The impact of Pay for Performance program - Assignment Example

? Teacher’s Introduction There have been many different approaches applied before to ensure quality health care service in nursing homes. Two of the most used tools were the reimbursement system and the surveillance and enforcement system. The reimbursement system covered residential care and quality of life via payments to the providers in accordance with the standards set by the federal Nursing Home Reform Law, 1987. And surveillance and enforcement system made sure that these standards were met by the providers and if they are not, then to penalize them through penalties and fines until the deficiencies are corrected. However, for numerous reasons these systems did not prove to be effective enough in improving health care standards and simply too many residents suffered every day. Providers often complained that they were more or less underpaid to do a better job. Under these circumstances, agencies came up with ‘Pay for Performance’ program to ensure better health care facilities by rewarding nurses and physicians according to their performances and improving the overall standard of care they’ve been providing (Mallot, 2008, p.2). Meaning of Pay for Performance, Compensation, benefits and entitlement Pay for Performance (P4P), is a growing program that encourages health care providers to provide better health care facilities by rewarding them on the basis of their performances. The program focuses on three key features namely: participation, achievement and rewards. Participation implies that all the employees of an organization participate and contribute beyond the standard levels. Achievement stresses on reducing costs and at the same time increasing profits. It also focuses on productivity by emphasizing on group rather than individual performances. Whereas rewards are usually in the shape of cash prizes given at regular intervals based on outstanding performances (American Nurse Association, 2006). Compensation is a system of exchange. Participants are given certain targets to achieve and in return are rewarded with either money or valuable assets. Compensation can be either direct or indirect. Direct compensation involves actual money given to workers and consists of base pay, incentive pay, merit pay and deferred pay whereas indirect compensation does not involve any money. Instead it includes protection programs such as health, pension, social security and other insurance services. Benefits on the other hand are the non-financial form of reimbursement offered in addition to cash salary to enrich workers’ living standards. Some of these benefits include health/medical benefits, educational assistance providing tuition reimbursements and cost of books, work/life benefits including life insurance programs, long or short term disability, cancer/critical illness plans, vision and dental coverage and most importantly retirement and pension plan for retirees since a large number of workers approach retirement every year (Report by Center of Health Program Development and Management, University of Maryland, Baltimore County, 2003). Challenges associated with Pay of Performance strategy There are a number of challenges or concerns faced by the Pay for Performance strategy. The first being its potential negative impacts on nursing through its worsening documentation load. Since the program requires a lot of documentation for keeping the record, through which nursing providers are monitored and are awarded based on their performance, more than 30 percent of the allocated time is spent on documentation of their work (American Hospitals Association, 2003; Pg 2004). One also questions the validity of these documentations since according to the analysis of the Centre for Medicare Advocacy, it is typical that providers self report their data in pay for performance programs. This leads to false documentation. Another challenge that comes to mind is that institutions tend to focus entirely on specific points targeted by the schemes rather than broader aspects such as safety and quality of care or on how patients actually fare. It is feared that clinicians and managers only focus on improving scores without necessarily working on greater issues of providing care or the final outcomes. Some raise concerns on the credibility of whether the currently used performance measures are true indicators of the quality of care or predictors of outcomes used in these institutions (Clarke, Raphael & Disch, 2009). Since the pay for performance program encourages providers to focus on achieving population-based benchmarks rather than meeting the specific needs of the individuals for whom they actually care, there is a danger that Pay for Performance programs may result in providers backing out from individualized resident care and culture change. This also poses challenges since it might encourage nursing homes to simply refuse the admission of residents that don’t fit in their criteria or lower their chances of achieving the benchmarks necessary to be awarded P4P funds. Another issue, equally distressing, is that institutions with only a handful of resources may find themselves in a downward spiral of producing poor outcomes and having minimal resources to improve the underlying performance or the documentation of their work to fulfill regulatory mandates, leading to lower reimbursement and even fewer resources and so forth. If a program is designed such that ‘good’ performers receive more money and ‘bad’ performers receive less, the bad performer’s ability to provide safe care and image are undermined (Mallot, 2008). Thus, Pay for Performance could indirectly feed widening gaps in care quality among facilities. Measures taken for implementing P4P The Pay for Performance programs which are primarily focused on improving the quality, safety and overall standards of patients’ healthcare can turn out to be a positive force for the healthcare system. For this to happen, measures should be taken for these programs to be implemented properly. These measures range from ensuring quality care services to building a healthy patient/physician relationship. P4P programs should be fair and ethical. Commitment to improved patient care should be given top priority. Quality of care should be evidence-based created by physicians across appropriate specialties. Furthermore, voluntary positions should be offered to physicians to participate in the program. And economic viability of the physicians who don’t participate in these program practices should not be threatened. This supports participation by physicians in all practice settings and minimizes the potential financial or technological barriers including start up costs. The patient/physician relationship also plays a very important role in building up a successful program. According to Press