"ProvenCareSM": a provider-driven pay-for-performance program for acute episodic cardiac surgical care

Area of Science:

• Cardiovascular Surgery
• Health Services Research
• Healthcare Quality Improvement

Background:

• Coronary artery bypass graft (CABG) surgery requires adherence to evidence-based guidelines for optimal patient outcomes.
• Integrated delivery systems offer a framework for implementing and monitoring complex care protocols.
• Pay-for-performance programs incentivize providers to meet quality benchmarks.

Purpose of the Study:

• To evaluate the feasibility and effectiveness of an integrated delivery system in implementing a pay-for-performance program for CABG surgery.
• To assess the impact of the program on adherence to best practices, clinical outcomes, and resource utilization.

Main Methods:

• Development of an evidence-based program (ProvenCareSM) with 40 verifiable best practices, risk-based pricing, and patient engagement.
• Integration of best practices into the electronic health record system for hardwiring adherence.
• Comparison of CABG patients in the ProvenCareSM group (2006-2007) with a conventional care group (2005).

Main Results:

• Program compliance with best practices reached 100% and was sustained after initial implementation challenges.
• A statistically significant increase in the likelihood of discharge to home was observed.
• A 16% decrease in length of stay and a 5.2% reduction in mean hospital charges were achieved.

Conclusions:

• A provider-driven, pay-for-performance model, supported by electronic health records, can reliably deliver evidence-based care for CABG surgery.
• This approach can effectively modify reimbursement incentives.
• The program shows potential for improving patient outcomes and reducing healthcare resource use.