PAY FOR PERFORMANCE IN HEALTHCARE

Pay-for-Performance Annotated Bibliography

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Pay-for-Performance Annotated Bibliography

Introduction

In healthcare, pay-for-performance is an umbrella term that is used to refer to various initiatives that are aimed at improving the healthcare industrys effectiveness, quality, and the overall value of the healthcare. Such arrangements are significant as they provide financial incentives to the physicians, hospitals, as well as other healthcare providers to be able to carry out improvements in the industry and attain optimum outcomes for the patients. Pay-for-performance is well-known amongst various policy makers and also civic and private healthcare players. The Affordable Care Act (Obamacare) encourages the expansion and use of this approach in the healthcare sector and also fosters research to point out programs and designs that are most efficient and operative.

Annotated Bibliography

Alshamsan, R., Majeed, A., Ashworth, M., Car, J., & Millett, C. (2010). Impact of pay for performance on inequalities in health care: a systematic review.Journal of Health Services Research & Policy,15(3), 178-184. doi:10.1258/jhsrp.2010.009113. The aim of this systematic review is to assess the impact of pay-for-performance programs on the inequalities in the healthcare quality about ethnicity, sex, and socioeconomic status. The authors used systemic search and appraisal of experimental and observational studies that evaluated quantitatively the effect of monetary incentives on the inequalities present in healthcare. The authors concluded that the inequalities in the management of chronic illness management have greatly persisted after the introduction of the Quality Outcome Framework. Also, they concluded that the pay-for-performance programs should be structured in a way to ensure the reduction in inequalities and also to improve the overall healthcare quality. As such, this is a reliable article as it offers comprehensive information on the research topic.

Cromwell, J., Trisolini, M. G., Pope, G. C., Mitchell, J. B., & Greenwald, L. M. (2011). Pay for performance in health care: methods and approaches.RTI Press Publication. NO. BK-002-1103. Retrieved February 15, 2014. This book offers a very balanced approach and assessment of pay-for-performance or P4P. These programs, according to the publication, have become far-reaching in the healthcare industry. This has resulted in the development and testing of new types of payment systems that are immensely featured in the current health reforms. The authors conduct a comprehensive review of the characteristics of pay-for-performance programs, analyzing its strengths and weaknesses. The authors, led by Jerry Cromwell, a Ph.D. holder, have extensive experience in conducting funded evaluation and technical projects in the field of health economics. Their rigorous review and assessment of the research topic make this book a significant source of information on pay-for-performance programs.

Donev, D. (2005). Payment methods and regulation of providers.World,119, 21. This article examines the concerns about the nature of the standard that is used to earn and distribute the incentive payments. It further offers three alternatives, the first being the focus on the provision of healthcare that meets a consensus-based quality standard. Another alternative provided by the article is that the actual performance of the healthcare service providers could be utilized to set up an empirical benchmark. Therefore, competition among the providers would be used to determine the standard and distribution of the incentive payments. The third alternative, as discussed in the article, is to focus on quality improvement in the healthcare sector. As such, a provider whose performance is wanting could still earn an incentive payment provided it improves its performance. This is an informative source as it offers credible information concerning the Centers for Medicaid Services emphasis on the importance of quality healthcare and policies regarding pay-for-performance.

Hahn, J. (2006, November). Pay-for-performance in health care. InThe Library of Congress: Washington, DC. This journal is a report for the Congress Research Service, and it gives more information about pay-for-performance in healthcare. It also describes the prerequisites for the success of pay-for-performance programs. It outlines the elements of pay-for-performance starting with its objectives, measures and performance standards for establishing the target criteria, and the rewards that are at risk. The article gives detailed information on the program and how the government is involved in rolling it out to both public and private health care. Therefore, this is a rich source of knowledge on the pay-for-performance program when writing the dissertation.

