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Incentivizing Hospital Quality Through Care Bundling.

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This summary is machine-generated.

Pay-for-performance schemes using care bundling significantly improved hospital quality. A UK study found a 52.5 percentage point increase in meeting all quality criteria after implementing a bundled payment for hip fracture care.

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Area of Science:

  • Health Services Research
  • Health Economics
  • Quality Improvement

Background:

  • Pay-for-performance (PFP) schemes are increasingly used to incentivize healthcare quality.
  • A critical design choice in PFP is whether to bundle payments for multiple quality measures or incentivize them individually.
  • Care bundling links payment to the achievement of a comprehensive set of quality process measures.

Purpose of the Study:

  • To develop a theoretical framework for provider incentives under care bundling.
  • To evaluate the impact of the Best Practice Tariff (BPT) for fragility hip fracture care in England on quality of care.
  • To assess the effectiveness of a care bundle approach in improving hospital performance.

Main Methods:

  • Developed a theoretical framework for provider incentives under care bundling.
  • Employed a difference-in-difference analysis to evaluate the BPT for fragility hip fracture.
  • The BPT incentivized providers based on a bundle of nine jointly achieved process measures.

Main Results:

  • The BPT policy successfully increased the proportion of patients meeting all quality criteria by 52.5 percentage points in the first five years.
  • The policy design was evidence-based with a significant bonus (up to 20% of baseline tariff).
  • No evidence was found that providers reduced effort on later process measures if an earlier one was missed.

Conclusions:

  • Evidence-based care bundling schemes with substantial financial incentives can effectively improve hospital performance.
  • The fragility hip fracture care bundle in England demonstrated success in enhancing the quality of care provided.
  • Care bundling appears to be a viable strategy for incentivizing comprehensive quality improvement in healthcare settings.