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

Saeed Piri ()
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Saeed Piri: Lundquist College of Business, University of Oregon

The European Journal of Health Economics, 2024, vol. 25, issue 2, No 4, 236 pages

Abstract: 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.

Keywords: Healthcare payment; Pay-for-performance; Empirical; Health economy; Dialysis facilities (search for similar items in EconPapers)
JEL-codes: C33 I13 I18 (search for similar items in EconPapers)
Date: 2024
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DOI: 10.1007/s10198-023-01582-x

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