Pay-for-performance is a phenomenon that has been developed to improve the efficiency and overall quality of the healthcare industry. According to James (2012), this term stands for providing “financial incentives to hospitals, physicians, and other health care providers to carry out such improvements and achieve optimal outcomes for patients’ ‘ (p. 1). This phenomenon is expected to solve deficiencies in the quality of US health care. Since this approach helps identify whether medical professionals have met or exceeded care delivery plans and patient outcomes, pay-for-performance is a useful tool to enhance quality in managed care systems.
Furthermore, the pay-for-performance approach implies four categories to measure performance, and they include process, outcome, patient experience, and structure measures (James, 2012). It is reasonable to present examples of each of them to demonstrate how these phenomena work. Firstly, process measures draw attention to whether, for example, consultations to quit smoking have been organized. Secondly, outcome measures focus on the effect of care, and they can refer to whether the patients’ blood tests are under control. Thirdly, patient experience measures analyze patients’ perception of care that can relate to assessing how effectively doctors and nurses have communicated. Finally, structure measures include the use of information technology to improve patient outcomes.
In addition to that, pay-for-performance offers penalties for medical establishments that fail to meet some goals. For example, James (2012) explains that “the Medicare program no longer pays hospitals to treat patients who acquire certain preventable conditions during their hospital stay” (p. 2). Furthermore, Rau (2012) emphasizes that Medicare will penalize more than 2,000 hospitals because “many of their patients are readmitted soon after discharge” (para. 1). Consequently, one can say that pay-for-performance is a sufficient stimulus for providers to improve their service, but it can offer significant issues for those establishments that fail to meet the requirements.
References
James, J. (2012). Health policy brief: Pay-for-performance. Health Affairs, 1-6.
Rau, J. (2012). Medicare to penalize 2,217 hospitals for excess readmissions. Web.