scholarly journals Reforming Payments to Healthcare Providers: The Key to Slowing Healthcare Cost Growth While Improving Quality?

2011 ◽  
Vol 25 (2) ◽  
pp. 69-92 ◽  
Author(s):  
Mark McClellan
Keyword(s):  
Empirical Studies ◽  
Healthcare Providers ◽  
Care Quality ◽  
Small Scale ◽  
Fee For Service ◽  
Provider Payment ◽  
Cost Growth ◽  
Quality And Outcomes ◽  
Welfare Implications

This paper focuses on a broad movement toward a fundamentally different way of paying healthcare providers. The approach reaches beyond the old dichotomies about whether healthcare providers are reimbursed on a fee-for-service or a “capitated” or per-person payment. Instead, these reforms seek to create direct linkages between payments to healthcare providers and measures of the quality and efficiency of care. After an overview of payment reforms for healthcare providers and their welfare implications, this paper discusses a range of empirical studies. These often small-scale studies suggest that provider payment reforms in conjunction with greater attention to improving measurements of care quality and outcomes can have a significant impact on quality of care and, in some cases, resource use and costs of care.

scholarly journals A scoping review of registry captured indicators for evaluating quality of critical care in ICU

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Issrah Jawad ◽  
Sumayyah Rashan ◽  
Chathurani Sigera ◽  
Jorge Salluh ◽  
Arjen M. Dondorp ◽  
...  
Keyword(s):  
Critical Care ◽  
Scoping Review ◽  
Health Care Quality ◽  
Grey Literature ◽  
Healthcare Providers ◽  
Evidence Base ◽  
Patient Reported Outcome ◽  
Care Quality ◽  
Patient Reported

Abstract Background Excess morbidity and mortality following critical illness is increasingly attributed to potentially avoidable complications occurring as a result of complex ICU management (Berenholtz et al., J Crit Care 17:1-2, 2002; De Vos et al., J Crit Care 22:267-74, 2007; Zimmerman J Crit Care 1:12-5, 2002). Routine measurement of quality indicators (QIs) through an Electronic Health Record (EHR) or registries are increasingly used to benchmark care and evaluate improvement interventions. However, existing indicators of quality for intensive care are derived almost exclusively from relatively narrow subsets of ICU patients from high-income healthcare systems. The aim of this scoping review is to systematically review the literature on QIs for evaluating critical care, identify QIs, map their definitions, evidence base, and describe the variances in measurement, and both the reported advantages and challenges of implementation. Method We searched MEDLINE, EMBASE, CINAHL, and the Cochrane libraries from the earliest available date through to January 2019. To increase the sensitivity of the search, grey literature and reference lists were reviewed. Minimum inclusion criteria were a description of one or more QIs designed to evaluate care for patients in ICU captured through a registry platform or EHR adapted for quality of care surveillance. Results The search identified 4780 citations. Review of abstracts led to retrieval of 276 full-text articles, of which 123 articles were accepted. Fifty-one unique QIs in ICU were classified using the three components of health care quality proposed by the High Quality Health Systems (HQSS) framework. Adverse events including hospital acquired infections (13.7%), hospital processes (54.9%), and outcomes (31.4%) were the most common QIs identified. Patient reported outcome QIs accounted for less than 6%. Barriers to the implementation of QIs were described in 35.7% of articles and divided into operational barriers (51%) and acceptability barriers (49%). Conclusions Despite the complexity and risk associated with ICU care, there are only a small number of operational indicators used. Future selection of QIs would benefit from a stakeholder-driven approach, whereby the values of patients and communities and the priorities for actionable improvement as perceived by healthcare providers are prioritized and include greater focus on measuring discriminable processes of care.

scholarly journals Quality of Care for Comorbid Conditions During the Transition to Survivorship: Differences Between Cancer Survivors and Noncancer Controls

2013 ◽  
Vol 31 (9) ◽  
pp. 1140-1148 ◽  
Author(s):  
Claire F. Snyder ◽  
Kevin D. Frick ◽  
Robert J. Herbert ◽  
Amanda L. Blackford ◽  
Bridget A. Neville ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Quality Of Care ◽  
Cancer Survivors ◽  
Breast Cancer Survivors ◽  
Care Quality ◽  
Comorbid Condition ◽  
Cancer Type ◽  
Fee For Service ◽  
To Receive

