Pay for Performance on Nursing Care

Pay for Performance on Nursing Care

Pay for performance is a growing trend across health care caused by calls to action regarding our nation's health care system. A new focus on patient safety and quality initiatives in hospitals has led to an increased level of support for a nationwide pay for performance initiative. Motivated by the belief that "traditional payment schemes reward the volume of services, and do not consider the quality and efficiency of health care" (Scott 2008 p.5) the Centers for Medicare and Medicaid instituted a pay for performance program in 2003. Hospitals scoring well in thirty standardized measures would receive a bonus for the care that they provided to their patients. Institutions not meeting the goals brought forth by these measures would not receive full compensation for the services provided. Upon initial evaluation of a pay for performance program one would believe that health care is moving toward a "reward" or money based system but through careful review of policies and safety measures instituted in response to the program pay for performance seems to be a system that encourages continuous quality initiatives and refinement of the system that has been in place for so many years.

Today, there are more than 100 pay for performance initiatives nationwide endorsed by a variety of health care plans. Looking at pay for performance as a quality initiative, this seems like it is the way to fix a broken health care system. While some believe that pay for performance will cause a greater disparity between hospitals in lower and upper class areas, with further development this plan could actually close the gap between rich and poor in relation to health care by providing greater access, monitoring and resources. Looking at pay for performance from a quality standpoint, I think that this is a great initiative that can only improve the care that patients receive in hospitals. By holding hospitals, physicians, nurses and administrators accountable and as a result creating a safer work and patient care environment for all, pay for performance will help us help our patients.

The first article, written for The New England Journal of Medicine presents a negative view on the pay for performance initiative. In this article, Dr. Fisher raises many concerns regarding the program. "Although the ostensible goal of pay for performance programs is to improve the quality of care, many physicians fear that efficiency will be the only focus" (Fisher, 2006, p. 1845). Another issue raised in this article is that perhaps pay for performance could cause more harm than good. "Unless physicians are firmly convinced that risk adjustment is sufficient, they could decide that the easiest way to achieve high scores is to avoid sick or challenging patients" (Fisher, 2006, p. 1846). If for instance, a physician did do this, many of our sickest and older patient populations may be left without a primary care physician thus causing further strain on hospital emergency rooms and budget. If a patient doesn't have a physician following them, chronic diseases such as hypertension, diabetes and asthma will not be monitored as closely resulting in unneeded emergency room visits. While hospitals and physicians cannot deny care to patients, the fear of not being reimbursed may lead them to not provide the proper and necessary care thus leading to more hospitalizations and further strain on the health care system. Others believe that "the emphasis on financial incentive could further undermine morale and the core professional value of altruism that is already threatened by the increasing commercialization of medicine" (Fisher, 2006, p.1846). After all, most health care professionals entered the field to help others, not to make more money. Exclusive pay for performance, according to the article may not be entirely beneficial to the majority if health care consumers and should be further investigated. (Fisher, 2006)

"P4P models could improve medical professionalism" suggests that pay for performance is a program that has potential to do a lot of good for people of all demographics if properly instituted. The point of pay for performance (P4P), the article states is to "align the interests of physicians and patients and this can often motivate both increased use of preventive services and improved care management" (Ledue, 2010, p. 54). If this is truly how P4P ends up working for patients, it can be nothing more than successful. Another possibility that this article suggests is that pay for performance could put some providers in competition with each other, Ledue believes that perhaps the system should be designed "to encourage the sharing of knowledge, scientific evidence and information- a principle of professionalism" (Ledue, 2010, p. 54).

Nurses, consumer satisfaction and pay for performance look at another important aspect of pay for performance, patient satisfaction. In a patient satisfaction survey issued by the federal government, patients are asked a variety of questions and asked to evaluate their satisfaction in these areas. Scores of nursing quality are posted for consumers to evaluate and make their health care choices. Many different aspects of nursing provide a direct tole in influencing these scores. Basic entry level programs must be enhanced to increase the workforce of nurses working in hospitals. Nursing and patient satisfaction directly correlate so a shortage of nurses or varying levels of staffing will greatly sway patient satisfaction scores. Hospitals must also do a better job at retaining trained nurses. "After two years half of all new nurses have left their first job" (Lutz, 2007, p.60) This article suggests partnerships between nursing schools and hospitals to provide new nurses with a sense of what it really means to work for a hospital may help in this endeavor. Greater staffing flexibility, IT tools to decrease charting and a culture of Magnet ideals are all ways high performing hospitals are trying to maintain their workforce (Lutz, 2007). This article provides a favorable view of pay for performance although believes that for the system to be effective, hospitals and nursing schools need to do a better job of preparing their nurses more effectively.

Pay for Performance: A Nursing Perspective discusses the history and perceived rationale for the pay for performance initiative. Medicare reimbursement was a driving force behind the implementation as pay for performance has been in place since early 2000. In response to surging health care costs and consumer dissatisfaction, "The pay for performance momentum was in direct response to concerns that traditional payment schemes reward volume of services and do not consider the quality and efficiency