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Pay for Performance in the Hospital Setting: What Is the State of the Evidence?

RAND Health, Pittsburgh, Pennsylvania

^* To whom correspondence should be addressed. E-mail: mehrotra{at}rand.org.

	Abstract

More than 40 private sector hospital pay-for-performance (P4P) programs now exist, and Congress is considering initiating a Medicare hospital P4P program. Given the growing interest in hospital P4P, this systematic review of the literature examines the current state of knowledge about the effect of P4P on clinical process measures, patient outcomes and experience, safety, and resource utilization. Little formal evaluation of hospital P4P has occurred, and most of the 8 published studies have methodological flaws. The most rigorous studies focus on clinical process measures and demonstrate that hospitals participating in the Centers for Medicare and Medicaid Services-Premier Hospital Quality Incentive Demonstration, a P4P program, had a 2-to 4-percentage point greater improvement than the improvement observed in control hospitals. There is a need for more systematic evaluation of hospital P4P to understand its effect and whether the benefits of investing in P4P outweigh the associated costs. (Am J Med Qual 2009;24:xxx-xxx)

First published on December 10, 2008, doi:10.1177/1062860608326634

American Journal of Medical Quality 2009;24:19.

A more recent version of this article appeared on January 1, 2009


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