Using Knowledge of Multiple Levels of Variation in Care to Target Performance Incentives to Providers
Bibliographic Data
| ID | 9101579 |
|---|---|
| Authors | Marc Turenne (0000-0002-5325-3381, University of Michigan, corresponding author), Marc N Turenne, Richard A Hirth (0000-0002-0654-3220, University of Michigan, corresponding author), Qing Pan (0000-0003-1253-0490, George Washington University), Robert A Wolfe (Arbor Research Collaborative for Health), Joseph M Messana (0000-0003-4650-5306, University of Michigan, corresponding author), John R C Wheeler (University of Michigan, corresponding author) |
| Year | 2008 |
| Volume | 46 |
| Issue | 2 |
| Pages | 120-126 |
| Publication date | 2008-02-01 |
| Peer Reviewed | Yes |
| Open Access | No |
| Type | ARTICLE |
| Venue | Medical Care (JOURNAL) |
| Journal identifiers | ISSN: 0025-7079 • E-ISSN: 1537-1948 |
| Publisher | Ovid Technologies (Wolters Kluwer Health) (PUBLISHER) |
| DOI | 10.1097/mlr.0b013e31815b9d7a |
| PMID | 18219239 |
| OpenAlex | W2087494163 |
| Language | EN |
| Citations received | 7 |
| References cited | 8 |
BACKGROUND: In developing "pay-for-performance" and capitation systems that provide incentives for improving the quality and efficiency of care, policymakers need to determine which healthcare providers to evaluate and reward. OBJECTIVES: This study demonstrates methods for determining and understanding the relative contributions of facilities and physicians to the quality and cost of care. Specifically, this study distinguishes levels of variation in resource utilization (RU), based on research to support the development of an expanded Medicare dialysis prospective payment system. RESEARCH DESIGN: Mixed models were used to estimate the variation in RU across institutional providers, physicians, patients, and months (within patients), after adjusting for case-mix. SUBJECTS: The study includes 10,367 Medicare hemodialysis patients treated in a 4.2% stratified random sample of dialysis facilities in 2003. MEASURES: Monthly RU was measured by the average Medicare allowable charge per dialysis session for separately billable dialysis-related services (mainly injectable medications and laboratory tests) from Medicare claims. RESULTS: There was financially significant variation in RU across institutional providers and to a lesser degree across physicians, after adjusting for differences in case-mix. The remaining variation in RU reflects unexplained differences across patients that persist over time and transitory fluctuations for individual patients. CONCLUSIONS: The greater variation in RU occurring across dialysis facilities than across physicians is consistent with targeting payments to facilities, but alignment of incentives between facilities and physicians remains an important goal. Similar analytic methods may be useful in designing payment policies that reward providers for improving the quality of care
Business · Economics · Incentive · Microeconomics · Variation (astronomy) · Dialysis and Renal Disease Management · Healthcare Policy and Management · Primary Care and Health Outcomes
Accounting for Variation in Technical Quality and Patient Satisfaction
Improving the Reliability of Physician “Report Cards”
When Payment Systems Collide
Can Multi-Level Research Help Us Design Pay-for-Performance Programs
Meaningful Variation in Performance
Do Resource Utilization and Clinical Measures Still Vary Across Dialysis Chains After Controlling for the Local Practices of Facilities and Physicians
Meaningful Variation in Performance
| Unique citing works | 7 |
|---|---|
| Citations per year | 0.39 |
| Citation span | 2008 - 2013 (6) |
| Citation velocity | historical |
| Highly cited | No |
| Citation types | Neutral: 7 |