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Rewarding excellence and efficiency in Medicare payments
1The Commonwealth Fund, New York, New York 10021, USA. dk@cmwf.org
The Milbank Quarterly
|August 28, 2007
Summary
Medicare can lead by incentivizing healthcare providers for high-quality, efficient patient care. A pay-for-performance system can reduce cost and quality variations, transitioning Medicare toward better physician alignment with patient outcomes.
Area of Science:
- Health economics
- Healthcare policy
- Quality improvement
Background:
- Variations in healthcare costs and quality exist within Medicare.
- Current payment models may not fully incentivize efficiency and quality.
- Need for innovative Medicare payment strategies.
Purpose of the Study:
- Examine cost and quality variations in patient care episodes.
- Propose a pay-for-performance system design for Medicare.
- Facilitate transition to a new Medicare payment policy.
Main Methods:
- Analysis of cost and quality variations in episodes of care.
- Design of a pay-for-performance payment model.
- Exploration of alternative payment methods beyond fee-for-service and capitation.
Main Results:
- Pay-for-performance can narrow variations in care costs and quality.
- Financial incentives can align physician performance with quality and efficiency goals.
- A blended fee-for-service and case-rate system is a viable transition.
Conclusions:
- Medicare can leverage financial incentives for improved healthcare delivery.
- Pay-for-performance offers a pathway to enhance quality and efficiency.
- Transitioning payment models is key to aligning physician incentives with better patient outcomes.
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