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Reimbursement In Brief

This article was originally published in The Gray Sheet

Executive Summary

Planning for P4P: CMS should leverage early commercial market pay-for-performance experience as it implements value-based hospital payments in FY 2009, an Agency for Healthcare Research & Quality-funded study in the Nov. 2 New England Journal of Medicine says. A survey of 242 HMOs revealed that in 2005 52% used pay-for-performance incentives in provider contracts. The authors note that programs were more prevalent when plan enrollees were required to select a primary care physician, an aspect not shared by Medicare, and physician rewards for quality care were generally greater than 5%, which may not be financially feasible for Medicare's program. Meanwhile, CMS' final hospital outpatient 1rule, released Nov. 1, expands quality measures hospitals must report to receive full inpatient payment increases in FY 2008. New pay-for-reporting measures include patient satisfaction and mortality outcomes. CMS postpones tying outpatient payments to quality reporting until 2009 to develop appropriate measures...
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