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2.
Front Public Health ; 9: 740257, 2021.
Article in English | MEDLINE | ID: covidwho-1775892

ABSTRACT

Hospitals are facing big challenges: decreasing reimbursements are going alongside increasing costs and the necessity of investments. At the same time occurring, excellent quality of care, and high-patient satisfaction have to be assured. The dilemma of providing both with decreasing rather than increasing resources cannot be solved only by striving for economies of scale, but by optimizing supply chain management, or reduction of overhead. Possible effects of these measures most often are already exhausted and seldom have a positive impact on the quality of care or patient satisfaction. Management is tempted to use its best-known instruments to reduce costs, while medical staff's focus is on quality of care and often battle against management as a perceived enemy. The solution to this dilemma lies in focusing on medical core processes that are directly linked to patients' treatments and, thereby improving all the parameters of Michael Porter's value equation: costs, outcome, and patient satisfaction. This approach of performance enhancement presumes understanding, acceptance, and constructive collaboration of two usually separated worlds: The medical-scientific world involved in patient care and the financial world of management. In this article, the authors explain performance enhancement for optimized delivery of care and how the dilemma mentioned above can be solved. The authors explain how performance enhancement can be achieved in daily clinical practice, which kind of obstacles have to be overcome, which changes are necessary within a hospital, how medical staff can be motivated, and how the value of care equation can be influenced.


Subject(s)
Delivery of Health Care , Quality of Health Care , Costs and Cost Analysis , Delivery of Health Care/economics , Hospitals , Humans , Patient Satisfaction , Quality of Health Care/economics , Reimbursement, Incentive
3.
Health Policy ; 126(6): 485-492, 2022 06.
Article in English | MEDLINE | ID: covidwho-1747975

ABSTRACT

Vaccinations are crucial to fighting SARS-CoV-2, and high coverage rates can in most countries probably only be achieved with the involvement of primary care physicians (PCPs). We aimed to explore how SARS-CoV-2 vaccination payment schemes in 43 countries differ with regard to the (i) type of payment scheme, (ii) amount paid, (iii) degree of bundling, and (iv) use of pay-for-performance elements. We collected information on payments and health system characteristics, such as PCP income and employment status, in all EU and OECD countries over time. We regressed the payment amount on the income of PCPs for countries with activity-dependent schemes using a linear regression (OLS), and we interpreted the residuals of this regression as a vaccination payment index. The majority of countries (30/43) had chosen payment schemes that reward PCPs for the activity they perform. Seventeen countries paid less per vaccination than the income-adjusted average, whereas 13 countries paid more. Twelve countries used pay-for-performance elements.


Subject(s)
COVID-19 , Physicians, Primary Care , COVID-19/prevention & control , COVID-19 Vaccines , Humans , Organisation for Economic Co-Operation and Development , Reimbursement, Incentive , SARS-CoV-2 , Vaccination
4.
Am J Law Med ; 47(4): 455-476, 2021 12.
Article in English | MEDLINE | ID: covidwho-1747364

ABSTRACT

The COVID-19 pandemic brought critical debates regarding private equity ownership of long-term care facilities to the forefront of political, legal, and social landscapes. Like many of the historical concerns about long-term care, these debates center around low quality patient care. While the concerns present important challenges to overcome, this note theorizes the kinds of organizational incentives that may provide opportunities to align patient quality care with the financial goals of private equity investing. After a discussion of the historical context of long term care facilities and the more recent trends towards for-profit and private equity ownership of these facilities (Parts II and III), I engage with value-based models as a starting point to consider organizational level incentive possibilities (Part IV). In Part V, I consider an organizational-level pay for performance model, a time-bound incentive structure, and investor-specific incentives as three distinct possibilities for addressing the patient care issues identified.


Subject(s)
COVID-19 , Motivation , Humans , Long-Term Care , Pandemics , Reimbursement, Incentive
5.
PLoS Med ; 19(2): e1003928, 2022 02.
Article in English | MEDLINE | ID: covidwho-1686091

