Pay-for-performance test run yields mixed results: report

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Pay-for-performance test run  yields mixed results: report
Pay-for-performance test run yields mixed results: report
An Affordable Care Act provision testing pay-for-performance incentives faces an uncertain future after a federal demonstration program testing it has so far brought “disconcerting” results.

The Nursing Home Value-Based Purchasing Demonstration, run by the Centers for Medicare & Medicaid Services, rewards nursing homes that meet financial savings goals and improve quality of care.

 Overall, 182 skilled nursing facilities in Wisconsin, New York and Arizona took part. Facilites could only receive the money if nursing homes participating in the project in their state achieved savings, as a group, when compared to a control group. The funds were allocated if the facility improved its performance and whether it made it into the top 20% of nursing homes. Those in the top 10% received additional reimbursements.

CMS submitted a report to Congress detailing the results from the first year of the pilot, which ran from 2009 to 2012. A full evaluation is expected in fall 2013, although more analysis could take another year.

First-year results were decidedly “mixed,” with Wisconsin SNFs attaining a fairly large savings, Arizona achieving modest savings, and New York SNFs netting no savings, said the program's lead investigator, Harvard's David Grabowski, Ph.D.

“The results are somewhat disconcerting,” Grabowski told Kaiser Health News. “There does appear to be some opportunity for cost savings, but we don't have a good sense yet as to whether this [demonstration project] will actually improve the quality of care.”

The project considered staffing issues such as registered-nurse hours per resident; clinical measures such as bed sores and physical restraints; potentially avoidable hospitalizations; and deficiency information from state surveys.
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