The Centers for Medicare and Medicaid Services (CMS) has developed a program entitled Pay for Performance (P4P), in which healthcare facilities will receive increased reimbursement if they improve the quality of care that they provide and the efficiency in which the organization operates. Hospitals measure their quality and must meet a certain criteria for each measure in order to receive payment. However, is it necessary for healthcare organizations to be paid to improve their quality of care?
The Pay for Performance initiative reminds me of a parental dilemma that is often experienced by parents of children in secondary school. Some parents struggle with the decision of whether to pay their children for receiving good grades. When I was in school, there were many kids that were paid by their parents for receiving A’s or B’s on their report card. One of my good friends was paid $10 for every A and $5 for every B she earned. My parents took the stance that going to school and working hard for my grades, without getting paid, was my duty as a student and part of the learning experience. They thought that receiving A’s and B’s should be more fulfilling than receiving payment for something that I am doing for my own self worth. On the other hand, other parents thought that providing a monetary incentive would encourage their child to work harder and instill a strong work ethic in a child. There is not a right answer to this dilemma, as they are two differing perspectives on an issue.
As in payment for grades, there are two differing perspectives on Pay for Performance. The perspective of CMS and other supporters of Pay for Performance is that providing monetary incentives for an organization will motivate them to focus on improving quality and will improve the overall quality and efficiency throughout the organization. In the pilot study of Pay for Performance, hospitals were asked to report ten quality indicators for their organizations. In the second year of the study, the Pay for Performance initiative demonstrated a moderate 2.5%-4.0% improvement in the quality indicators when compared to control hospitals. Though these results only reflect the second year of a pilot study, the results are still not as high as one might expect. At the same time, some improvement is better than no improvement at all.
The other perspective of Pay for Performance is that hospitals should not be paid for what they should already be doing in serving the community. We are in a field in which human lives are potentially at risk, so how is there not already a constant drive by healthcare professionals to provide quality healthcare without money? I am in the field of healthcare because I want to help patients receive the best care possible, even though I will not have a clinical role in the patient’s care. As healthcare professionals, we have a duty to the patients to continually work to increase our quality and efficiency, with patients being our main motivation. Increased payment should not be the main motivation to provide a safe environment for patients. I think that the moderate results from the Pay for Performance initial study is due to the fact that I do not see the potential for drastic improvement. Under the assumption that majority of healthcare providers feel some sort of duty to the patient to continually improve quality care and the patient experience, the quality improvement that we will see will be minimal.
This article is not meant to insinuate that healthcare facilities should not receive more reimbursement. Many healthcare facilities are not reimbursed enough for the cost of their services. Nor am I suggesting that we do not need quality improvement departments in healthcare organizations. Quality improvement departments are crucial in coordinating quality efforts and fostering a culture of quality throughout the organization. Quality improvement initiatives drive quality to the forefront of employees’ minds. However, consistent and continuous quality should be what every healthcare professional strives for on a daily basis, regardless of whether the organizations receive performance-based payment.
