Does Pay-for-Performance Steal From the Poor and Give to the Rich?
Authors: Rachel M. Werner
Journal: Annals of Internal Medicine (2010)

Editorials7 September 2010Does Pay-for-Performance Steal From the Poor and Give to the Rich?Rachel M. Werner, MD, PhDRachel M. Werner, MD, PhDFrom Philadelphia Veterans Affairs Medical Center and University of Pennsylvania, Philadelphia, PA 19104.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-153-5-201009070-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Historically, most health care payment systems have paid providers on the basis of the quantity or intensity of the services they provide. In contrast, pay-for-performance ties a portion of payment to quality of care by paying more to providers whose care meets specified standards. By doing so, pay-for-performance shifts the emphasis of health care delivery from the quantity to the quality of care. Because the principle of realigning payment to improve quality of care is difficult to dispute, many pay-for-performance programs have recently been implemented in health care.Whether pay-for-performance succeeds in its goal of improving health care quality is ...References1. Casalino LP, Elster A, Eisenberg A, Lewis E, Montgomery J, Ramos D. Will pay-for-performance and quality reporting affect health care disparities? Health Aff (Millwood). 2007;26:w405-14. [PMID: 17426053] CrossrefMedlineGoogle Scholar2. Institute of Medicine. America's Health Care Safety Net: Intact but Endangered. Washington, DC: National Academy Pr; 2000. Google Scholar3. Goldman LE, Vittinghoff E, Dudley RA. Quality of care in hospitals with a high percent of Medicaid patients. Med Care. 2007;45:579-83. [PMID: 17515786] CrossrefMedlineGoogle Scholar4. Werner RM, Goldman LE, Dudley RA. Comparison of change in quality of care between safety-net and non-safety-net hospitals. JAMA. 2008;299:2180-7. [PMID: 18477785] CrossrefMedlineGoogle Scholar5. Meyer JA, Silow-Carrol S, Kutyla T, Stepnick LS, Rybowski LS. Hospital Quality: Ingredients for Success—Overview and Lessons Learned. New York: The Commonwealth Fund; 2004. Google Scholar6. Silow-Carrol S, Alteras T, Meyer JA. Hospital Quality Improvement: Strategies and Lessons From U.S. Hospitals. New York: The Commonwealth Fund; 2007. Google Scholar7. Bazzoli GJ, Chen HF, Zhao M, Lindrooth RC. Hospital financial condition and the quality of patient care. Health Econ. 2008;17:977-95. [PMID: 18157911] CrossrefMedlineGoogle Scholar8. Bazzoli GJ, Clement JP, Lindrooth RC, Chen HF, Aydede SK, Braun BI, et al. Hospital financial condition and operational decisions related to the quality of hospital care. Med Care Res Rev. 2007;64:148-68. [PMID: 17406018] CrossrefMedlineGoogle Scholar9. Jha AK, Orav EJ, Epstein AM. The effect of financial incentives on hospitals that serve poor patients. Ann Intern Med. 2010;153:299-306. LinkGoogle Scholar10. Werner RM, Dudley RA. Making the ‘pay’ matter in pay-for-performance: implications for payment strategies. Health Aff (Millwood). 2009;28:1498-508. [PMID: 19738269] CrossrefMedlineGoogle Scholar11. Werner RM, Tamara Konetzka R, Liang K. State adoption of nursing home pay-for-performance. Med Care Res Rev. 2010;67:364-77. [PMID: 19923629] CrossrefMedlineGoogle Scholar12. Werner RM, Konetzka RT, Kruse GB. Impact of public reporting on unreported quality of care. Health Serv Res. 2009;44:379-98. [PMID: 19178586] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Rachel M. Werner, MD, PhDAffiliations: From Philadelphia Veterans Affairs Medical Center and University of Pennsylvania, Philadelphia, PA 19104.Disclaimer: The contents of this article do not represent the views of the U.S. Department of Veterans Affairs or the U.S. government.Acknowledgment: The author thanks David Asch, MD, for helpful comments on an earlier draft of this manuscript.Grant Support: By a U.S. Department of Veterans Affairs Health Services Research and Development Service Career Development Award.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-1688.Corresponding Author: Rachel Werner, MD, PhD, University of Pennsylvania, 1230 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104; e-mail, [email protected]edu. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Effect of Financial Incentives on Hospitals That Serve Poor Patients Ashish K. Jha , E. John Orav , and Arnold M. Epstein Metrics Cited byHospital value-based payment programs and disparity in the United States: A review of current evidence and future perspectivesImpact of competition on process of care and resource investmentsA Cross-sectional Study of Emergency Department Boarding Practices in the United StatesThe Effect of Phase 2 of the Premier Hospital Quality Incentive Demonstration on Incentive Payments to Hospitals Caring for Disadvantaged PatientsThe Promise And Peril Of Accountable Care For Vulnerable Populations: A Framework For Overcoming ObstaclesPatient Satisfaction at America's Lowest Performing HospitalsAssociation Between Quality of Care and the Sociodemographic Composition of Physicians’ Patient Panels: A Repeat Cross-Sectional Analysis 7 September 2010Volume 153, Issue 5Page: 340-341KeywordsForecastingHealth careHealth care providersHealth care qualityMotivationPopulation statisticsQuality improvementResearch quality assessmentSafety studiesTheft ePublished: 7 September 2010 Issue Published: 7 September 2010 PDF downloadLoading ...