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Pay-for-performance programs effectiveness in healthcare: the case of the end-stage renal disease quality incentive program

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  • Saeed Piri

    (Lundquist College of Business, University of Oregon)

Abstract

This paper focuses on Medicare’s End-Stage Renal Disease Quality Incentive Program (QIP). QIP aims to promote high-quality services in outpatient dialysis facilities by tying their payments to their performance on pre-specified quality measures. In this paper, employing principal-agent theory, we examine the effectiveness of QIP by exploring the changes in various clinical/operational measures when they become a part of the program as a performance measure. We study five QIP quality measures; two are operational: hospitalization and readmission. And three others are clinical: blood transfusion, hypercalcemia, and dialysis adequacy. Overall, we observe a significant improvement in all QIP quality measures after being included in the program, except for readmission. We recommend adjusting the weight and redesigning the readmission measure for Medicare to incentivize providers to reduce readmission. We also discuss establishing care coordination and employing data-driven clinical decision support systems as opportunities for dialysis facilities to improve the care delivery process.

Suggested Citation

  • Saeed Piri, 2024. "Pay-for-performance programs effectiveness in healthcare: the case of the end-stage renal disease quality incentive program," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 25(2), pages 221-236, March.
    • Handle: RePEc:spr:eujhec:v:25:y:2024:i:2:d:10.1007_s10198-023-01582-x
    DOI: 10.1007/s10198-023-01582-x
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    References listed on IDEAS

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    JEL classification:

    • C33 - Mathematical and Quantitative Methods - - Multiple or Simultaneous Equation Models; Multiple Variables - - - Models with Panel Data; Spatio-temporal Models
    • I13 - Health, Education, and Welfare - - Health - - - Health Insurance, Public and Private
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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