PPM Exam 2

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  1. Purpose and rationale for pay-for-performance programs
    • incentive programs designed to overcome limitation of current reimbursement systems by aligning financial rewards witn improved pt outcomes
    • use clinical evidence to drive financial incentives
  2. Goals of pay for performance
    • reduce clinical practice variation
    • reduce errors
    • reduce acute exacerbations
    • increase transparency of provider performance
  3. How does provider buy in impact effectiveness of a reimbursement system?
    providers will not participate if they do not believe it works
  4. how does bonus amount impact the effectiveness of the reimbursement system?
    • bonus must be sufficient to cause provider to want to make changes or be able to make changes
    • provider buy in
  5. How do performance measures impact effectiveness of reimbursement system?
    • result in provider buy in
    • measures need to be grounded in evidence
  6. Components that may change provider behavior to consider
    • bonus distribution
    • reward based on current performance, improvement or both?
    • gradient sufficient to motivate all providers?
    • do low performers have equal incentive?
  7. types of incentives
    • bonuses
    • withholds
    • adjustable fee schedules - retroactive
  8. Reimbursement scoring designs
    • threshold scoring
    • scoring based on rank
    • tiered scoring
  9. threshold scoring
    scored based on meeting or exceeding a benchmark
  10. scoring based on rank
    scored based upon rank among peers
  11. tiered scoring
    • scored based on a combo of improvement and benchmarks across multiple domains
    • absolute score and improvement over time
  12. Bonus incentive strategies
    • relative rank
    • relative rank with penalties
    • target attainment
    • target attainment plus improvement
    • percentage recommended
  13. relative rank
    based on performance rank compared to other providers
  14. relative rank with penalties
    • bonus paid based on rank compared to other providers
    • penalty paid if benchmark is not met
  15. target attainment
    bonus to all that attain a target level of performance
  16. target attainment plus improvement
    bonus paid as long as they have improved from previous and or met the target
  17. percentange recommended
    • bonus paid based on percentage of patients receiving recommended care
    • 1:1 match between care and bonus
  18. components that differ in effectiveness
    • scoring method
    • magnitude of bonus
    • gradient of bonus distribution
  19. Relative rank advantages
    gives top performers incentive to maintain high performance
  20. relative rank with penalties advantages
    may provide increased incentive for the worst performers
  21. target attainment advantages
    gives incentive to achieve and maintain performance at the target level (but not above)
  22. Target attainment with improvement advantages
    • incentive to acheive and maintain target level
    • direct incentive to improve performance
  23. percent recommendation advantages
    inventive to do the right thing every time they see a pt
  24. relative rank disadvantages
    low incentive for poor performers
  25. relative rank with penalties disadvantages
    not beneficial for those with financial constraints
  26. steeper gradient
    associated with improved care
  27. Relative rank score method, bonus magnitude and gradient
    • score: based on rank
    • magnitude: large for top performers, none for poor
    • gradient: concentration toward top
  28. relative rank with penalties score, bonus and gradient
    • score: rank & prior performance
    • magnitude: large for top, penalty for poor
    • gradient: penalty steepens gradient
  29. Target attainment score, magnitude & gradient
    • score: based on threshold
    • magnitude: 1/3 of relative rank
    • gradient: more diffuse than relative rank
  30. target attainment score, magnitude & gradient
    • score: threshold + prior performance
    • magnitude: smaller than target attainment alone
    • gradient: more diffuse than target attainment
  31. High performers prefer
    relative rank +/- penalties
  32. Poor performers prefer
    target attainment+/- improvement
Card Set:
PPM Exam 2
2012-03-15 03:11:28
Payment Systems

Payment Systems
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