Journal article
Sustainability of Quality Improvement Following Removal of Pay-for-Performance Incentives
Journal of general internal medicine : JGIM, Vol.29(1), pp.127-132
2014
DOI: 10.1007/s11606-013-2572-4
PMCID: PMC3889947
PMID: 23929219
Abstract
BACKGROUND
Although pay-for-performance (P4P) has become a central strategy for improving quality in US healthcare, questions persist about the effectiveness of these programs. A key question is whether quality improvement that occurs as a result of P4P programs is sustainable, particularly if incentives are removed.
OBJECTIVE
To investigate sustainability of performance levels following removal of performance-based incentives.
DESIGN, SETTING, AND PARTICIPANTS
Observational cohort study that capitalized on a P4P program within the Veterans Health Administration (VA) that included adoption and subsequent removal of performance-based incentives for selected inpatient quality measures. The study sample comprised 128 acute care VA hospitals where performance was assessed between 2004 and 2010.
INTERVENTION
VA system managers set annual performance goals in consultation with clinical leaders, and report performance scores to medical centers on a quarterly basis. These scores inform performance-based incentives for facilities and their managers. Bonuses are distributed based on the attainment of these performance goals.
MEASUREMENTS
Seven quality of care measures for acute coronary syndrome, heart failure, and pneumonia linked to performance-based incentives.
RESULTS
Significant improvements in performance were observed for six of seven quality of care measures following adoption of performance-based incentives and were maintained up to the removal of the incentive; subsequently, the observed performance levels were sustained.
LIMITATIONS
This is a quasi-experimental study without a comparison group; causal conclusions are limited.
CONCLUSION
The maintenance of performance levels after removal of a performance-based incentive has implications for the implementation of Medicare’s value-based purchasing initiative and other P4P programs. Additional research is needed to better understand human and system-level factors that mediate sustainability of performance-based incentives.
Details
- Title: Subtitle
- Sustainability of Quality Improvement Following Removal of Pay-for-Performance Incentives
- Creators
- Justin K BENZER - Center for Organization, Leadership, and Management Research (COLMR) at the VA Boston Healthcare System (152 M), Boston, MA, United StatesGary J YOUNG - Center for Organization, Leadership, and Management Research (COLMR) at the VA Boston Healthcare System (152 M), Boston, MA, United StatesJames F BURGESS - Center for Organization, Leadership, and Management Research (COLMR) at the VA Boston Healthcare System (152 M), Boston, MA, United StatesErrol BAKER - Center for Organization, Leadership, and Management Research (COLMR) at the VA Boston Healthcare System (152 M), Boston, MA, United StatesDavid C MOHR - Center for Organization, Leadership, and Management Research (COLMR) at the VA Boston Healthcare System (152 M), Boston, MA, United StatesMartin P CHARNS - Center for Organization, Leadership, and Management Research (COLMR) at the VA Boston Healthcare System (152 M), Boston, MA, United StatesPeter J KABOLI - Comprehensive Access and Delivery Research and Evaluation (CADRE) Center at the Iowa City VA Healthcare System, Iowa City, IA, United States
- Resource Type
- Journal article
- Publication Details
- Journal of general internal medicine : JGIM, Vol.29(1), pp.127-132
- DOI
- 10.1007/s11606-013-2572-4
- PMID
- 23929219
- PMCID
- PMC3889947
- NLM abbreviation
- J Gen Intern Med
- ISSN
- 0884-8734
- eISSN
- 1525-1497
- Publisher
- Springer
- Language
- English
- Date published
- 2014
- Academic Unit
- Epidemiology; Internal Medicine
- Record Identifier
- 9984094569802771
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