Purpose Building on previous research documenting differences in preventive care quality between cancer survivors and noncancer controls, this study examines comorbid condition care. Methods Using data from the Surveillance, Epidemiology, and End Results (SEER) –Medicare database, we examined comorbid condition quality of care in patients with locoregional breast, prostate, or colorectal cancer diagnosed in 2004 who were age ≥ 66 years at diagnosis, who had survived ≥ 3 years, and who were enrolled in fee-for-service Medicare. Controls were frequency matched to cases on age, sex, race, and region. Quality of care was assessed from day 366 through day 1,095 postdiagnosis using published indicators of chronic (n = 10) and acute (n = 19) condition care. The proportion of eligible cancer survivors and controls who received recommended care was compared by using Fisher's exact tests. The chronic and acute indicators, respectively, were then combined into single logistic regression models for each cancer type to compare survivors' care receipt to that of controls, adjusting for clinical and sociodemographic variables and controlling for within-patient variation. Results The sample matched 8,661 cancer survivors to 17,322 controls (mean age, 75 years; 65% male; 85% white). Colorectal cancer survivors were less likely than controls to receive appropriate care on both the chronic (odds ratio [OR], 0.88; 95% CI, 0.81 to 0.95) and acute (OR, 0.72; 95% CI, 0.61 to 0.85) indicators. Prostate cancer survivors were more likely to receive appropriate chronic care (OR, 1.28; 95% CI, 1.19 to 1.38) but less likely to receive quality acute care (OR, 0.75; 95% CI, 0.65 to 0.87). Breast cancer survivors received care equivalent to controls on both the chronic (OR, 1.06; 95% CI, 0.96 to 1.17) and acute (OR, 0.92; 95% CI, 0.76 to 1.13) indicators. Conclusion Because we found differences by cancer type, research exploring factors associated with these differences in care quality is needed.

Designing Payment Contracts for Healthcare Services to Induce Information Sharing: The Adoption and the Value of Health Information Exchanges (HIEs)

MIS Quarterly ◽  
2021 ◽  
Vol 45 (2) ◽  
pp. 637-692 ◽  
Author(s):  
Mehmet Ayvaci ◽  
Huseyin Cavusoglu ◽  
Yeongin Kim ◽  
Srinivasan Raghunathan
Keyword(s):  
Health Information ◽  
Healthcare Services ◽  
Care Quality ◽  
Switching Behavior ◽  
Fee For Service ◽  
Payment Model ◽  
Health Information Exchanges ◽  
Provider Payment ◽  
The Government ◽  
Payment Models

Recent initiatives to improve healthcare quality and reduce costs have centered around payment mechanisms and IT-enabled health information exchanges (HIEs). Such initiatives profoundly influence both providers’ choices in terms of healthcare effort levels and HIE adoption and patients’ choice of providers. Using a game-theoretical model of a healthcare setup, we examine the role of payment models in aligning providers’ and patients’ incentives for realizing socially optimal (i.e., first-best) choices. We show that the traditional fee-for-service (FFS) payment model does not necessarily induce the first-best solution. The pay-for-performance (P4P) model may induce the first-best solution under some conditions if provider switching by patients during a health episode is socially suboptimal, making provider coordination less of an issue. We identify an episode-based payment (EBP) model that can always induce the first-best solution. The proposed EBP model reduces to the P4P model if the P4P model induces the first-best solution. In other cases, the first-best inducing EBP model is multilateral in the sense that the payment to a provider depends not only on the provider’s own efforts and outcomes but also on those of other providers. Furthermore, the payment in this EBP model is sequence dependent in the sense that payment to a provider is contingent upon whether the patient visits a given provider first or second. We show that the proposed EBP model achieves the lowest healthcare cost, not necessarily at the expense of care quality or provider payment, relative to FFS and P4P. Although our proposed contract is complex, it sets an optimality baseline when evaluating simpler contracts and also characterizes aspects of payment that need to be captured for socially desirable actions. We further show that the value of HIEs depends critically on the payment model as well as on the social desirability of patient switching. Under all three payment models, the HIE value is higher when switching by at least some patients is desirable than when switching by any patient is undesirable. Moreover, the HIE value is highest under the FFS model and lowest under the P4P model. Hence, assessing the value of HIEs in isolation from the underlying payment mechanism and patient-switching behavior may result in under- or overestimation of the HIE value. Therefore, as payment models evolve over time, there is a real need to reevaluate the HIE value and the government subsidies that induce providers to adopt HIEs.

