Canada Values Health - Dialogue on Health Care -

A stick or a carrot: Will hospital “pay-for-performance” incentives improve patient care?

2009-03-06 14:10:30

A stick or a carrott: Will hospital "pay-for-performance" incentives improve patient care?

Source: Surrey Now.

The Health Ministry in British Columbia will institute “pay for performance” incentives for hospitals in the hopes of moving patients through the health care system faster.

For example, Surrey Memorial Hospital will receive funds for meeting certain benchmarks, including:

- Lower acuity patients discharged from the emergency department in two hours or less will result in a payment to the department of $100;

- Higher acuity patients discharged from the ER in four hours or less will net the hospital $100;

- A patient who requires admission to the hospital and gets a bed in 10 hours or less will net the hospital $600. “ – Source, Surrey Now.

Are pay-for-performance incentives a good idea? Will they improve the care patients receive? Will they result in better value for money in our health care system?

Your responses
laughable jwickstrom Posted: 2009-11-23 23:50:54 Ha ha, yes lets pay the hospitals for rushing the acute patient out of the door. pay them extra for lower quality of care. More sensible idea is to charge a user fee for minor, non emergency cases. Non life- threatening injuries or disorders:direct them to 24 hour federally funded community clinics staffed by well paid nurses and chiroprators who act a gate keepers to the big system; hospitals, and emergency rooms. Sweden, a very socialized country introduced user fees not only at the emergency dept. but for visits to the general practitioner. In 1994, the fee was $50.00. This was fifteen or tweny years ago, probably just before their 'universal medical system', much like ours, bankrupt the country. These public discussion initiated by the government are probably another waste of tax payers money. Who will actually read this material I wonder? Heres some basic money saving advice; -physical education for all children: manditory -more recreational activities for adults and seniors with tax credit provided. -lower income taxes for the mid and lower income earners, so they can eat properly. -higher taxes for the rich, or restrictions on who has universal coverage, the rich like to have the best medical care (read private) anyway and if not: If you earn over 100,000 per year, you pay full premium for your medical insurance. There are so many ways to save money rather than feed a system that rates 30th in the world as it is. jw
not a good idea molson Posted: 2009-05-31 01:39:21 No, I wonder what the readmission rate would be for all the people who arn't ready to go, who get pushed through the system to fast, with out a proper assessment. we spent to much time doing paperwork for readmissions who were just discharged yesterday and have to come back today!
good cop/bad cop annkast Posted: 2009-04-29 16:43:32 I think incentives are a fine idea when you are talking about getting a 4 year old to bed but I have rarely seen a hospital that needs this. Most I have been in are struggling as it is to do what they have to. If you need to improve the response time of the emergency department, maybe you should look at WHO is using the department and why AND, who is staffing the department, maybe they need to be re-tasked to another department. If the hospital needs a specialty trauma unit because of where they are then that is what they should get, not a stop-watch and a bag of loonies for doing a faster job.
health incentive lpmoyer Posted: 2009-03-13 18:40:36 Why not charge the hospitals with producing healthy people and pay only for health not long term pharmacutcal cases. Doesn't that make sense you get the bonus if i walk with health, you loose if i am a long term drug user. then instead of burdening the system with drug costs we creat what we really want healthy people. I reallise this idea is simplistic but it has more merit than letting doctors decide where to spend money. and we all know how that is working. more surgery and more pharma. because that is where the money is. everyone deserves to be rewarded for their education but lets let them put it to a desired end use healthy people, with all their parts.
Who drives the bus? Al Posted: 2009-03-12 09:20:24 Physicians aren't employees of hospitals, but drive most all the activity. A joint hospital/physician strategy would be more effective in achieving the desired outcomes, otherwise hospital leadership alone will only be able to do so much.
Fund hospitals based on performance salee Posted: 2009-03-11 07:11:10 It is a good idea only if patient's input is the key benchmark. Block funding to hospitals have not worked ...hospitals continue to demand for more money and threaten to reduce hospital beds. Yet, we see careless spending of funds - eg. hiring nurses through agency instead of direct employment. Agree with Tracy that hospitals need to stop functioning as a long-term care facility.
The right service for the right patient Tracy Lister Posted: 2009-03-09 09:55:54 It seems hospitals have become everything but hospitals; they are long term care facilites, drug and rehab facilities, day care, and respite. Acute care hospitals should be for acute care patients. It is less expensive to have someone admitted to a care facility even if it is short term and to use an acute care hospital bed.
Pay for Incentives not a good idea Debby Posted: 2009-03-09 08:35:29 The idea of a hospital moving patients through the system is NOT a good idea. This will lead to encouragment by management to maximize their benefits and reduce the care to the patient. Benchmarks are an administrative tool not a health care tool. We already feel pushed out of our doctors offices because of their X minute benchmarks, now we will be tossed right out of the hospital. Not everyone can articulate their problems in the way that is required by a hospital in a given amount of time. Hospital staff should not have the added pressure of 'race the clock' or deal with administrative reprecussions. People, in most cases I find, don't work well with that additional pressure.