Pay for performance for hospitals

Abstract

Trusted evidence. Informed decisions. Better health. Cochrane Database of Systematic Reviews Main results We included 27 studies (20 CBA, 7 ITS) on six di erent P4P programs. Studies analyzed between 10 and 4267 centers. All P4P programs targeted acute or emergency physical conditions and compared a capitation-based payment scheme without P4P to the same capitationbased payment scheme combined with a P4P add-on. Two P4P program used rewards or penalties; one used first rewards and than penalties; two used penalties only and one used rewards only. Four P4P programs were established and evaluated in the USA, one in England and one in France. Most studies showed no di erence or a very small e ect in favor of the P4P program. The impact of each P4P program was as follows. Premier Hospital Quality Incentive Demonstration Program: It is uncertain whether this program, which used rewards for some hospitals and penalties for others, has an impact on mortality, adverse clinical events, quality of care, equity or resource use as the certainty of the evidence was very low. Value-Based Purchasing Program: It is uncertain whether this program, which used rewards for some hospitals and penalties for others, has an impact on mortality, adverse clinical events or quality of care as the certainty of the evidence was very low. Equity and resource use outcomes were not reported in the studies, which evaluated this program. Non-payment for Hospital-Acquired Conditions Program: It is uncertain whether this penalty-based program has an impact on adverse clinical events as the certainty of the evidence was very low. Mortality, quality of care, equity and resource use outcomes were not reported in the studies, which evaluated this program. Hospital Readmissions Reduction Program: None of the studies that examined this penalty-based program reported mortality, adverse clinical events, quality of care (process quality score), equity or resource use outcomes. Advancing Quality Program: It is uncertain whether this reward-/penalty-based program has an impact on mortality as the certainty of the evidence was very low. Adverse clinical events, quality of care, equity and resource use outcomes were not reported in any study. Financial Incentive to Quality Improvement Program: It is uncertain whether this reward-based program has an impact on quality of care, as the certainty of the evidence was very low. Mortality, adverse clinical events, equity and resource use outcomes were not reported in any study. Subgroup analysis (analysis of modifying design and context factors) Analysis of P4P design factors provides some hints that non-payments compared to additional payments and payments for quality attainment (e.g. falling below specified mortality threshold) compared to quality improvement (e.g. reduction of mortality by specified percent points within one year) may have a stronger impact on performance. Authors' conclusions It is uncertain whether P4P, compared to capitation-based payments without P4P for hospitals, has an impact on patient outc...

Clinical Excellence Awards—time for a fairer NHS rewards scheme

“…This does not necessarily mean an evidence of absence, but research indicates that most performance related pay systems do not improve performance in healthcare and other sectors. Evidence from systematic reviews suggests the impact of pay for performance schemes is, at best, minimal 272829. Other studies call for caution, warning that such incentives don’t work 30.…”

Effect of monitoring surgical outcomes using control charts to reduce major adverse events in patients: cluster randomised trial

“…In the broader context of improvement in health services performance based on strategies to feedback on indicators, inconsistent findings resulted from non-randomised studies. Pay-for-performance models that reward or penalise hospitals for meeting predefined indicator targets showed no or at most modest improvement in patient outcomes 24. Although hospital enrolment in a national surgical outcomes benchmarking programme did not result in performance improvement over time,25 alerts notification from a surveillance system using control charts might be associated with a reduction in inpatient mortality 26.…”

“…Pay-for-performance models that reward or penalise hospitals for meeting predefined indicator targets showed no or at most modest improvement in patient outcomes. 24 Although hospital enrolment in a national surgical outcomes benchmarking programme did not result in performance improvement over time, 25 alerts notification from a surveillance system using control charts might be associated with a reduction in inpatient mortality. 26 A plausible explanation is that cross sectional comparison of aggregated outcomes between institutions is not ideally suited to assess hospital performance prospectively or to highlight the sudden occurrence of improving or worsening outcomes.…”

Reorienting Oral Health Services to Prevention: Economic Perspectives

“…In a pilot project switching some primary care dentists from FFS to capitation in Northern Ireland, treatment volumes fell but preventive interventions did not increase (Hill et al 2017). Pay-for-performance models have been investigated for doctors in hospital settings with no impact found on patient outcomes, although quality of care did improve (Mathes et al 2019).…”