The Positives And Negatives Of Pay For Performance Nursing Essay

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The purpose of this research essay will discuss aspects concerning the effects of pay-for-performance policies on quality improvement. The pay-for-performance policies are continually a debated issue concerning quality of care. This incentive program could open doors in a positive or negative way, but P4P, may lead to results of improving the quality of care; which the research in this essay will assess and analyse these perspectives. Also, reflect on pay-for-performance programs; will be a crucial aspect in the paper. Furthermore, the results that would show the successfulness of these programs, as well. In additional, do the P4P programs meet their goals and how effective they are will be share in the research essay. Other components, that will be mention such as the impact on quality improvement, unintended or negative consequences, and implications for cost containment.

Introduction

The purpose of this research essay is to discuss aspects of pay for performance from a positive and negative perspective. As the health sector, continue to move toward a positive path, in efforts to improve the quality of care. This quality issue has and will continue to affect many Americans patients nationwide in a positive or negative way, based on, the quality care they are receiving. Therefore, health care providers and managed care organizations (MCO) are encouraged by the monetary incentive programs, in order to give prestige quality of care (Anderson, Rice, Komininski, 2007; Laureate Education, 2009). The strong components of payment policies, such as pay-for-performance (P4P) are aspects of health care services and the influence of patient’s choice; in which led to quality initiatives (Hillman, 1991). In addition, the factors will help to assess the need of care for patients, and the health organization, which is a positive reinforcement of quality initiatives. For instances, an intention of the incentives program like (P4P) would reward high-quality of care and permit growth in the way of becoming more efficient and effective; when servicing clients with their care needs (Teitelbaum &Wilensky, 2007). Also, this quality initiative will help providers to figure out what they need to do; in order to continue to improve quality care procedures on a proficient level.

The next step in the pay-for-performance (P4P) policy will permit health organizations JCI (2010) to benefit in aspects of financial incentives; through organizational principles. Therefore, the organizational leaders would produce documents to offer a reliable outline to carry out these accountabilities. For instances, health care organizational leaders must examine the national and worldwide norms that consist of human-beings right, quality initiatives, and professional principles when forming the framework. This pay for performance quality initiatives of services for patients, could JCI (2010) examine access, convey, patient-centred, discharge regulations; correctly bill for services; and help in resolution of conflicts, which financial incentives and payments measures maybe negotiation in patient services (JCI, 2010).

Pay-for- performance programs quality initiatives were organized by governmental; Young, Conrad, and Fallot (2007) also the private ownerships and organizations, in which support the aspects of quality performances. Author suggests there are over 100 incentive programs; that focus on quality initiatives and preventive care for consumers (Young, Conrad, & Fallot, 2007). Research suggests; the centres for Medicare and Medicaid services (CMS) are one of organizations that started the pay-for- performance programs (Anderson, Rice, & Kominski; Teitelbaum & Wilensky, 2007). Author suggests there is a lot of evidence, which implies the pay-for-performance incentive program has improved the overall quality of care initiative (Kuhmerker & Hartman, 2007). Also, there is evidence that Jarlier and Charvet-Protat (2000) pay- for-performance quality initiatives, are profitable and can save in the long term for all health care services.

Nevertheless, there will always be various negatives issues of barriers that hinder the quality care Datz, (2012); Galvin (2006) progress and growth of stronger incentives for quality advantage. The approach of the pay-for-performance has features that involve the amount of the incentive payment that result into, additional incentives such as of education, patient satisfaction, organizational information technology abilities, health provider’s level of performance, and diagnostics sources (Young, Conrad, & Fallot, 2007). Furthermore, special interest groups seemed to be a particular alarm about the barriers that relates to the less effective method of (P4P) incentive programs, which have to do with the lack of those who do not invest in the continue quality initiatives for the delivery of health care (Young, Conrad & Fallot, 2007; Dudley & Rosenthal, 2006). Pay-for-performance impacts vary stakeholders, which involves all parties such as, health organizations, government, payers, medical providers, public, and private sectors, so the investment in the aspects of quality initiatives is crucial to the care process.

