Efforts to align payments with the quality of care—so-called
"pay for performance" programs—are growing in number. Most
of these initiatives target effectiveness measures, but some are
beginning to include other dimensions of performance, such as patients'
experiences with care and indicators of efficiency. For example,
Medicare and Premier Inc., a nationwide organization of nonprofit
hospitals, are conducting the Hospital Quality Incentive Demonstration
to test whether bonus payments and public reporting of performance
data can foster quality. With Fund support, the Urban Institute's
Robert Berenson, M.D., is studying whether New York State's incentive
program for Medicaid managed care plans has encouraged quality improvement
efforts and improved the quality of care for enrollees.
There is keen interest in developing indicators of efficiency for hospitals, physician groups, and other providers of care. Yet, the relationship between cost and quality is poorly understood, and health system characteristics associated with higher performance are not firmly established. With Fund support, Sharon Silow-Carroll and her colleagues at the Health Management Associates are exploring the dynamics of high performance over time and the factors that contribute to its sustainability.
Using CareScience's national database of more than 3,000 hospitals, Silow-Carroll and her team have been tracking hospital quality and efficiency as measured by such factors as mortality, complications, and resource use over three years. What interests them most are hospitals that are able to achieve high performance on a broad set of indicators, rather than just a few. As part of their work, the researchers are performing analyses of quarterly performance data from 200 hospitals and developing profiles of four of the highest-performing hospitals.
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