Ganey Associates Inc., the nurse patient relationship sets the tone of the care experience and has a powerful impact on patient satisfaction. Since patients spend most of their time with these nurses, their interaction allows the patients to draw positive conclusions about the providers and the overall program. This also supports the Pay for Performance program since the program is all about performing and maintaining the standards. Failure to do so would result in penalization through fines and other penalties, generally until their deficiencies are covered. Use of accurate data and fair reporting should also be practiced during implementation of these programs since documentation plays a vital role in awarding these nurses. This also includes scientifically valid analytical methods. There should be some check in place for these physicians and nurses while documenting so that their performance is evaluated on fair basis. One other suggestion could be to take feedback from the patients themselves together with their families of the services provided by these physicians and if they are satisfied with them. Another important factor contributing to the overall performance by these physicians is providing new funds for positive incentives to physicians for their participation in the program. This not only supports a healthy competition but also the goal of quality improvement across all participating physicians. Agency theories suggest that these financial incentives are most likely to influence behaviors when there is a clear link between behaviors and rewards. Pay for performance programs should also be made public for the sake of transparency. All the information regarding different programs including their awards and criteria should be put on a dedicated website which should be monitored on regular basis. This will not only create public awareness of the program but also help sharing of data and information on the best practices available (American Medical Association Report, 2005). Review on a Registered Nurse Position Registered Nurse position under review in this report would be of a labor and delivery nurse. One of the primary responsibilities of a labor and delivery nurse is to assist a mother or a pregnant woman during the whole child delivery process. For some women, having children can be a very stressful and a frightening experience. Fatal complications can arise for both baby and the mother and its highly important and recommended if there is some medical professional present with the mother at all times. A successful labor and delivery nurse loves to work with people and perform in pressure situations. And when needed, they help the doctor deliver the baby by monitoring the mother throughout the labor process providing guidelines, support and directions in breathing and relaxing techniques as necessary. In many hospitals, they help mothers to prepare for delivery and accompany them into the delivery room. Typically, they are employed in hospital maternity wards but may also be employed in health clinics, birthing centers or obstetrics and gynecology (OB/GYN) offices. There are some specific requirements for one to become a labor and delivery nurse. One should have successfully completed a Bachelor of Science in Nursing and must be a registered nurse (RN). Some prior work experience in this field is critical. A background in teaching or social work can also be helpful since their work includes interacting with women and educating them on birth control, nursing, postpartum depression and other child care issues. All in all, labor and delivery nurses have a great prospect of excelling in their field with job offers projected to grow at a rate of 21-23% throughout year 2018 (Top Nursing Schools, 2012). Pay for Performance plan including Compensations and Benefits There are a few questions that should be kept in mind when considering Pay for Performance. The first one is if the agency is ready for Pay for performance program. This includes if the organizational culture supports this program and if the management is committed to change in the culture. Secondly, what are the goals of pay for performance? Is it motivation or to increase individual or organizational performances etc. Who should be paid for performance? Does it cover all the employees? What should be rewarded and how should employees be rewarded? What sort of compensation and benefits are included? Who provides input on the performance ratings? Is it the managers or first-level supervisors? How are these programs funded and how the overall cost is managed? These are all the questions that should be considered while writing a successful Pay for Performance plan. Since it is a performance driven program, individuals are gauged according to their performances and meeting their goals in order to be eligible for the rewards. Rewards should be awarded in the form of cash bonuses. Unlike base pay which an employee is bound to get and is part of the employment contract, bonuses should depend purely on performance and are not guaranteed. Other form of a benefit can be performance-based pay increase which in contrast to bonuses are incorporated into employee’s base pay and is usually adjusted upwards. Employees may find this more attractive as compared to the bonuses since it enhances the value of several other benefits including retirement earnings, savings plan and life insurance (McPhie, 2006). Conclusion The facts and figures regarding the impact of Pay for Performance program are understandably quite limited. Since it is a relatively fresh program, a careful thought has to be put in about the type of research needed to truly understand its impact on health care practices. It is clear that it provides great opportunities to the care providers to enhance their care standards by providing reimbursements corresponding to their performances and also to improve overall medical care process. However, it is yet to be seen if the system is efficient and effective enough to sustain for a longer period of time. References McPhie, A. G. (January, 2006). Report on Design an Effective Pay for Performance Compensation Plan American Medical Association Report. (2005, June 21). Principles for Pay for Performance Program Clarke, Raphael & Disch. (2009). Challenges and Directions for Nursing in Pay for Performance Movement. Retrieved from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697611/ Mallot, J. (2008). Report of the Long Term Care Community Coalition Report by Center of Health Program Development and Management, University of Maryland, Baltimore County (2003, October). The Americal Nurse Association. (2006). RNs and Pay for Performance. Retrieved from: http://www.nursingworld.org/dlwa/wages/wp8.htm Top Nursing Schools. (2008). Retrieved from: http://www.topschoolsfornursing.com/445/labor-delivery-nurse Read More