Document Detail

"Pay-for-performance" as a Quality Improvement Tool: Perceptions and Policy Recommendations of Physicians and Program Leaders.
MedLine Citation:
PMID:  21725221     Owner:  NLM     Status:  Publisher    
BACKGROUND:: Although pay-for-performance (P4P) compensation is widespread, questions have arisen about its efficacy in improving health care quality and consequences for vulnerable patients. OBJECTIVE:: To assess perceptions of general internists and P4P program leaders regarding how to implement fair and effective P4P. METHODS:: Qualitative investigation using in-depth interviews with P4P program leaders and focus groups with general internists. RESULTS:: Internists emphasized a gradual and cautious approach to P4P implementation. They strongly recommended improving P4P measure validity and had detailed suggestions regarding how. Program leaders saw a need to implement perhaps imperfect programs but with continual improvement. Both groups advocated protecting vulnerable populations and made overlapping recommendations: improving measure validity; adjusting for patient characteristics; measuring improvements in quality (vs cutpoints); and providing incentives to physicians of vulnerable populations. Internists tended to favor explicit protections, while program leaders felt that P4P might inherently protect vulnerable patients by improving overall quality. DISCUSSION:: Internists favored gradual P4P implementation, while P4P leaders saw an immediate need for implementation with iterative improvement. Both groups recommended specific measures to protect vulnerable populations such as improving measure validity, assessing improvements in quality, and providing special incentives to physicians of vulnerable populations.
J Frank Wharam; Matthew B Frank; Ann-Marie Rosland; Michael K Paasche-Orlow; Neil J Farber; Christine Sinsky; Lisa Rucker; Kimberly J Rask; Michael J Barry; M Kathleen Figaro
Publication Detail:
Journal Detail:
Title:  Quality management in health care     Volume:  20     ISSN:  1550-5154     ISO Abbreviation:  -     Publication Date:    2011 July/September
Date Detail:
Created Date:  2011-7-4     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9306156     Medline TA:  Qual Manag Health Care     Country:  -    
Other Details:
Languages:  ENG     Pagination:  234-245     Citation Subset:  -    
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts (Dr Wharam); Program in Health Policy, Harvard University, Cambridge, Massachusetts (Mr Frank); Department of Internal Medicine, University of Michigan Health System, Ann Arbor (Dr Rosland); Department of Medicine, Boston University School of Medicine, Boston, Massachusetts (Dr Paasche-Orlow); University of California, San Diego (Dr Farber); Medical Associates Clinic and Health Plan, Dubuque, Iowa (Dr Sinsky); Albert Einstein College of Medicine, Bronx, New York (Dr Rucker); Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia (Dr Rask); Medical Practices Evaluation Center, General Medicine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (Dr Barry); and Department of General Internal Medicine, Vanderbilt University School of Medicine, Nashville Tennessee (Dr Figaro).
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