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- Technologic Approaches 2
Search results for "Incentives"
Journal Article > Study
Al Mohajer M, Joiner KA, Nix DE. Acad Med. 2018;93:1827-1832.
The Hospital-Acquired Condition Reduction Program (HACRP) was established by the Centers for Medicare and Medicaid Services (CMS) and withholds payment to hospitals for several hospital-acquired conditions deemed to be preventable sources of patient harm. Prior research has shown that teaching hospitals, hospitals caring for more complicated and high-risk patients, and safety-net hospitals may be more likely to experience financial penalties under HACRP compared to nonteaching hospitals caring for less sick patients. These findings raised concerns regarding the possible unintended consequences related to pay-for-performance. Researchers sought to identify factors associated with HACRP performance and penalties. They found that teaching institutions and hospitals with higher case-mix index, length of stay, and those located in the Northeast or Western United States were more likely to receive penalties under the CMS program. A previous WebM&M commentary discussed the unintended consequences associated with publicly reported health care quality measures.
Rau J. Kaiser Health News. December 3, 2018.
Journal Article > Study
Preventing hospital-acquired infections: a national survey of practices reported by U.S. hospitals in 2005 and 2009.
Krein SL, Kowalski CP, Hofer TP, Saint S. J Gen Intern Med. 2012;27:773-779.
The impact of the Centers for Medicare and Medicaid Services' (CMS) 2008 policy denying additional payment to hospitals for preventable complications, including certain health care–associated infections (HAIs), remains a subject of debate. This study assessed the effect of the CMS policy on use of infection control practices, using federal Veterans Affairs hospitals (which do not receive CMS payments) as a comparison group. Infection control practitioners at both federal and non-federal hospitals reported a greater organizational emphasis on HAI prevention and increased use of specific HAI preventive practices, over the time period before and after the CMS policy was implemented. This finding indicates that factors other than the CMS policy have driven efforts to reduce HAIs.
Journal Article > Review
Meta-analysis: effect of interactive communication between collaborating primary care physicians and specialists.
Foy R, Hempel S, Rubenstein L, et al. Ann Intern Med. 2010;152:247-258.
This meta-analysis found that interactive communication between collaborating primary care providers and specialists (psychiatrists and endocrinologists in this study) is associated with improved patient outcomes. The interactive communication methods included joint consultations, scheduled phone discussions, and shared documentation, with the authors suggesting a need for changes in reimbursement models to support such interventions.
The Commonwealth Fund Commission on a High Performance Health System. New York, NY: The Commonwealth Fund; August 2006.
This report calls for providing "safe, well-coordinated, accessible, and efficient" care through five key steps: expanding health insurance coverage, implementing evidence-based patient safety and quality interventions, increasing use of health information technology, public reporting of safety and quality measures, and rewarding achievement in quality through "pay-for-performance." The authors ascribe the current quality problems in the U.S. health care system to system failures, including misaligned payment incentives, inadequate motivation to challenge the status quo, inadequate information systems, duplicative regulatory systems, and an overemphasis on autonomy.
Journal Article > Commentary
Leape LL, Berwick DM. JAMA. 2005;293:2384-2390.
Two of the leaders in the patient safety movement, Lucian Leape and Donald Berwick, share their perspectives on the progress made since the Institute of Medicine's (IOM) release of To Err is Human. They summarize the shifts in thinking that have occurred, from blaming individual physicians towards targeting systems as a method to improve both quality and safety. Discussion includes the evolution of error prevention strategies, the role of interested stakeholders in the safety movement, and the impact of implementing best practices. Barriers to ongoing progress are also shared, including the increasing complexity of health care, a tradition of autonomy in care, and the current financial incentive systems. The authors provide a vision for the next five years with expectations for rapid change in adoption of electronic medical records, teamwork training, and full disclosure to patients. While they applaud several efforts and initiatives, such as the growth of AHRQ-funded research, the authors call for a rededication of providers and policymakers to the cause of patient safety, promoted by increased funding, better alignment of incentives, and the setting of ambitious but achievable safety targets.
Weise E. USA Today. May 18, 2005.
Legislation/Regulation > Federal Legislation
HR 2234, 109th Cong, 1st Sess (2005).
This bill, which garnered bipartisan support, proposes developing health information technology networks (known as "Regional Health Information Organizations," or RHIOs) with a strong focus on state- and community-based efforts. It is presently under consideration in the United States House of Representatives.