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Research Studies is a monthly compilation of research articles funded by AHRQ or authored by AHRQ researchers and recently published in journals or newsletters.
Results1 to 7 of 7 Research Studies Displayed
Paddock SM, Damberg CL, Yanagihara D
What role does efficiency play in understanding the relationship between cost and quality in physician organizations?
Previous studies demonstrate overuse of a narrow set of services, suggesting provider inefficiency, but existing studies neither quantify inefficiency more broadly nor assess its variation across physician organizations (POs). This study found that POs had substantial variation in efficiency, producing widely differing levels of quality for the same cost.
Citation: Paddock SM, Damberg CL, Yanagihara D . What role does efficiency play in understanding the relationship between cost and quality in physician organizations? Med Care 2017 Dec;55(12):1039-45. doi: 10.1097/mlr.0000000000000823.
Keywords: Value, Practice Patterns, Healthcare Costs, Quality of Care, Quality Improvement, Payment, Provider Performance
Kronick R, Casalino LP, Bindman AB
AHRQ Author: Kronick R
Apple pickers or federal judges: strong versus weak incentives in physician payment.
The authors provide an introduction for five papers commissioned by AHRQ focusing on incentives for physicians that are featured in this special issue of Health Services Research. These papers concentrate on suggesting a conceptual framework for the use of financial incentives in health care, key implications of the evidence to date on pay for performance and public reporting in health care and several related topics.
Citation: Kronick R, Casalino LP, Bindman AB . Apple pickers or federal judges: strong versus weak incentives in physician payment. Health Serv Res 2015 Dec;50 Suppl 2:2049-56. doi: 10.1111/1475-6773.12424.
Keywords: Payment, Provider Performance, Policy, Health Services Research (HSR), Quality of Care, Value, Healthcare Costs, Quality Improvement
Berenson RA, Rice T
Beyond measurement and reward: methods of motivating quality improvement and accountability.
The article examines public policies designed to improve quality and accountability that do not rely on financial incentives and public reporting of provider performance. It concludes that public policies related to quality improvement should focus more on methods of enhancing professional intrinsic motivation, while recognizing the potential role of organizations to actively promote and facilitate that motivation.
Citation: Berenson RA, Rice T . Beyond measurement and reward: methods of motivating quality improvement and accountability. Health Serv Res 2015 Dec;50 Suppl 2:2155-86. doi: 10.1111/1475-6773.12413.
Keywords: Quality Improvement, Policy, Provider Performance, Quality of Care, Value, Payment
Layton TJ, Ryan AM
Higher incentive payments in Medicare Advantage's pay-for-performance program did not improve quality but did increase plan offerings.
The researchers evaluated the effects of the size of financial bonuses on quality of care and the number of plan offerings in the Medicare Advantage Quality Bonus Payment Demonstration. They concluded that at great expense to Medicare, double bonuses in the Medicare Advantage Quality Bonus Payment Demonstration were not associated with improved quality but were associated with more plan offerings.
Citation: Layton TJ, Ryan AM . Higher incentive payments in Medicare Advantage's pay-for-performance program did not improve quality but did increase plan offerings. Health Serv Res 2015 Dec;50(6):1810-28. doi: 10.1111/1475-6773.12409..
Keywords: Medicare, Payment, Provider Performance, Value, Health Services Research (HSR), Quality Improvement, Quality of Care
Schlesinger M, Grob R, Shaller D
Using patient-reported information to improve clinical practice.
The purposes of this study were to assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives. It concluded that unless public policies are attentive to patients' perspectives, stronger financial incentives for clinicians can threaten aspects of care that patients most value.
Citation: Schlesinger M, Grob R, Shaller D . Using patient-reported information to improve clinical practice. Health Serv Res 2015 Dec;50 Suppl 2:2116-54. doi: 10.1111/1475-6773.12420.
Keywords: Quality Improvement, Quality of Care, Patient Experience, Provider Performance, Policy, Value, Payment, Public Reporting
Ryan AM, Burgess JF, Pesko MF
The early effects of Medicare's mandatory hospital pay-for-performance program.
This study evaluated the impact of hospital value-based purchasing (HVBP) on clinical quality and patient experience during its initial implementation period. It found that hospitals that were exposed to HVBP did not show greater improvement for either the clinical process or patient experience measures during the program’s initial implementation period.
Citation: Ryan AM, Burgess JF, Pesko MF . The early effects of Medicare's mandatory hospital pay-for-performance program. Health Serv Res. 2015 Feb;50(1):81-97. doi: 10.1111/1475-6773.12206..
Keywords: Medicare, Provider Performance, Payment, Hospitals, Value, Quality Improvement, Quality of Care, Patient Experience
DeVoe JE, Stenger R
Aligning provider incentives to improve primary healthcare delivery in the United States.
This critical review uses a theoretical framework from game-theory models to discuss some of the dominant primary care provider payment models and how they create 'prisoner's dilemmas' that have stalled past reform efforts, then illustrates an escape from the dilemma. It concludes that a blend of guaranteed payment and selective incentives designed to encourage primary care providers to deliver high quality care, efficient and equitable care and to eliminate incentives towards over-servicing could reach outcomes leading to shared benefits for everyone involved.
AHRQ-funded; HS014645; HS016181.
Citation: DeVoe JE, Stenger R . Aligning provider incentives to improve primary healthcare delivery in the United States. OA Fam Med 2013 Jun 1;1(1):7.
Keywords: Healthcare Delivery, Payment, Primary Care, Quality Improvement, Value