Patient perceptions of quality: analyzing patient satisfaction surveys

2015 ◽  
Vol 35 (8) ◽  
pp. 1158-1181 ◽  
Author(s):  
Roberta S. Russell ◽  
Dana M. Johnson ◽  
Sheneeta W White
Keyword(s):  
Patient Satisfaction ◽  
Care Provider ◽  
Healthcare Providers ◽  
Academic Research ◽  
Quality Of Healthcare ◽  
Care Quality ◽  
Patient Perceptions ◽  
Medical Specialties ◽  
Content Type

Purpose – Healthcare facilities are entering an era of increased oversight and heightened expectations concerning both reduced costs and measureable quality. The US Affordable Care Act requires healthcare organizations to collect certain metrics, including patient assessments of quality, in order to monitor and improve the quality of healthcare. These metrics are used as a basis for graduated insurance reimbursements, and are available to consumers as an aid in selecting healthcare providers and insurance plans. The purpose of this paper is to provide healthcare providers with the analytic capabilities to better understand quality of care from the patient’s point of view. Design/methodology/approach – This research examines patient satisfaction data from a multi-specialty Medical Practice Group, and uses regression analysis and paired comparisons to provide insight into patient perceptions of care quality. Findings – Results show that variables related to Access, Moving Through the Visit, Nurse/Assistant, Care Provider and Personal Issues significantly impact overall assessments of care quality. In addition, while gender and type of care provider do not appear to have an impact on overall patient satisfaction, significant differences do exist based on age group, specialty of the physician and clinic type. Originality/value – This study differs from most academic research as it focusses on medical practices, rather than hospitals, and includes multiple clinic types, medical specialties and physician types in the analysis. The study demonstrates how analytics and patient perceptions of quality can inform policy decisions.

scholarly journals Prioritization of Indicators of the Quality of Care Provided to Older Adults with Frailty by Key Stakeholders from Five Canadian Provinces

2021 ◽  
Author(s):  
Anik Giguere ◽  
Jayna M. Holroyd-Leduc ◽  
Sharon E. Straus ◽  
Robin Urquhart ◽  
Véronique Turcotte ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Family Doctor ◽  
Healthcare Providers ◽  
Policy Decision ◽  
Structured Interview ◽  
Care Quality ◽  
Key Stakeholders ◽  
Healthcare Administrators

Abstract Background: To meet the needs of older adults with frailty better, it is essential to understand which aspects of care are important from their perspective. We therefore sought to assess the importance of a set of quality indicators (QI) for monitoring outcomes in this population. Methods: In this mixed-method study, key stakeholders completed a survey on the importance of 36 QIs, and then explained their ratings in a semi-structured interview. Stakeholders included older adults with frailty and their caregivers, healthcare providers (HCPs), and healthcare administrators or policy/decision makers (DMs). We conducted descriptive statistical analyses of quantitative variables, and deductive thematic qualitative analyses of interview transcripts. Results: The 42 participants (8 older adults, 18 HCPs, and 16 DMs) rated six QIs as more important: increasing the patients’ quality of life; increasing healthcare staff skills; decreasing patients’ symptoms; decreasing family caregiver burden; increasing patients’ satisfaction with care; and increasing family doctor continuity of care.Conclusions: Key stakeholders prioritized QIs that focus on outcomes targeted to patients and caregivers, whereas the current healthcare systems generally focus on processes of care. Quality improvement initiatives should therefore take better account of aspects of care that are important for older adults with frailty, such as having a chance to express their individual goals of care, receiving quality communications from HCPs, or monitoring symptoms that they might not spontaneously describe. Our results point to the need for patient-centred care that is oriented toward quality of life for older adults with frailty.

Achieving better quality care in general practice: are incentives the answer?

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711461
Author(s):  
Kanwal Ahmed ◽  
Salma Hashim ◽  
Mariyam Khankhara ◽  
Ilhan Said ◽  
Amrita Shandakumar ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Intrinsic Motivation ◽  
Financial Incentives ◽  
Quality Care ◽  
Healthcare Providers ◽  
Structured Interviews ◽  
Multiple Indicators ◽  
Improved Outcomes ◽  
Quality And Outcomes