ABSTRACT

BACKGROUND: Digital network-based methods may enhance peer distribution of HIV self-testing (HIVST) kits, but interventions that can optimize this approach are needed. We aimed to assess whether monetary incentives and peer referral could improve a secondary distribution program for HIVST among men who have sex with men (MSM) in China. METHODS AND FINDINGS: Between October 21, 2019 and September 14, 2020, a 3-arm randomized controlled, single-blinded trial was conducted online among 309 individuals (defined as index participants) who were assigned male at birth, aged 18 years or older, ever had male-to-male sex, willing to order HIVST kits online, and consented to take surveys online. We randomly assigned index participants into one of the 3 arms: (1) standard secondary distribution (control) group (n = 102); (2) secondary distribution with monetary incentives (SD-M) group (n = 103); and (3) secondary distribution with monetary incentives plus peer referral (SD-M-PR) group (n = 104). Index participants in 3 groups were encouraged to order HIVST kits online and distribute to members within their social networks. Members who received kits directly from index participants or through peer referral links from index MSM were defined as alters. Index participants in the 2 intervention groups could receive a fixed incentive ($3 USD) online for the verified test result uploaded to the digital platform by each unique alter. Index participants in the SD-M-PR group could additionally have a personalized peer referral link for alters to order kits online. Both index participants and alters needed to pay a refundable deposit ($15 USD) for ordering a kit. All index participants were assigned an online 3-month follow-up survey after ordering kits. The primary outcomes were the mean number of alters motivated by index participants in each arm and the mean number of newly tested alters motivated by index participants in each arm. These were assessed using zero-inflated negative binomial regression to determine the group differences in the mean number of alters and the mean number of newly tested alters motivated by index participants. Analyses were performed on an intention-to-treat basis. We also conducted an economic evaluation using microcosting from a health provider perspective with a 3-month time horizon. The mean number of unique tested alters motivated by index participants was 0.57 ± 0.96 (mean ± standard deviation [SD]) in the control group, compared with 0.98 ± 1.38 in the SD-M group (mean difference [MD] = 0.41),and 1.78 ± 2.05 in the SD-M-PR group (MD = 1.21). The mean number of newly tested alters motivated by index participants was 0.16 ± 0.39 (mean ± SD) in the control group, compared with 0.41 ± 0.73 in the SD-M group (MD = 0.25) and 0.57 ± 0.91 in the SD-M-PR group (MD = 0.41), respectively. Results indicated that index participants in intervention arms were more likely to motivate unique tested alters (control versus SD-M: incidence rate ratio [IRR = 2.98, 95% CI = 1.82 to 4.89, p-value < 0.001; control versus SD-M-PR: IRR = 3.26, 95% CI = 2.29 to 4.63, p-value < 0.001) and newly tested alters (control versus SD-M: IRR = 4.22, 95% CI = 1.93 to 9.23, p-value < 0.001; control versus SD-M-PR: IRR = 3.49, 95% CI = 1.92 to 6.37, p-value < 0.001) to conduct HIVST. The proportion of newly tested testers among alters was 28% in the control group, 42% in the SD-M group, and 32% in the SD-M-PR group. A total of 18 testers (3 index participants and 15 alters) tested as HIV positive, and the HIV reactive rates for alters were similar between the 3 groups. The total costs were $19,485.97 for 794 testers, including 450 index participants and 344 alter testers. Overall, the average cost per tester was $24.54, and the average cost per alter tester was $56.65. Monetary incentives alone (SD-M group) were more cost-effective than monetary incentives with peer referral (SD-M-PR group) on average in terms of alters tested and newly tested alters, despite SD-M-PR having larger effects. Compared to the control group, the cost for one more alter tester in the SD-M group was $14.90 and $16.61 in the SD-M-PR group. For newly tested alters, the cost of one more alter in the SD-M group was $24.65 and $49.07 in the SD-M-PR group. No study-related adverse events were reported during the study. Limitations include the digital network approach might neglect individuals who lack internet access. CONCLUSIONS: Monetary incentives alone and the combined intervention of monetary incentives and peer referral can promote the secondary distribution of HIVST among MSM. Monetary incentives can also expand HIV testing by encouraging first-time testing through secondary distribution by MSM. This social network-based digital approach can be expanded to other public health research, especially in the era of the Coronavirus Disease 2019 (COVID-19). TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR) ChiCTR1900025433.


Subject(s)
HIV Infections/diagnosis , HIV Testing/instrumentation , Homosexuality, Male , Reimbursement, Incentive , Self-Testing , Sexual and Gender Minorities , Adult , China , Costs and Cost Analysis , HIV Testing/economics , HIV Testing/methods , Humans , Male
6.
J Am Pharm Assoc (2003) ; 62(1): 214-217, 2022.
Article in English | MEDLINE | ID: covidwho-1608659

