Reporting and Motivating Performance Reputational Incentives Created by
Reporting and Motivating Performance: Reputational Incentives Created by Report Cards Thomas R Mc. Lean, MD, JD, FACS, ESQ. CEO, Third Millennium Consultants, LLC Attending Surgeon, Eastern Kansas VA Health Care System tmclean@dnamail. com
Disclaimer & Disclosures Nothing in this talk is be considered VA – policy – procedure, or – Recommendations I have no financial interests in the material presented.
Thank You Integrated Healthcare Association Ms. Cindy Ernst
Report Cards & Reputational Incentives http: //company. ipro. org/pix/P 4 P. png
Report Cards & Reputational Incentives § Why shift to VBP? – At the time, MDs failed to follow evidencebased medicine practices 55% of the time. – Estimated that 30 -40% Medicare expenditures were waste. Elizabeth A Mc. Glynn, Steven M. Asch, John Adams, et al. , “The Quality of Health Care Delivered to Adults in the United States, ” New England Journal of Medicine, June 26, 2003; http: //content. nejm. org/cgi/content/full/348/26/2635 (29 Dec 08); Arthur A. Levin, “Medicare Turns 40, ” Center for Medicare Consumers, August 2005 (29 Dec 08); http: //www. wasteofadollar. com/dollar_in_toilet. jpg
Report Cards & Reputational Incentives § VBP – Carrot: P 4 P – Stick: § the government should “encourage the adoption of best practices through the release of public domain comparative quality data. ” § Translation: Providerspecific report cards Leadership by Example, p 56; http: //company. ipro. org/pix/P 4 P. png http: //www. ffitz. com/ff/main/graphic 2/icarrot. gif
Report Cards & Reputational Incentives § Public dissemination § The private handling of adverse outcomes “works best in circumstances where the public has a high degree of trust in [the reviewing] institutions. ” § Public trust is at a minimum – Managed care – Ineffectiveness of peer review – Daily newspaper stories of provider incompetence Steven Clarke and Justin Oakley: Informed Consent and Clinician Accountability: The Ethics of Report Cards on Surgeon Perfomance, Cambridge 2008. http: //blog. evidenceinmotion. com/photos/uncategorized/2008/06/25/reportcard. gif
Report Cards & Reputational Incentives § Primary purpose of report cards is to influence behavior. § Report Cards should – reward good performance – “remove” poor performers § Therefore, report cards create reputational incentives for providers Inst. of Med. : Rewarding Provider Performance. NAS Press, Washington DC (2007); Wicks EK and Meyer JA: Making Report Cards Work. Health Affairs 1999; 18(2): 152 -6; Wicks, EW; Meyer, JA. Making Report Cards Work. Health Affairs. 1999; 18: 152– 155; Palmer, RH. Securing Health Care Quality for Medicare. Health Affairs. 1995; 14: 89– 100.
Report Cards & Reputational Incentives § Provider report cards are new a new idea: – Mesopotamia – 1850’s Florence Nightingale – 1900’s Earnest Codmen – 1980’s NYS collects cardiac services outcomes data – Web-based provider-specific outcomes data
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