As discussed, the Medicare pay-for-performance (P4P) model offers financial incentives to health care providers to improve quality and efficiency. Typically, incentives are paid on top of the standard fee-for-service compensation if the provider meets or exceeds certain pre-established metrics of performance. Additionally, some models penalize providers when they do not meet the predetermined standards, or for specific occurrences like medical errors (wrong site surgery) and hospital readmissions. The Affordable Care Act (ACA) expanded the use of pay-for-performance programs in Medicare and encouraged experimentation to evaluate program effectiveness.
Hospital Value-Based Purchasing Program
Hospital Readmission Reduction Program
Physician Quality Reporting System (which was transitioned into MIPS)
Research these three programs which reward providers for providing efficient and quality care and write a brief summary of each. A good starting place is the CMS website; however, there are many other resources and articles readily available (for example, https://www.healthaffairs.org/do/10.1377/hpb20121011.90233/full/
In responding and in order to receive full credit, you must answer the following in as much detail as possible:
What type of provider does the program apply (hospital, physician, etc.);
How is quality measured and what metrics are used; and
How is provider performance specifically linked to payment?
Sample Solution
