60 Seconds with... Mark Wynn, CMS Division Director of Payment Policy Demonstrations

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Q: A Medicare pay-for-performance demonstration project for nursing home operators could be in motion by the end of the year. Who will be involved in the three-year study? A: There will be about 50 nursing homes in each of about four or five states. Mostly Medicaid agencies will be solicited to help. It would be a voluntary demonstration. Better care can reduce the necessity for hospitalization of patients, and we can use this as a funding source.

Q: How would bonus pay be decided?

A: In our draft design, we have 20% of the participants getting an incentive payment due to high achievement of quality. And 20% would be getting an incentive payment due to high improvement. One of the key points here is we're not just looking for the very best nursing homes to join us. We want some in the middle with room to improve. There are no losers: We're not going to take money from anyone.

Q: Will that remain true for a real pay-for-performance program?

A: Anything in terms of legislation or large-scale implementation is some way off. We don't have a crystal ball over the legislation.

Q: Should providers be concerned they could, in effect, be penalized for having higher-acuity residents?

A: We should have risk adjustment that would appropriately ensure that a nursing home with a more severe caseload is measured appropriately. We'll be further refining the research design and will have public meetings with major interest groups.