Value-based Incentive Research Articles

Positive Peer-Pressured Productivity (P-QUAD): Novel Use of Increased Transparency and a Weighted Lottery to Increase a Division's Academic Output

ObjectiveEvaluate a dual incentive model combining positive peer pressure through increased transparency of peers' academic work with a weighted lottery where entries are earned based on degree of productivity. MethodsWe developed a dual-incentive peer mentoring model, Positive Peer-Pressured Productivity (P-QUAD), for faculty in the Pediatric Hospital Medicine Division at the University of Minnesota Masonic Children's Hospital. This model provided relative value-based incentives, with points assigned to different scholarly activities (eg. 1 point for abstract submission, 2 points for poster presentation, 3 points for oral presentation, etc.). These points translated into to lottery tickets for a semi-annual drawing for monetary prizes. Productivity was compared among faculty for P-QUAD year to the preintervention year. ResultsFifteen (83%) of 18 eligible faculty members participated. Overall annual productivity per faculty member as measured by total P-QUAD score increased from a median of 3 (interquartile range [IQR] 0–14) in the preintervention year to 4 (IQR 0–27) in the P-QUAD year (P = .051). Submissions and acceptances increased in all categories except posters which were unchanged. Annual abstract submissions per faculty member significantly increased from a median of 1 (IQR 0–2) to 2 (IQR 0–2; P = .047). Seventy-three percent (8 of 11) of post-survey respondents indicated that the financial incentive motivated them to submit academic work; 100% indicated that increased awareness of their peers' work was a motivator. ConclusionsThe combination of increased awareness of peers' academic productivity and a weighted lottery financial incentive appears to be a useful model for stimulating academic productivity in early-career faculty.

The Value of Exceptional Patient Experience.

Patient experience metrics are increasingly the focus of value-based incentive programs by both the federal government and private payers. A clear financial imperative exists to improve experience; at the same time, it is becoming evident that engaging patients in their care also leads to better clinical outcomes.

Truncal blocks for perioperative pain management: a review of the literature and evolving techniques.

As the American healthcare system continues to evolve and reimbursement becomes tied to value-based incentive programs, perioperative pain management will become increasingly important. Regional anesthetic techniques are only one component of a successful multimodal pain regimen. In recent years, the use of peripheral and paraneuraxial blocks to provide chest wall and abdominal analgesia has gained popularity. When used within a multimodal regimen, truncal blocks may provide similar analgesia when compared with other regional anesthetic techniques. While there are other reviews that cover this topic, our review will also highlight the emerging role for serratus plane blocks, pectoral nerve blocks and quadratus lumborum blocks in providing thoracic and abdominal analgesia.

Understanding Value-Based Incentive Models and Using Performance as a Strategic Advantage

The Centers for Medicare & Medicaid Services (CMS) implemented hospital quality incentive and penalty programs as part of the Affordable Care Act, and they are the starting points for transitioning to value-based payment. Not only do the programs affect hospitals' bottom line, but they also could affect their market position because of the transparency of results. Thus, creating an effective strategy to succeed under these programs is important.The authors address some important questions about the CMS incentive and penalty programs.What upside benefits and downside penalties do the CMS incentive and penalty models offer hospitals?The CMS quality- and value-based incentive and penalty models will collectively put up to 6% of hospitals' Medicare payments at risk by 2017 (Rau, 2015). The three CMS programs are the Value-Based Purchasing (VBP) program, the Hospital Readmissions Reduction Program (HRRP), and the Hospital-Acquired Conditions (HAC) program. As part of healthcare reform, these programs are designed to transition hospitals to more value-based reimbursement by incentivizing or penalizing providers on the basis of their performance on certain quality metrics. These three programs reflect a fundamental change in how Medicare reimburses hospitals for services and in how hospitals manage and monitor quality performance. The VBP program is the only one of the three that has upside benefits in providing a bonus; the HRRP and HAC programs are strictly penalty programs for hospitals that do not perform well under the criteria established by CMS.The VBP program is technically a payment redistribution program in that eligible hospitals contribute a set percentage of base operating payments to a VBP payment pool; the percentage is 1.75% for fiscal year (FY) 2016 and 2% for FY 2017. This VBP payment pool is used to provide a to hospitals for performance on the VBP criteria, which are grouped into the domains of process of care, outcomes, patient experience, and efficiency. Thus, all hospitals pay into the pool, and if they do not perform well, their bonus could be less than the amount of their contribution (i.e., a net penalty). On the other hand, hospitals that perform well receive a payment that is more than the amount they paid in (i.e., a net bonus).HRRP and HAC programs are strictly penalty programs. HRRP issues a penalty of up to 3% for hospitals with excessive avoidable readmissions, and HAC issues a 1% penalty for hospitals whose performance is in the bottom quartile. However, the 1% penalty under HAC is not limited to the hospital base operating payment, but is also applied to add-on payments, such as those for outliers, disproportionate share hospitals, uncompensated care, and indirect medical education, making its impact more pronounced. On the basis of CMS data (2015a), we estimated the average penalty for FY 2015 to be $520,000 per penalized hospital under the HAC program, whereas the average readmissions penalty was projected to be $165,000.Is the magnitude of the benefits and penalties substantial enough to warrant being proactive?For FY 2016, only 799 of 3,414 eligible hospitals (23%) avoided a penalty for excessive avoidable readmissions, meaning that 77% of eligible hospitals are being penalized under HRRP (CMS, 2015b). (Readmissions data are based on a rolling 3-year assessment period; for FY 2016, the data are from July 1, 2011, to June 30, 2014.) However, the penalty for the majority of hospitals was in the range of 0.01% to 0.5%, and both the number of hospitals penalized and the average penalty fell from the levels in FY 2015. Since enactment of the readmissions penalties in 2013, readmissions have dropped, but approximately one in five patients admitted to the hospital is still readmitted within 30 days of discharge. In FY 2017, a new condition-coronary artery bypass graft-will be added to the list of measured conditions for HRRP. Historically, CMS has added a new condition every other year, and hospitals typically struggle when new conditions are added. …

