Quality Management in Healthcare

Question by professor:

Should healthcare providers be paid (reimbursed) according to the quality of care as incentive to improve their performance (known as pay for performance)? Explain why or why not (hint: www.ncqa.org)

What criteria would you use to rate their performance?

Can physicians negatively impact the CQI effects of a healthcare facility?

Student 1: Dabin Jung

I think that healthcare providers should be continued to be paid according to the quality of care to improve their performance. According to Beich, Scanlon, and Boyce (2010), both financial incentives and public recognition have been shown to be related to increased quality improvement activities among health care providers (HCP). The financial incentives are what is known as pay for performance. According to Sutton et al. (2012), the institution of pay for performance in a region of England was associated with a significantly reduced mortality rate.

The criteria I would use to rate HCP’s performance are clinical outcomes like the effectiveness of care, an average of hospital stays for patients, and the mortality rate. However, sometimes the mortality rate is not decided by the HCP’s abilities. Therefore, I would include one more criterion which is participation. There is already a similar way to motivate HCP to involve in quality improvement activities which is pay for participation (Beich, Scanlon & Boyce, 2010). In this case, HCP are reimbursed according to their time and cost of engaging in quality improvement activities (Beich, Scanlon & Boyce, 2010). Physicians can negatively impact the CQI effects of a healthcare facility in many ways. One way of negatively impacting the CQI effects of a healthcare facility is by not adhering to the recommended processes (McGlynn et al, 2003).

Beich, J., Scanlon, D. P., & Boyce, P. S. (2010). A community-level effort to motivate physician participation in the National Committee for Quality Assurance Diabetes Physician Recognition Program. Population Health Management.13(3). https://doi.org/10.1089/pop.2009.0035

Glynn, E. A., Asch, S. M., Adams, J., Keesey, J., Hicks, J., DeCristofaro, A., & Kerr, E. A. (2003). The quality of health care delivered to adults in the United States. The New England journal of medicine, 348(26), 2635–2645. https://doi.org/10.1056/NEJMsa022615

Sutton, M., Nikolova, S., Boaden, R., Lester, H., McDonald, R., & Roland, M. (2012). Reduced mortality with hospital pay for performance in England. New England Journal of Medicine, 367(19), 1821–1828. https://doi.org/10.1056/nejmsa1114951

Student 2: Cheryl Brockhouse 

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I feel that health care providers should be paid according to the care that they give. It is commonly accepted that payment methods influence physician practice behavior and is equally clear that non-financial incentives also play an important role in shaping behavior (Rudmik, Wranik, & Rudisill-Michaelsen, 2014). Pay for performance can be used to enhance performance and also improve the quality of care while reducing cost. With the objective to improve the quality of health care delivery as well as efficient delivery of care, pay-for performance (P4P) both remunerates and measures physician performance based on achieving certain clinical targets at the patient population level and quality goals  (Rudmik, Wranik, & Rudisill-Michaelsen, 2014). This can provide diverse results because pay for performance directly increase the level of performance of the employer with the expectation of better wages. This method reviews the groundwork and existing condition of both public and private pay-for-performance activities. In theory, paying providers for accomplishing better results for patients should enhance those results.

The pay-for-performance model offers financial impetuses to providers to enhance quality and proficiency. Incentives are rewarded in conjunction with the standard fee-for-service if the provider meets or surpasses established measurements of performance. Pay-for-performance programs can also impose financial penalties on providers that fail to achieve specified goals or cost savings (James, 2012). The quality measures used in pay-for-performance generally fall into the four categories described below (James, 2012).

Process: activities that have been shown to enhance patient results for, e.g., directing patients to stop smoking

Outcome: the impacts that provider care had on patient health for, e.g., lower circulatory strain in a stroke understanding

Patient Satisfaction: it includes patient's opinion about the quality and conveyance of care for, e.g., hold up times and communication from staff

 Structure: the facilities, faculty, and equipment used amid care for, e.g., electronic

It is possible that physicians can negatively influence the continuous quality improvement effects within a healthcare organization. If the physician does not apply changes, shows dismissal to adjusting changes, and the delivery of the services to patients the impact of the changes could be seriously affected and undeniably reduces the level of efficiency of continuous quality improvement.

References

James, J. (2012, October 11). Pay-for-Performance. Retrieved from Health Affairs: https://www.healthaffairs.org/do/10.1377/hpb20121011.90233/full/

Johnson, J. K., & Sollecito, W. A. (2020). McLaughlin & Kaluzny's Continuous Quality Improvement in Health Care (Fifth ed.). Burlington, MA: Jones & Bartlett Learning, LLC, an Ascend Learning Company.

Rudmik, L., Wranik, D., & Rudisill-Michaelsen, C. (2014). Physician payment methods: a focus on quality and cost control. Journal of Otolaryngology -Head and Neck Surgery. Retrieved from chrome-extension://efaidnbmnnnibpcajpcglclefindmkaj/viewer.html?pdfurl=https%3A%2F%2Fjournalotohns.biomedcentral.com%2Ftrack%2Fpdf%2F10.1186%2Fs40463-014-0034

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