Face the Facts: We Need to Change the Way We Do Pay for Performance
Authors: Austin B. Frakt, Ashish K. Jha
Journal: Annals of Internal Medicine (2017)

Editorials20 February 2018Face the Facts: We Need to Change the Way We Do Pay for PerformanceAustin B. Frakt, PhD and Ashish K. Jha, MD, MPHAustin B. Frakt, PhDVA Boston Healthcare System, Boston University School of Public Health, and Harvard T.H. Chan School of Public, Health Boston, Massachusetts. (A.B.F.) and Ashish K. Jha, MD, MPHHarvard T.H. Chan School of Public Health Boston, Massachusetts (A.K.J.)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-3005 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Medicare and other health care payers have initiated various pay-for-performance (P4P) approaches to improve the quality and efficiency of health care delivery. The idea is simple and appealing: Providing financial incentives for quality improvement and efficiency gain should lead to both. In practice, however, the results have been disappointing. Most P4P programs attempted to date have shown little benefit.The new article by Roberts and colleagues should be the final nail in the coffin of the current generation of P4P. The authors found that the Medicare Value-Based Payment Modifier (VM), which measures quality and cost among physician group practices and ...References1. Roberts ET, Zaslavsky AM, McWilliams JM. The Value-Based Payment Modifier: program outcomes and implications for disparities. Ann Intern Med. 2018;168:255-65. doi:10.7326/M17-1740 LinkGoogle Scholar2. Pearson SD, Schneider EC, Kleinman KP, Coltin KL, Singer JA. The impact of pay-for-performance on health care quality in Massachusetts, 2001-2003. Health Aff (Millwood). 2008;27:1167-76. [PMID: 18607052] doi:10.1377/hlthaff.27.4.1167 CrossrefMedlineGoogle Scholar3. Jha AK, Joynt KE, Orav EJ, Epstein AM. The long-term effect of premier pay for performance on patient outcomes. N Engl J Med. 2012;366:1606-15. [PMID: 22455751] doi:10.1056/NEJMsa1112351 CrossrefMedlineGoogle Scholar4. Glickman SW, Ou FS, DeLong ER, Roe MT, Lytle BL, Mulgund J, et al. Pay for performance, quality of care, and outcomes in acute myocardial infarction. JAMA. 2007;297:2373-80. [PMID: 17551130] CrossrefMedlineGoogle Scholar5. Rosenthal MB, Frank RG. What is the empirical basis for paying for quality in health care? Med Care Res Rev. 2006;63:135-57. [PMID: 16595409] CrossrefMedlineGoogle Scholar6. Joynt KE, Jha AK. Characteristics of hospitals receiving penalties under the Hospital Readmissions Reduction Program. JAMA. 2013;309:342-3. [PMID: 23340629] doi:10.1001/jama.2012.94856 CrossrefMedlineGoogle Scholar7. McWilliams JM, Hatfield LA, Chernew ME, Landon BE, Schwartz AL. Early performance of Accountable Care Organizations in Medicare. N Engl J Med. 2016;374:2357-66. [PMID: 27075832] doi:10.1056/NEJMsa1600142 CrossrefMedlineGoogle Scholar8. Dummit LA, Kahvecioglu D, Marrufo G, Rajkumar R, Marshall J, Tan E, et al. Association between hospital participation in a Medicare bundled payment initiative and payments and quality outcomes for lower extremity joint replacement episodes. JAMA. 2016;316:1267-78. [PMID: 27653006] doi:10.1001/jama.2016.12717 CrossrefMedlineGoogle Scholar9. Landon BE, Zaslavsky AM, Saunders R, Pawlson LG, Newhouse JP, Ayanian JZ. A comparison of relative resource use and quality in Medicare Advantage health plans versus traditional Medicare. Am J Manag Care. 2015;21:559-66. [PMID: 26295355] MedlineGoogle Scholar10. MedPAC. Refining the hospital readmissions reduction program. 2013. Accessed at www.medpac.gov/docs/default-source/reports/jun13_ch04.pdf on 8 November 2017. Google Scholar Author, Article, and Disclosure InformationAffiliations: VA Boston Healthcare System, Boston University School of Public Health, and Harvard T.H. Chan School of Public, Health Boston, Massachusetts. (A.B.F.)Harvard T.H. Chan School of Public Health Boston, Massachusetts (A.K.J.)Disclaimer: The contents do not represent the views of the U.S. Department of Veterans Affairs, the U.S. government, Boston University, or Harvard University.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-3005.Corresponding Author: Austin B. Frakt, PhD, 150 South Huntington Avenue (152H), Boston, MA 02130; e-mail, [email protected]edu.Current Author Addresses: Dr. Frakt: 150 South Huntington Avenue (152H), Boston, MA 02130.Dr. Jha: Harvard School of Public Health, 42 Church Street, Cambridge, MA 02138.This article was published at Annals.org on 28 November 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoThe Value-Based Payment Modifier: Program Outcomes and Implications for Disparities Eric T. Roberts , Alan M. Zaslavsky , and J. 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