Incentive Design and Quality Improvements: Evidence from State Medicaid Nursing Home Pay-for-Performance Programs

R.T. Konetzka, Meghan Skira and R.M. Werner

Health, Econometrics and Data Group (HEDG) Working Papers from HEDG, c/o Department of Economics, University of York

Abstract: Pay-for-performance (P4P) programs have become a popular policy tool aimed at improving health care quality. We analyze how incentive design affects quality improvements in the nursing home setting, where several state Medicaid agencies have implemented P4P programs that vary in incentive structure. Using the Minimum Data Set and the Online Survey, Certification, and Reporting data from 2001 to 2009, we examine how the weights put on various performance measures that are tied to P4P bonuses, such as clinical outcomes, staffing levels, and inspection deficiencies, affect improvements in those measures. We find larger weights on clinical outcomes often lead to larger improvements, but small weights can lead to no improvement or worsening of some clinical outcomes. We find a qualifier for P4P eligibility based on having few or no severe inspection deficiencies is more effective at decreasing inspection deficiencies than using weights, suggesting simple rules for participation may incent larger improvement.

Keywords: pay-for-performance; nursing home quality; long-term care; incentive design (search for similar items in EconPapers)
JEL-codes: I11 I18 (search for similar items in EconPapers)
Date: 2016-08
New Economics Papers: this item is included in nep-hrm
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Related works:
Journal Article: Incentive Design and Quality Improvements: Evidence from State Medicaid Nursing Home Pay-for-Performance Programs (2018)
Journal Article: Incentive Design and Quality Improvements: Evidence from State Medicaid Nursing Home Pay-for-Performance Programs (2018)
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Persistent link: https://EconPapers.repec.org/RePEc:yor:hectdg:16/24

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