BackgroundThe introduction of financial incentives, such as the quality and outcomes framework (QOF), historically lead to improvements in standardising practice. However, with shifting demands on healthcare providers, are these schemes still enough to drive high-quality care?AimTo explore current incentives, intrinsic and extrinsic, their role and effectiveness in improving quality of care and how they are perceived by GPs.MethodMixed methods study using two systematic literature reviews including 44 papers and 18 semi-structured interviews with GPs.ResultsIn the literature, QOF was associated with reduced socioeconomic inequalities, decreased mortality and improved outcomes. However, the absence of control groups and the simultaneous analysis of multiple indicators complicates the findings. GPs agreed with the literature and viewed financial incentives as beneficial, however, they felt the key driver in providing good-quality care was their intrinsic motivation. Financial incentives were found to contribute to depersonalised care, diluted provision of non-incentivised activities and hindered overall practice. The results from the second literature review were in keeping with the views of the participants. They illustrated the importance of managing factors contributing to physician burnout, reduced performance, and low job satisfaction, which can result in the provision of low-quality care.ConclusionFinancial incentives have the potential to induce behaviour change, however, their use in quality improvement is limited when used alone. If used in an environment that nurtures intrinsic motivation, healthcare providers will be more driven to achieve a higher quality of care and will be better able to cope with shifting demands.

scholarly journals Relationship Between Quality of Comorbid Condition Care and Costs for Cancer Survivors

2016 ◽  
Vol 12 (6) ◽  
pp. e734-e745 ◽  
Author(s):  
Kevin D. Frick ◽  
Claire F. Snyder ◽  
Robert J. Herbert ◽  
Amanda L. Blackford ◽  
Bridget A. Neville ◽  
...  
Keyword(s):  
Cancer Survivors ◽  
Glycosylated Hemoglobin ◽  
Care Quality ◽  
Chronic Obstructive ◽  
Comorbid Condition ◽  
Fee For Service ◽  
Obstructive Pulmonary Disease ◽  
Recommended Care ◽  
Patients With Diabetes

Purpose: To estimate the association between cancer survivors’ comorbid condition care quality and costs; to determine whether the association differs between cancer survivors and other patients. Methods: Using the SEER–Medicare-linked database, we identified survivors of breast, prostate, and colorectal cancers who were diagnosed in 2004, enrolled in Medicare fee-for-service for at least 12 months before diagnosis, and survived ≥ 3 years. Quality of care was assessed using nine process indicators for chronic conditions, and a composite indicator representing seven avoidable outcomes. Total costs on the basis of Medicare amount paid were grouped as inpatient and outpatient. We examined the association between care quality and costs for cancer survivors, and compared this association among 2:1 frequency-matched noncancer controls, using comparisons of means and generalized linear regressions. Results: Our sample included 8,661 cancer survivors and 17,332 matched noncancer controls. Receipt of recommended care was associated with higher outpatient costs for eight indicators, and higher inpatient and total costs for five indicators. For three measures (visit every 6 months for patients with chronic obstructive pulmonary disease or diabetes, and glycosylated hemoglobin or fructosamine every 6 months for patients with diabetes), costs for cancer survivors who received recommended care increased less than for noncancer controls. The absence of avoidable events was associated with lower costs of each type. An annual eye examination for patients with diabetes was associated with lower inpatient costs. Conclusion: Higher-quality processes of care may not reduce short-term costs, but the prevention of avoidable outcomes reduces costs. The association between quality and cost was similar for cancer survivors and noncancer controls.

scholarly journals A scoping review of registry captured indicators for evaluating quality of critical care in ICU.

2021 ◽  
Author(s):  
Issrah Jawad ◽  
Sumayyah Rashan ◽  
Chathurani Sigera ◽  
Jorge Salluh ◽  
Arjen M Dondorp ◽  
...  
Keyword(s):  
Critical Care ◽  
Quality Indicators ◽  
Scoping Review ◽  
Health Care Quality ◽  
Grey Literature ◽  
Healthcare Providers ◽  
Evidence Base ◽  
Care Quality ◽  
Patient Reported

Abstract Background Excess morbidity and mortality following critical illness is increasingly attributed to potentially avoidable complications occurring as a result of complex ICU management [1–3]. Routine measurement of quality indicators through an EHR or registries are increasingly used to benchmark care and evaluate improvement interventions. However, existing Indicators of quality for intensive care are derived almost exclusively from relatively narrow subsets of ICU patients from high-income healthcare systems. The aim of this scoping review is to systematically review the literature on quality indicators (QIs) for evaluating critical care, identify QIs, map their definitions, evidence base, and describe the variances in measurement, and the reported challenges of implementation.Method We searched MEDLINE, EMBASE, CINAHL and the Cochrane libraries from the earliest available date through to January 2019. To increase sensitivity of the search, grey literature and reference lists were reviewed. Minimum inclusion criteria were a description of one or more QIs designed to evaluate care for patients in ICU captured through a registry platform- or Electronic Health Record (EHR) adapted for quality of care surveillance.Results The search identified 4780 citations. Review of abstracts led to retrieval of 276 full-text articles, of which 123 articles were accepted. 51 unique QIs in ICU were classified using the three components of health care quality proposed by the High Quality Health Systems (HQSS) framework. Adverse events including hospital acquired infections (13.7%) hospital processes (54.9%) and outcomes (31.4%) were the most common QIs identified. Patient reported outcome QIs accounted for less than 6%. Barriers to the implementation of QIs were described in 35.7% of articles and divided into operational barriers (51%) and acceptability barriers (49%).Conclusions Despite the complexity and risk associated with ICU care, there are only a small number of operational indicators used. Future selection of QIs would benefit from a stakeholder driven approach, whereby the values of patients and communities and the priorities for actionable improvement as perceived by healthcare providers are prioritised and include greater focus on measuring discriminable processes of care.

