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Medical University of South Carolina case study: A structured approach to improving quality metrics for achieving maximum pay-for-performance incentive payments

Author

Listed:
  • Bowen Scheurer, Danielle

    (Medical University of South Carolina, USA)

  • Adelman, Kimberly

    (ECG Management Consultants, USA)

  • Myerson, Sandra

    (ECG Management Consultants, USA)

  • Carley Reed, Lisa

    (ECG Management Consultants, USA)

Abstract

To get healthcare costs under control and ‘bend the cost curve’, the Centers for Medicare & Medicaid Services is driving a shift from the fee-for-service (FFS) reimbursement model, which rewards quantity over quality, to value-based care payment models that encourage efficient delivery of high-quality, lower-cost care. Commercial payers are also shifting away from FFS and tying payment to quality metric scores and performance. The Medical University of South Carolina (MUSC) participates in one of the state’s largest pay-for-performance (P4P) initiatives. The payer uses a scorecard that assigns points, associated with incentive dollars, for meeting or exceeding benchmarks in publicly reported quality metrics. In late 2020, MUSC and ECG Management Consultants partnered to assess MUSC’s flagship hospital performance, analysing historical scorecard performance and improvement opportunities. MUSC’s biggest challenges included clinical practice variation, data accessibility and competing priorities, particularly during the COVID-19 pandemic. The hospital was leaving money on the table for process and outcomes measures for harm avoidance and patient safety, unplanned readmissions and appropriate use of emergency department and outpatient cardiac imaging. To overcome quality improvement (QI) barriers, multidisciplinary workgroups were established for each of the focus areas. Workgroup participants used MUSC’s IMPROVE methodology, incorporating Lean, Six Sigma and continuous process improvement best practices to effect change. From this foundational, structured QI approach — focused on a select group of metrics — MUSC is projected to earn US$11.6m in incentives between fiscal years 2023 and 2025, while improving clinical outcomes and patient safety. MUSC will apply the critical success factors and lessons learned to other QI opportunities across the entire MUSC Health system as the organisation strives to reduce process and outcome variability. Hospitals and health systems that engage in efforts similar to those undertaken in the ECGMUSC collaboration can build a foundation of strong QI capabilities and realise improved incentive payment dollars under P4P arrangements.

Suggested Citation

  • Bowen Scheurer, Danielle & Adelman, Kimberly & Myerson, Sandra & Carley Reed, Lisa, 2023. "Medical University of South Carolina case study: A structured approach to improving quality metrics for achieving maximum pay-for-performance incentive payments," Management in Healthcare: A Peer-Reviewed Journal, Henry Stewart Publications, vol. 7(3), pages 237-249, March.
  • Handle: RePEc:aza:mih000:y:2023:v:7:i:3:p:237-249
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    More about this item

    Keywords

    pay for performance; quality metrics; performance improvement; incentive payment; clinical outcomes; value-based care;
    All these keywords.

    JEL classification:

    • I1 - Health, Education, and Welfare - - Health
    • I10 - Health, Education, and Welfare - - Health - - - General

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