How has P4P influenced hospital or physician performance?

Pay-for-performance, or value-based purchasing to properly utilize the Center for Medicare and Medicaid Services definition, is a highly touted but relatively new reimbursement methodology that rewards providers more for doing the right things. The hospitals have three years of payout experience under the Premier project, and the physicians have just received their second distribution. The post-acute-care sector is currently studying a pilot intake assessment tool to measure patients who move from acute care to home health, SNF, LTAC and rehab settings. The short answer is: it’s too soon to tell and the dollars on the table are too small to really measure. The plethora of quality indicators and scoring systems has been well documented. Providers can be paid more for doing the “right things” under these pilot P4P programs. However, they stand to lose a good deal more if they don’t focus on the “never events” that will deny payment for hospital-acquired complications, infections and the like that should “never” occur. The federal and state payers, along with a host of high-profile managed care payers have all signed on to this patient-centered safety focus. The corollary to the short answer is: given the dwindling margins, providers have to find ways to do P4P for additional revenue and avoid “never events” with non-payments for the patient’s sake.