Kirchner, J. (2015). Statin in patients with diabetes.Patient Care,38(11), 70-71. According to this journal, a lot of confusion surrounds the proper administration of statin to patients with diabetes. The use of a statin for these patients is dependent on the patients risk of developing cardiovascular problems. This article seeks to clarify the confusion of the new Standards of Medical Care in Diabetes dispensed by the American Diabetes Association in 2015, which differs with the recommendation for statin use outlined by the American College of Cardiology in 2013. The relevance of this article to the research topic is that it seeks to include the diabetes health care issue to the pay-for-performance programs. Diabetes is a life-threatening ailment and the patients suffering from it should be given access to affordable and high-quality healthcare.

Mendelson, A., Kondo, K., Damberg, C., Low, A., Motapuaka, M., Freeman, M., Kansagara, D. (2017). The Effects of Pay-for-Performance Programs on Health, Health Care Use, and Processes of Care.Annals of Internal Medicine,166(5), 341. doi:10.7326/m16-1881- This peer-reviewed journal is a study that sought to examine the benefits of pay-for-performance. The objective of the study was to expand and update previous systematic reviews that scrutinized the impact of pay-for-performance programs focused on the physician, managerial, group, or institutional levels on the process of care and patient results in inpatient and ambulatory contexts. The authors concluded that the pay-for-performance programs might be related to improved processes of care in ambulatory contexts, but consistently impressive associations with improved patient health outcomes have not been proven in any setting. This article is relevant to the research topic as it provides previous studies on pay-for-performance programs effectiveness in ambulatory and health outcomes setting.

Miller, R. H., & Sim, I. (2004). Physicians use of electronic medical records: barriers and solutions.Health Affairs,23(2), 116-126. The author conducted a survey on the physician who uses the electronic medical record (EMR) technology. EMR is an emergent technology that enables the physicians to pursue more robust quality improvement programs such as the pay-for-performance programs. Using this technology, according to the author, is time saving and effective. Based on the survey carried out, the author discovered that quality improvement in healthcare is heavily dependent on the physicians use of an electronic medical record for their daily work. This journal is significant to the topic of research since it focuses on how the quality of healthcare can be improved using technological advancements since such technologies facilitate the success of programs such as pay-for-performance.

Nix, K. (2013). What Obamacare’s Pay-For-Performance Programs Mean for Health Care Quality.The Heritage Foundation, Leadership for America, 1-9. This journal gives a detailed explanation of the Patient Protection and Affordable Care Act of 2010 or simply known as Obamacare. The author elaborates that the Obamacare Act created several new medical programs that intend to enhance the quality of healthcare in the United States using pay-for-performance strategies to exert pressure on the medical providers. The author talks about how these programs payment plans are based on performance metrics founded on the adherence to particular care processes, patient satisfaction surveys, and patient outcomes. However, the author argues that the incentives offered by the government do not necessarily guarantee value or benefit to the patients. This is a credible source of information on governments role in the pay-for-performance programs and what it means to the quality of healthcare.

Petersen, L. A., Woodard, L. D., 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. This systematic review attempts to answer the question on whether pay-for-performance improves the quality of healthcare. It is a relevant peer reviewed article since the authors seek to address the aforementioned question by conducting various studies and analyses of whether explicit financial incentives are responsible for enhancing the quality of the healthcare industry. The authors accomplish their study by examining various measures of care process, the majority of which are aimed at preventive services. Most of the surveys conducted by the authors of this article found a positive correlation between pay-for-performance and access to healthcare, while another study presented proof of gaming behavior signifying an undesirable effect on access to healthcare. This article is significant to the topic of research as it divulges credible literature review and studies.

Scott Endsley, M. D., Kirkegaard, M., Baker, G., & Murcko, A. C. (2004). Getting rewards for your results: pay-for-performance programs.Fam Pract Manag,11(3), 45-48. The authors of this article are renowned professionals in the field of healthcare. The article attempts to give an elaboration of the basics of the pay-for-performance program. The authors indicate that even amongst the healthcare professionals who are motivated to offer the best care to the patients, the payment structure and incentives may not enable the necessary actions required to systematically improve the quality of healthcare. This publication is important to the research topic as it provides the necessary knowledge about the relationship between pay-for-performance plans and the performance of the physicians in the provision of quality healthcare.

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