance Measurement: Accelerating Improvement, 2, 1718, 51, 137138

Physician Group Practice Demonstration, 38, 69

Physician–patient relationship, 29

Physician Practice Connections, 41

Physicians

distribution of rewards, 118119

Medicare prospective payment system, 3435, 149150

Medicare qualifications, 25

negative perceptions of payment system reform, 5253

pay-for-performance implementation in private practice, 110

payment incentives as barrier to performance improvement, 29

virtual groups, 119

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

Population health

international comparison, 19

patterns and trends, 19

significance of Medicare practices, 26

Preferred provider organizations, 41

Premier Hospital Quality Incentive Demonstration, 38

Preventive care

shortcomings of current payment system, 1, 4

shortcomings of Medicare reimbursement, 33

Primary care, 4, 27, 43, 5253, 73, 120

Priority Areas for National Action: Transforming Health Care Quality, 71

Private sector

in collaborations for performance measurement, 14, 23

cost-shifting outcomes of payment system reform, 5354

pay-for-performance funding models in, 62

pay-for-performance in executive compensations, 47

recent pay-for-performance experiments, 3941

Prospective payment, 3435, 37, 38

for home health care, 147148

for inpatient hospital care, 145146

Medicare programs, 145151

for outpatient dialysis services, 148149

outpatient hospital care, 145146

for physician services, 149150

shortcomings of current system, 4, 26

for skilled nursing facilities, 146147

Public reporting

access to care decreased by, 50

costs, 105106

current Medicare efforts, 104105

distribution of rewards and, 107

pay-for-performance implementation, 5, 1011, 12, 103106

quality of care and, 26

rationale, 103104

Q

Quality Improvement Organizations, 18, 52, 94, 128

Quality of care

ambulatory care performance assessment, 213

consumer spending and, 19

current Medicare payment system and, 4, 2526, 3334

current shortcomings, 1, 15

dialysis services assessment, 208209

domains of quality, 9, 21, 51, 9596

health plan performance assessment, 215

home health agency performance assessment, 217

hospital performance assessment, 211

information technology to improve, 13

Medicare Advantage program, 150151

Medicare provider qualifications, 25

payment system linkage, 3, 5

prospective payment system and, 146

public reporting of provider performance and, 26

recommendations for payment incentive program design, 9, 2122, 82

See also Performance improvement;

Clinical quality

R

Regional Health Information Organizations, 126

Relative value of medical services, 1, 2526

Research

long-term funding for payment incentives program, 75

needs of pay-for-performance program, 139141

oversight, 140

pay-for-performance studies, 3, 36, 4648

payment incentive implementation, 23

payment system effects on provider behavior, 3738

performance measurement, 137139

performance monitoring, 67

Retrospective payment system, 34

Risk adjustment, 4850, 129130

S

Safety of care

aims, 1, 81

as basis for performance reward, 81

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

Settings for care

defining comparison groups for reward distribution, 9495

distribution of rewards, 118119

funding sources for payment incentive programs, 7, 8

health information technologies for, 125

implementation of pay-for-performance, 1112, 27, 110112, 116117

Medicare prospective payment system, 145151

Medicare spending, 35

performance measurement and, 1112, 116117

size of organizations, 115

Size of reward, 100

Skilled nursing facilities

Medicare payment system effects, 38

Medicare prospective payment system, 3435, 146147

pay-for-performance implementation, 111112, 219

performance measurement, 219

Social Security Act, 2, 17

Specialization

implementation of pay-for-performance, 118

patterns, 117

pay-for-performance programs, 43

performance measurement, 117118

shortcomings of current payment system, 4

Sustainable growth rate, 8, 35, 66, 68, 75, 149

T

Technical assistance for quality improvement, 18

Timeliness of care, 1, 81

To Err Is Human: Building a Safer Health System, 15

U

United Kingdom, 42, 6364

Utilization

consumer spending, 1819

Medicare patterns and trends, 13, 19, 37, 119

shortcomings of current Medicare payment system, 2526, 80

specialty care, 117

V

Virtual groups, 119, 122123

Suggested Citation:"Index." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
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Suggested Citation:"Index." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
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Suggested Citation:"Index." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
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Suggested Citation:"Index." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
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Suggested Citation:"Index." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
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Suggested Citation:"Index." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
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Suggested Citation:"Index." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
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Suggested Citation:"Index." Institute of Medicine. 2007. Rewarding Provider Performance: Aligning Incentives in Medicare. Washington, DC: The National Academies Press. doi: 10.17226/11723.
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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.

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