The Implications of “Pay‐for‐Performance” Reimbursement for Otolaryngology—Head and Neck Surgery

Otolaryngology - Head and Neck Surgery - Tập 134 - Trang 1036-1042 - 2006
David M. Cognetti1, David Reiter1
1Department of Otolaryngology–Head and Neck Surgery, Jefferson Medical College, Philadelphia, PA.

Tóm tắt

OBJECTIVETo introduce otolaryngologists to outcomes‐linked reimbursement (“pay‐for‐performance”), identify clinical practice implications, and recommend changes for successful transition from the traditional “pay‐for‐effort” reimbursement model.STUDY DESIGNPolicy review.RESULTSPayers are actively linking reimbursement to quality. Since the Institute of Medicine issued its report on medical errors in 1999, there has been much public and private concern over patient safety. In an effort to base health care payment on quality, “pay‐for‐performance” programs reward or penalize hospitals and physicians for their ability to maintain standards of care established by payers and regulatory groups. More than 100 such programs are operational in the United States today. This reimbursement model relies on detailed documentation in specific patient care areas to facilitate evaluation of outcomes for purposes of determining reimbursement. Because performance criteria for reimbursement have not yet been proposed within otolaryngology—head and neck surgery, otolaryngologists must be involved to ensure the adoption of reasonable goals and development of reasonable systems for documentation.CONCLUSION“Pay‐for‐performance” reimbursement is increasingly common in the current era of outcomes‐based medicine. It will assume an even greater role over the next 3 years and will directly affect most otolaryngologists.

Tài liệu tham khảo

Starr P, 1982, The social transformation of American medicine, 4 Egdahl RH, 1976, Quality assurance in healthcare, 8 ReutersAmericans Paying More for Health Insurance [MSNBC Web site]. August 25 2005. Available at:http://www.msnbc.msn.com/id/9069341. Accessed September 6 2005. Kohn KT, 1999, To err is human: Building a safer health system Institute of Medicine, 2001, Crossing the quality chasm: a new health system for the 21st century HealthGradesPatient safety in American hospitals [HealthGrades Web site]. July 2004. Available at:http://www.healthgrades.com/media/DMS/pdf/HG_Patient_Safety_Study_Final.pdf. Accessed September 6 2005. 10.1097/00005537-200408000-00003 Henley E, 2005, Pay‐for‐performance: What can you expect?, J Fam Pract, 54, 609 Gosfield AG, 2005, P4P: Transitional at best, Manag Care, 14, 64 Terry K, 2005, Pay for performance: A double‐edged sword, Med Econ, 82, 64 The Leapfrog Group Fact Sheet [The Leapfrog Group Web Site] January 2005. Available at:http://www.leapfroggroup.org/about_us/leapfrog‐factsheet. Accessed September 5 2005. Colwell J, 2005, Pay for performance takes off in California, ACP Observer, 25, 1 10.1056/NEJMsb035374 Sipkoff M, 2005, Is pay for performance: Part of the cure or the problem?, Manag Care, 14, 48 Glendenning D, 2005, AMA: Medicare pay‐for‐performance must be voluntary and not punitive, Am Med News, 46, 1 Schneider ME, 2005, Coalition defines set of 26 clinical care measures, Intern Med News, 38, 1, 10.1016/S1097-8690(05)70905-7 O'Reilly KB, 2005, Panel sets primary care standards for Medicare pay‐for‐performance, Am Med News, 48, 1 10.1001/jama.293.19.2384 Benko LB, 2005, Blues primed to pay. 29 plans are already paying for performance, Mod Health, 35, 16 Doherty RB, 2005, Pay for performance: Moving from concept to legislation, ACP Observer, 25, 13 Poll: health plan to encourage quality [AAO‐HNS Web site]. September 2005. Available at:http://entlink.net. Accessed September 1 2005. Surgical Care Improvement Project Summary [SCIP Web Site]. Available at:http://www.medqic.org/scip/pdf/SCIPsummary_092704.pdf. Accessed September 6 2005. About ACS NSQIP [ACS NSQIP Web site]. Available at:https://acsnsqip.org/main/about_history.asp. Accessed September 6 2005.