Challenges and Directions for Nursing in the Pay-for-Performance Movement (original) (raw)
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The Importance and Challenge of Paying for Quality Nursing Care
Policy, Politics, & Nursing Practice, 2008
Historically, the economic value that nursing brings to the patient care process has not been recognized or quantified. Improving the quality of nursing care through work environment changes or increases in staffing is viewed by many as an added cost, but the benefits in terms of money saved through improved nursing satisfaction and patient outcomes are not considered. This article introduces nine articles that were originally presented at the Economics of Nursing Invitational Conference: Paying for Quality Nursing Care held at the Robert Wood Johnson Foundation in Princeton, New Jersey, June 13 and 14, 2007. Recommendations are to conduct research on the impact of policy and payment changes on the nursing workforce and quality of care and to correct the misalignment of socioeconomic and business case incentives for quality by payment systems and other changes.
The relationship of nursing workforce characteristics to patient outcomes
OJIN: The Online Journal of Issues in …, 2007
Three report s from t he I nst it ut e of Medicine found t hat errors in hospit al care were m ore com m on t han previously t hought ; t hat healt h care delivery should be reorganized t o im prove t he qualit y of care; and t hat , operat ionally, nurses have a crit ical role in securing pat ient safet y. Now t he cont ribut ion of nursing t o t he reduct ion of adverse event s m ust be est ablished em pirically, so t hat nursing-sensit ive indicat ors can be incorporat ed in such healt h care-im provem ent st rat egies as public report ing of hospit al qualit y and perform ance-based paym ent syst em s. This art icle r eviews what is known from previous nursing out com es research and ident ifies gaps in t he current st at e of knowledge. I t t hen describes t he cont ribut ion t o r esearch t hat can be m ade t hrough t he Nat ional Dat abase of Nursing Qualit y I ndicat ors TM ( NDNQI ® ) . Next it report s an NDNQI st udy t hat found t hree nursing workforce charact erist ics t o be relat ed significant ly t o pat ient out com es: t ot al nursing hours per pat ient day, percent age of hours supplied by RNs, and years of experience in nursing, and concludes wit h a discussion of t he im plicat ions of t hese findings for bot h for nursing adm inist rat ors and out com es-based, qualit y-im provem ent init iat ives.
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The payment approach known as "pay-for-performance" has been widely adopted with the aim of improving the quality of health care. Nonetheless, little is known about how to use the approach most effectively to improve care. We examined the effects in 260 hospitals of a pay-for-performance demonstration project carried out by the Centers for Medicare and Medicaid Services in partnership with Premier Inc., a nationwide hospital system. We compared these results to those of a control group of 780 hospitals not in the demonstration project. The performance of the hospitals in the project initially improved more than the performance of the control group: More than half of the pay-forperformance hospitals achieved high performance scores, compared to fewer than a third of the control hospitals. However, after five years, the two groups' scores were virtually identical. Improvements were largest among hospitals that were eligible for larger bonuses, were well financed, or operated in less competitive markets. These findings suggest that tailoring pay-for-performance programs to hospitals' specific situations could have the greatest effect on health care quality. P ay-for-performance has been widely adopted by health care providers as an incentive to improve health care quality. In contrast, most health care payment systems simply use a fee-for-service approach, paying providers based on the intensity-or the volume, duration, frequency, and type-of services they provide. Payfor-performance adjusts the fee-for-service model to include higher payments for higherquality care.
Affordable Care: Harnessing the Power of Nurses
OJIN: The Online Journal of Issues in Nursing, 2019
Original Medicare produced an increased index of suspicion regarding health costs in 1965. As services expanded, costs escalated. Policy makers moved to control upward spending trends in an attempt to leverage resources across the population. Changes in reimbursement accompanied by the expansion of levels of care during an episode of illness caused stakeholders to carefully analyze value based opportunities. The groundbreaking Patient Protection and Affordable Care Act (ACA) compels nurses to continue innovation, transformational leadership, and care coordination as major stakeholders in provision of the next generation of cost containment, quality advances, and patient access improvements. This article discusses the nurse impact on national health cost reduction, value based healthcare reimbursement, and opportunities for nurses to impact healthcare quality. In addition, we consider the nurse impact on healthcare quality and access to care, as well as continued opportunities for nu...
مراقبتهای نوین, 2018
Background: Pay-for-performance (PFP) plan is regarded as one of the approaches to increase the efficiency of healthcare organizations. In this respect, indifference to the challenges of implementing the given plan may result in its failure and irreparable damage to health systems. Objectives: The present study aimed at identifying the challenges of implementing the PFP plan in the views of nurses working in hospitals of Mashhad University of Medical Sciences, Iran. Methods: This study was done in the form of qualitative research using a content analysis method conducted in a cross-sectional manner in early 2016. To this end, sampling was of a purposive type and it continued until the data saturation was fulfilled. The participants consisted of 12 men and 17 women with at least 10 years of service, who were selected out of nurses or head nurses working in public hospitals in the city of Mashhad, Iran, as well as nursing experts of the headquarter office of the vice-chancellor for treatment affairs at Mashhad University of Medical Sciences. Data collection was carried out through semi-structured interviews. The content analysis method was employed for data analysis with regard to accuracy, precision, reliability, and consolidation of the data (via triangulation). Results: The results of the study led to the categorization of the data into four main themes and 25 subthemes. The four main themes included structural challenges (10 subthemes), operational challenges (five subthemes), motivational challenges (six subthemes), and biases in decision-making (four subthemes). The theme of structural challenges, among the others, was mentioned as one of the significant factors affecting the implementation of the PFP plan addressed by all study participants. Conclusions: It was concluded that the PFP plan is encountering many challenges in practice; thus, efforts to cope with them could be a big step toward meeting satisfaction in employees and patients. According to the study results, managers are recommended to consider the necessary measures prior to implementing this plan to avoid such challenges as much as possible.
An environmental scan of pay for performance in the hospital setting: final report
2007
In recent years, pay-for-performance (P4P) programs have emerged as a strategy for driving improvements in the quality, safety, and efficiency of delivered health care. In 2005, with passage of the Deficit Reduction Act, Congress mandated that the Secretary of the Department of Health and Human Services (DHHS) develop a plan for value-based purchasing (VBP) for Medicare hospital services. VBP is one strategy for modifying the payment system to incentivize improvements in the quality of care delivered to beneficiaries in the Medicare program. The use of incentives-by paying differentially for performance-is a key component of building a value-driven health care system as called for by the DHHS Secretary's Four Cornerstones Initiative. To inform the development of the VBP plan for Medicare hospital services, the Assistant Secretary for Planning and Evaluation (ASPE), in collaboration with the Centers for Medicare & Medicaid Services, contracted with the RAND Corporation to conduct an environmental scan of the hospital P4P landscape. This report presents the results from the environmental scan of P4P and pay-for-reporting (P4R) programs; it also includes a review of the empirical evidence about the impact of these programs, a description of program design features, and a summary of lessons learned from currently operating P4P and P4R programs about the structure of these programs and implementation issues.