Public Reporting and Pay-for-Performance: Safety-Net Hospital Executives' Concerns and Policy Suggestions

Abstract

Safety-net hospitals (SNHs) may gain little financial benefit from the rapidly spreading adoption of public reporting and pay-for-performance, but may feel compelled to participate (and bear the costs of data collection) to meet public expectations of transparency and accountability. To better understand the concerns that SNH administrators have regarding public reporting and pay-for-performance, we interviewed 37 executives at randomly selected California SNHs. The main concerns noted by SNH executives were that human and financial resource constraints made it difficult for SNHs to accurately measure their performance. Additionally, some executives felt that market-driven public reporting and pay-for-performance may focus on clinical areas and incentive structures that may not be high-priority clinical areas for SNHs. Executives at SNHs suggested several policy responses to these concerns-such as offering training programs for SNH data collectors-that could be relatively inexpensive and might improve the cost-benefit ratio of public reporting and pay-for-performance programs.

Leaders’ experiences and perceptions implementing activity-based funding and pay-for-performance hospital funding models: A systematic review

“…See Table 3 [61,74,76,77,79]. More specifically, implementation requires the organization to be fully committed to, and supportive of, the chosen funding model, recognizing it as a strategy to improve quality [71,74,76,77]. Implementation success of P4P also requires the necessary infrastructure to support the individuals and activities required to accurately measure quality [61,74,77].…”

“…Several themes emerged from the data, each describing leaders' perspectives and/or experiences of implementing ABF or P4P in inpatient hospital settings: (1) pre-requisites for success, (2) perceived benefits, (3) barriers/challenges, (4) unintended consequences, and (5) leader recommendations. See Table 3 [61,74,76,77,79]. More specifically, implementation requires the organization to be fully committed to, and supportive of, the chosen funding model, recognizing it as a strategy to improve quality [71,74,76,77].…”

Healthcare organizations’ attitudes toward pay-for-performance in Korea

“…The last component to take into consideration is the additional costs (i.e., cost for pay for reporting) because they can be a burden to healthcare organizations financially. In relation to this matter, Goldman et al indicated that government or health plan should support to gather quality data and should pay for additional costs or reduce the costs for data collection [26]. Overall, to allow a smoother and successful expansion of the VIP for hospitals and clinics, HIRA could to take into the consideration of volunteer participation and financial incentives without penalties in the early stages of the VIP.…”

Valuing Improvement in Value-Based Purchasing

“…24,25 It would be surprising if the observed improvements came without financial cost. To our knowledge, this is the first published study to examine the relationship between alternative definitions of "performance" and the distribution of winners and losers.…”