Nurse Bullying: A Review And A Proposed Solution

Nurse bullying is an extremely common phenomenon which has detrimental consequences to nurses, patients, health care institutions, and to the nursing profession itself. It has even been linked to increased patient mortality. This article demonstrates the critical need to resolve the issue of nurse bullying. It also shows that previous attempts of resolution have not been successful, which may be partly due to the fact that the problem is relatively unacknowledged outside the nursing profession. To resolve the problem of nurse bullying, we believe that the solution must include an incentive for institutions to implement the necessary interventions and to ensure that they are effective. We propose that a measurement pertaining to the level of nurse bullying be factored into the calculation of the value-based incentive payment in the Hospital Value-Based Purchasing program. To facilitate this, we propose that a survey be developed and implemented which is similar to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. However, whereas the HCAHPS survey measures patients' perspectives of hospital care, this survey would measure nurses' perspectives of workplace bullying.

The Radiologist Will See You Now: Patients’ Perceptions of an Outpatient Interventional Clinic

Patient satisfaction is becoming an increasingly important part of America's healthcare system. Patient satisfaction is now a metric assessed for value-based incentive payments by the Center for Medicare and Medicaid Services, and the healthcare market is becoming increasingly consumer-driven as patients are provided with more options regarding where they receive care as well as improved access to medical information. Radiologists, while less involved with direct patient care than other medical specialties, are not immune to the changing medical landscape and need to adapt to a progressively value- and patient-oriented healthcare system. At our institution, first-year radiology residents take an active role in our outpatient interventional radiology clinic by performing clinical histories and physical exams in a dedicated radiology clinic examination rooms. Stressing the various opportunities for patient interaction and the potential benefits of patient- centered radiology in the evolving healthcare system may increase its perceived value among both radiology residents as well as practicing radiologists. ​Directly engaging patients may be unfamiliar territory for the practicing radiologist and an unexpected prospect for current residents, but available data suggests that patients do value direct interaction with radiologists during the course of their care.

Anesthesiologists and the Transformation of the Healthcare System

Anesthesiologists and the Transformation of the Healthcare System

Extracting Value From Oral and Maxillofacial Surgery

Extracting Value From Oral and Maxillofacial Surgery

CMS reveals Medicare’s value-based purchasing program for hospitals

A cute care hospitals’ performance on 13 measures of care in the coming nine months will determine how the government distributes about $850 million for the fiscal year that starts October 1, 2012. The money, the Department of Health and Human Services said, will be a reward to hospitals for the quality of the care they provide to Medicare beneficiaries. Even the lowest-scoring hospital will receive some of the money, about 0.0236%, the Centers for Medicare and Medicaid Services (CMS) said. The rewards, also known as value-based incentive payments, result from the Patient Protection and Affordable Care Act, signed into law in March 2010. Under this law, the money for the rewards in fiscal year 2013 will come from a 1% cut to Medicare’s diagnosis-related-group payment rates. The cut increases by 0.25%/yr to fiscal year 2017 and tops out at 2%. CMS estimated that about half of the facilities participating in this Hospital Inpatient Value-Based Purchasing Program will receive a net increase in their Medicare payments. The other half will receive a net decrease.