Pay-for-Performance or Pay for Value?

Smoldt, Robert K.; Cortese, Denis A.

doi:10.1016/s0025-6196(11)61001-x

Cited by 47 publications

(14 citation statements)

References 7 publications

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“…Value in health care has been conceptualized as health outcomes per dollar spent 12 and outcomes per dollar spent over time. 13 Patients, however, typically view value more broadly as benefits received for burdens endured. 14 Burdens include both monetary costs and nonmonetary costs.…”

Section: Principle 2: Lean Is Value-creatingmentioning

confidence: 99%

The Promise of Lean in Health Care

Toussaint

Berry

2013

Mayo Clinic Proceedings

311

241

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An urgent need in American health care is improving quality and efficiency while controlling costs. One promising management approach implemented by some leading health care institutions is Lean, a quality improvement philosophy and set of principles originated by the Toyota Motor Company. Health care cases reveal that Lean is as applicable in complex knowledge work as it is in assembly-line manufacturing. When well executed, Lean transforms how an organization works and creates an insatiable quest for improvement. In this article, we define Lean and present 6 principles that constitute the essential dynamic of Lean management: attitude of continuous improvement, value creation, unity of purpose, respect for front-line workers, visual tracking, and flexible regimentation. Health care case studies illustrate each principle. The goal of this article is to provide a template for health care leaders to use in considering the implementation of the Lean management system or in assessing the current state of implementation in their organizations.

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Section: Principle 2: Lean Is Value-creatingmentioning

confidence: 99%

The Promise of Lean in Health Care

Toussaint

Berry

2013

Mayo Clinic Proceedings

311

241

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“…For the most part payfor-performance is already a process that is well underway in many areas of medicine. 13,14 Establishing databases with data fi elds that the medical community truly considers relevant is an important initiative, and as we have shown here, it is "doable" and valuable. Allocating resources to this initiative in order to make ongoing measurement sustainable will be an important future consideration if pay-for-performance is to be a reality.…”

Section: Acknowledgmentsmentioning

confidence: 94%

A Multicenter, Prospective, Advanced Diagnostic Bronchoscopy Outcomes Registry

Ernst

Simoff

Ost

et al. 2010

Chest

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The expense for medical care is increasing rapidly in the United States. New diagnostic and therapeutic technologies are frequently cited as a signifi cant contributor to increasing health-care costs. New technologies are usually expensive and may be of either unproven benefi t or of unclear improved effi cacy as compared with existing conventional modalities. 1 It has therefore been proposed that devices undergo more rigorous comparative evaluation to better assess their use in order to justify reimbursement levels. 2 A good example of structured comparative effectiveness analysis exists in Great Britain, with the National Institute for Health and Clinical Excellence program. 3 This group reviews the available evidence for medical interventions, assesses the potential impact on the patients and health-care systems by calculating the price to be paid for a quality-adjusted life years, and then makes recommendations regarding coverage to the respective agency. Designing trials that enable proper comparative technology evaluation is complex and expensive and funding mechanisms at least for now are limited for this kind of important research. Also lacking are Background: Multiple new diagnostic bronchoscopic technologies are available, but little is known about their comparative performance and specifi c yield when adjusted for location of lesions, target size, and diagnosis. We present a multi-institutional prospective-outcomes database to assess diagnostic yields of advanced bronchoscopic procedures, as well as related morbidity and mortality. Methods: Data were extracted and reviewed from an ongoing, paper-based, prospective, multiinstitutional outcomes database for advanced diagnostic bronchoscopic procedures. All consecutive eligible patients are entered into this database, and information on demographics, procedure, and lesion characteristics as well as complications were documented. Descriptive statistical analyses were performed. Results: A total of 310 diagnostic procedures were performed over a 1-year period in four institutions by 15 different clinicians. The majority of the patients were white (66%), male (56%), former smokers (55%), with a mean age of 61 6 14 years. The average procedure time was 36 min, and the most common procedure was transbronchial needle aspiration (TBNA) (n 5 198). Nodal tissue was obtained in 82.3% from TBNA sampling with a mean of three passes using endobronchial ultrasound guidance with a 22-gauge needle and mostly without on-site cytology. The overall diagnostic yield for all procedures was 75%. There were few complications, and none required a change in disposition. Conclusions: Prospective and ongoing data analysis for bronchoscopic procedures is feasible and valuable. Lesion-adjusted diagnostic yields can be documented and potentially used for comparative assessment of different technologies and operators, as well as benchmarking and quality improvement initiatives. Extending the number of participating centers and web-based submission to minimize missing data components ...

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“…15,16 Ultimately, quality is represented as various outcomes of interest, including meeting certain goals, avoiding harm, and experiencing healthcare with dignity. Costs are often distributed between patient and third parties initially, but ultimately become reflected in costs directly born by the patient.…”

Section: Why Measure Quality Of Care?mentioning

confidence: 99%