Research suggests some payment incentives programs like (P4P) purpose is for cost containment (IOM, 2001). Also, the negative aspect of the pay-for-performance; there is no clear intention concerning making sure quality care initiatives, or improvement plan, in which relates to this program. Also, there should be some initiatives developed, such as perspectives and goals, in order to improve the aspects of the incentive payment of the health care services; which to provide IOM (2001) higher quality care and to focus on cost containment (IOM, 2001).

In summary

The positive aspect of health care delivery service can certainly be more effective through the pay-for-performance incentive programs. Nevertheless, the effectiveness of sustainability through this incentives program it has to be a constant arrangement, in which rewards quality of care effectiveness. In addition, all parties involved must be willing to help improve quality policies and make this initiative one of the focal points for the (P4P) programs. These arrangements could consist of fair adequate payment for excellence managerial services and that applies to the care process; which relates to financial incentives. Furthermore, to make sure that (P4P) programs meets its attended goals is to have other primary sources for recognizing and assessments for the performance initiatives, such as the Joint Commission, National Committee for quality assurance, and other agencies (Dudley and Rosenthal, 2006). A priority focus is to motivate and promote standards and firmed bylaws, in order to continuous to improve and maintain the quality of care initiatives through aspects of accreditation and licensure, in which would be a great addition to the perspective of the (P4P).

Sources

Andersen, R. M., Rice, T. H., & Kominski, G. F. (2007). Changing the U.S. health care system: Key issues in health services policy and management (3rd ed.). San Francisco, CA: Jossey-Bass.

Classen, D. C., Pestotnik, S. L., Evans, R., Lloyd, J, F., Burke, J. P. (1997). Adverse Drug Events in Hospitalized Patients: Excess Length of Stay, Extra Costs, and Attributable Mortality. JAMA. 277(4), 301-306.

Clemmer, T. P., Vicki, J. S., Thomas, A. O., & Susan, D. H. (1999). Results of a Collaborative Quality Improvement Program on Outcomes and Costs in a Tertiary Critical Care Unit. Crit. Care Med, 27(9):1768-74.

Conrad, D., Wickizer, T., Maynard, C., Klastorin, T., Lessler, D., Ross, A., Soderstrom, N., Sullivan, S., Alexander, J., Travis, K. (1996). Managing Care, Incentives and Information: An Exploratory Look Inside the “Black Box” of Hospital Efficiency. Health Services Research, 31(3), 235-59.

Datz, T. (2012). No improvement in patient outcomes seen in hospitals with pay-for-performance programs. Health Insurance Law Weekly. Retrieved from: http://www.hsph.harvard.edu/news/press-releases/2012-releases/pay-for-performance-patient-outcomes.html

Dudley, R. A. & Rosenthal, M. B. (2006). Pay for Performance: A decision guide for purchasers. Rockville, MD: Agency for Healthcare Research and Quality. Retrieved from: http://www.ahrq.gov/qual/p4pguide.pdf

Galvin, R. (2006). Pay-for-performance: Too much of a good thing? A conversation with Martin Roland. Health Affairs, 25, w412 – w419.

Hillman, A. L. (1991). Managing the Physician: Rules Versus Incentives. Health Affairs 10(4):138-46.

Jarlier, A., & Charvet-Protat, S. (2000). Can Improving Quality Decrease Hospital Costs? International Journal for Quality in Health Care, 12(2), 125-31.

Joint Commission International, Inc. (2010). Joint Commission International Accreditation Standards for Hospitals. (4th ed.). Illinois, Chicago: Joint Commission International.

Kuhmerker, K. & Hartman, T. (2007). Pay-for-performance in state Medicaid programs: A

survey of state directors and programs. The Commonwealth Fund. Retrieved October 24, 2012 from: http://www.commonwealthfund.org/Publications/Fund-Reports/2007/Apr/Pay-for-Performance-in-State-Medicaid-Programs–A-Survey-of-State-Medicaid-Directors-and-Programs.aspx

Laureate Education, Inc. (Executive Producer). (2009). Health Policy. “Access Challenges”

Baltimore, MD: Author:  (Dr. Gerald Kominski and Jim Lott).

Institute of Medicine. (2001). Crossing the Quality Chasm: A New Health System for the 21st Century. National Academy of Sciences.

Young, G.J., Conrad, D.A., & Fallat, A. (2007). Practical issues in the design and implementation of pay-for-quality programs. Journal of Healthcare Management, 52(1), 10-19.

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