ABSTRACT

BACKGROUND: Pharmacists can optimize outcomes related to type-2 diabetes (T2D) by taking advantage of telehealth opportunities despite the coronavirus 2019 (COVID-19) Public Health Emergency (PHE). OBJECTIVE: Identify and compare changes in T2D outcomes before (August 2019 through February 2020) and during (March 2020 through October 2020) the COVID-19 PHE. Secondary objectives were to identify and compare pay-for-performance metrics and additional fee-for-service submitted in these patients. METHODS: This study examined changes in T2D outcomes at one primary care office within a community health system. Pharmacists started regularly using Remote Patient Monitoring (RPM) services during the COVID-19 PHE to reduce in-person visits. Patients with an initial glycosylated hemoglobin (A1C) greater than or equal to 8% were included. Data collected included comorbidities, change in A1C, and diabetes and statin medication therapy adherence. Percentage of Healthcare Effectiveness Data and Information Set (HEDIS) and Merit-Based Incentive Payment System (MIPS) measures were met, and billing code frequencies were also assessed. RESULTS: In the pre-COVID-19 PHE group (N = 30), the average 3- and 6-month A1C reductions were 1.3% and 1.2%, respectively, and the reductions were 2.0% and 2.2% in the during-COVID-19 PHE group (N = 61). The percentage of patients appropriately initiated or maintained on statins was 96.2% in the pre-COVID-19 PHE group versus 82.6% in the during-COVID-19 PHE group. Related to HEDIS, statin adherence was 95.2% in the pre-COVID-19 PHE group and 84.2% in the during-COVID-19 PHE group, and A1C control was 41.7% versus 54%, respectively. A1C control related to MIPS was 60% before COVID-19 PHE versus 73.8% during the COVID-19 PHE. Diabetes medication adherence related to HEDIS and medication reconciliation related to MIPS was 100% for both groups. CONCLUSION: Data demonstrate the opportunity for pharmacists to maintain and improve clinical outcomes related to T2D despite the ongoing COVID-19 PHE through implementation of telephonic monitoring.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 2 , Telemedicine , Glycated Hemoglobin A/analysis , Humans , Pharmacists , Reimbursement, Incentive , SARS-CoV-2
7.
Int J Environ Res Public Health ; 18(21)2021 10 29.
Article in English | MEDLINE | ID: covidwho-1512289

ABSTRACT

Overqualification is prevalent in times of economic downturn, and research has increasingly focused on its outcomes. This study aimed to explore the psychological burden caused by perceived overqualification (POQ) and its impact on creativity among high-tech enterprise employees. Drawing from effort-reward imbalance theory, we examined the effect of POQ on emotional exhaustion, along with the mediating role of emotional exhaustion in the POQ-creativity relationship and the moderating role of pay for performance (PFP) in strengthening the link between POQ and emotional exhaustion. Using cross-sectional data from a sample of 359 employees in China, we found that (1) POQ was positively related to emotional exhaustion; (2) emotional exhaustion was negatively related to creativity; (3) PFP moderated the effect of POQ on emotional exhaustion as well as the indirect effect of POQ on creativity via emotional exhaustion. These findings have both theoretical and practical implications.


Subject(s)
Emotions , Reimbursement, Incentive , Creativity , Cross-Sectional Studies , Reward
9.
Science ; 374(6569): 879-882, 2021 Nov 12.
Article in English | MEDLINE | ID: covidwho-1455668

ABSTRACT

The stalling of COVID-19 vaccination rates threatens public health. To increase vaccination rates, governments across the world are considering the use of monetary incentives. Here we present evidence about the effect of guaranteed payments on COVID-19 vaccination uptake. We ran a large preregistered randomized controlled trial (with 8286 participants) in Sweden and linked the data to population-wide administrative vaccination records. We found that modest monetary payments of 24 US dollars (200 Swedish kronor) increased vaccination rates by 4.2 percentage points (P = 0.005), from a baseline rate of 71.6%. By contrast, behavioral nudges increased stated intentions to become vaccinated but had only small and not statistically significant impacts on vaccination rates. The results highlight the potential of modest monetary incentives to raise vaccination rates.


Subject(s)
COVID-19 Vaccines , COVID-19/prevention & control , Intention , Reimbursement, Incentive , Vaccination/economics , Vaccination/methods , Adolescent , Adult , Female , Humans , Male , Middle Aged , Records , Sweden , Vaccination/statistics & numerical data , Young Adult
10.
Med Care ; 59(12): 1099-1106, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1447673