scholarly journals Effect of Personnel Care Quality of Private Healthcare Providers on Arab Patients’ Satisfaction and Word-of-Mouth Communication:An Empirical Research in India

2019 ◽  
Vol 9 (1) ◽  
pp. 5374-5383
Keyword(s):  
Health Care Providers ◽  
Structural Equation ◽  
Word Of Mouth ◽  
Healthcare Providers ◽  
Care Quality ◽  
Equation Modeling ◽  
Care Providers ◽  
Patients Satisfaction ◽  
Private Healthcare

Personnel quality in service industry is a significant factor as it interacts directly with customers. Thus, the understanding of personnel quality is an important aspect for strategies’ development and implementation to enhance the service delivery process. In the healthcare and medical tourism industries, personnel quality such as quality of doctors, nurses, administrative staff and interpreters play a major role in delivering good service to patients. Generally, there are studies relating to quality of service based on selected dimensions and its effects on patients’ satisfaction and word-of-mouth. However, studies focusing on personnel quality and its impact on the satisfaction and word-of-mouth of patients are still scarce. Hence, the present research aims to measure perspectives of Arab patients concerning the personnel quality of health care providers, satisfaction and word-of-mouth of patients in Indian private hospitals. To achieve this aim, a required data was collected from 335 Arab patients though valid and reliable structural questionnaire. Appropriate statistical methods including Structural Equation Modeling (SEM) were applied in the present research to analyze the collected data and to examine the proposed model and hypotheses. Based on the analysis, it was found that the dimensions of doctors’ quality and nurses’ quality were significant, whereas the dimensions of administrative staffs’ quality and interpreters’ quality were not significant to predict the satisfaction and word-of-mouth of Arab patient. Thus, the results of this research can assist private healthcare providers to take appropriate policy decisions.

Understanding good leadership in the context of English care home inspection reports

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ceara Mongan ◽  
Will Thomas
Keyword(s):  
Consumer Choice ◽  
Qualitative Content Analysis ◽  
Care Home ◽  
Care Quality ◽  
Small Scale ◽  
Discussion Section ◽  
Content Type ◽  
Care Quality Commission ◽  
Management Capabilities

Purpose As part of their inspection of care homes in England, the statutory inspector (the Care Quality Commission [CQC]) makes a judgement on the quality of the home’s leadership. Their view is critical as it is intended to inform consumer choice and because the statutory nature of inspection means these views hold considerable authority. The purpose of this paper is to look at the content of a selection of reports and seek to determine what the CQC understands by the concept of “good leadership”. Design/methodology/approach A purposive sample of recent CQC inspection reports was selected and subjected to a qualitative content analysis. Inspections are structured around five main questions. The resulting themes describe areas of focus within the section of reports that feature the question “Are they well-led?”. Findings Inspection reports were found to focus on four main themes: safety and quality of care; day-to-day management of staff; governance and training in the home; and integration and partnership working. In the discussion section, the authors reflect on these themes and suggest that the CQC’s view of leadership is rather limited. In particular, while an emphasis is placed within the literature and policy on the importance of leadership in delivering change and quality improvement, little attention is paid to this within the leadership section of inspection reports. Research limitations/implications The authors’ research is based on a small-scale sample of inspection reports; nevertheless, it suggests a number of avenues for further research into the way in which leadership and management capabilities are developed and monitored in the sector. Originality/value The analysis in this report offers a view of how the inspection regime implements its own guidance and how it assesses leadership. The reports, as public-facing documents, are artefacts of the inspection regime and critical not just as evidence of the practice of inspection but as influence on care home operations and the choices of care home residents and their families.

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