Although many physicians are less than enchanted with pay for
performance—the concept of paying hospitals and physicians for adhering
to practice guidelines and meeting standards of quality improvement—the
concept has received the endorsement of many members of Congress.
As a result, the federal Centers for Medicare and Medicaid Services (CMS)
has received money to launch various pay-for-performance (P4P) demonstration
For example, CMS and Premier Inc. of San Diego joined forces in 2003 to
launch a P4P demonstration project in some 250 American hospitals. The goal
was to determine whether economic incentives could improve the quality of
patient care in them. In 2006 CMS launched a three-year P4P program to
encourage physicians who treat chronically ill patients to adhere to specific
quality-control guidelines (Psychiatric News, November 17, 2006). The
Tax Relief and Healthcare Act of 2006 authorizes CMS's Physician Quality
Reporting Initiative, which is getting under way this year (Psychiatric
News, December 21, 2007).
P4P is getting a foothold in England as well. In 2004 England's National
Health Service implemented a P4P contract with family practitioners
(Psychiatric News, December 15, 2006). And now the North West
Strategic Health Authority, which is part of England's National Health
Service, has commissioned Premier Inc. of San Diego to implement a P4P
demonstration project in hospitals and other health-care sites in northwest
According to Mike Farrar, chief executive of the North West Strategic
Health Authority, "We have carried out an extensive search to identify
the most effective health services offered around the globe, and we have
teamed up with a world leader that has already delivered dramatic results in
the United States."
The P4P demonstration project in northwest England, called "Advancing
Quality," will first focus on improving the quality of care in the five
areas targeted by the American project—heart attacks, heart bypass,
heart failure, hip and knee replacements, and pneumonia. If those efforts
prove successful, the project might then be expanded to other areas of
Premier will work with hospitals and the ambulance service in northwest
England to set up data collection and processing systems. The structure of the
financial-incentive scheme is currently being developed. There are no plans to
penalize hospitals that do not meet quality-care standards.
The northwest region of England includes some 7 million people, both in
cities and in rural areas, and with a wide range of incomes. Some of the major
health challenges in the region are cancer, excessive alcohol use, obesity,
and teenage pregnancies.
More information about the "Advancing Quality"
demonstration project is posted at<www.northwest.nhs.uk/about_us/>