ABSTRACT

BACKGROUND: The Skilled Nursing Facility Value-based Purchasing Program (SNF-VBP) incentivizes facilities to coordinate care, improve quality, and lower hospital readmissions. However, SNF-VBP may unintentionally punish facilities with lower profit margins struggling to invest resources to lower readmissions. OBJECTIVE: The objective of this study was to estimate the SNF-VBP penalty amounts by skilled nursing facility (SNF) profit margin quintiles and examine whether facilities with lower profit margins are more likely to be penalized by SNF-VBP. RESEARCH DESIGN: We combined the first round of SNF-VBP performance data with SNF profit margins and characteristics data. Our outcome variables included estimated penalty amount and a binary measure for whether facilities were penalized by the SNF-VBP. We categorized SNFs into 5 profit margin quintiles and examined the relationship between profit margins and SNF-VBP performance using descriptive and regression analysis. RESULTS: The average profit margins for SNFs in the lowest profit margin quintile was -14.4% compared with the average profit margin of 11.1% for SNFs in the highest profit margin quintile. In adjusted regressions, SNFs in the lowest profit margin quintile had 17% higher odds of being penalized under SNF-VBP compared with facilities in the highest profit margin quintile. The average penalty for SNFs in the lowest profit margin quintile was $22,312. CONCLUSIONS: SNFs in the lowest profit margins are more likely to be penalized by the SNF-VBP, and these losses can exacerbate quality problems in SNFs with lower quality. Alternative approaches to measuring and rewarding SNFs under SNF-VBP or programs to assist struggling SNFs is warranted, particularly considering the coronavirus disease 2019 pandemic, which requires resources for prevention and management.


Subject(s)
Skilled Nursing Facilities/economics , Skilled Nursing Facilities/statistics & numerical data , Value-Based Purchasing/economics , Value-Based Purchasing/statistics & numerical data , Medicare/organization & administration , Reimbursement, Incentive/organization & administration , United States
12.
JAMA Netw Open ; 3(7): e2010231, 2020 07 01.
Article in English | MEDLINE | ID: covidwho-831807
13.
Int J Environ Res Public Health ; 17(7)2020 03 30.
Article in English | MEDLINE | ID: covidwho-760902

ABSTRACT

This study aims to explore the impact of healthcare digitalization on smart hospital project financing (PF) fostered by pay-for-performance (P4P) incentives. Digital platforms are a technology-enabled business model that facilitates exchanges between interacting agents. They represent a bridging link among disconnected nodes, improving the scalable value of networks. Application to healthcare public-private partnerships (PPPs) is significant due to the consistency of digital platforms with health issues and the complexity of the stakeholder's interaction. In infrastructural PPPs, public and private players cooperate, usually following PF patterns. This relationship is complemented by digitized supply chains and is increasingly patient-centric. This paper reviews the literature, analyzes some supply chain bottlenecks, addresses solutions concerning the networking effects of platforms to improve PPP interactions, and investigates the cost-benefit analysis of digital health with an empirical case. Whereas diagnostic or infrastructural technology is an expensive investment with long-term payback, leapfrogging digital applications reduce contingent costs. "Digital" savings can be shared by key stakeholders with P4P schemes, incentivizing value co-creation patterns. Efficient sharing may apply network theory to a comprehensive PPP ecosystem where stakeholding nodes are digitally connected. This innovative approach improves stakeholder relationships, which are re-engineered around digital platforms that enhance patient-centered satisfaction and sustainability. Digital technologies are useful even for infectious disease surveillance, like that of the coronavirus pandemic, for supporting massive healthcare intervention, decongesting hospitals, and providing timely big data.


Subject(s)
Public-Private Sector Partnerships , Reimbursement, Incentive , Costs and Cost Analysis , Hospitals , Humans , Motivation , Patient Satisfaction
14.
J Am Geriatr Soc ; 68(11): 2447-2453, 2020 11.
Article in English | MEDLINE | ID: covidwho-760156

ABSTRACT

BACKGROUND/OBJECTIVES: In April 2020, Massachusetts nursing homes (NHs) became a hotspot for COVID-19 infections and associated deaths. In response, Governor Charles Baker allocated $130 million in additional funding for 2 months contingent on compliance with a new set of care criteria including mandatory testing of all residents and staff, and a 28-point infection control checklist. We aimed to describe the Massachusetts effort and associated outcomes. DESIGN: Longitudinal cohort study. SETTING: A total of 360 Massachusetts NHs. PARTICIPANTS: The Massachusetts Senior Care Association and Hebrew SeniorLife rapidly organized a Central Command team, targeted 123 "special focus" facilities with infection control deficiencies for on-site and virtual consultations, and offered all 360 facilities weekly webinars and answers to questions regarding infection control procedures. The facilities were also informed of resources for the acquisition of personal protective equipment (PPE), backup staff, and SARS-CoV-2 testing. MEASUREMENTS: We used two data sources: (1) four state audits of all NHs, and (2) weekly NH reports to the Massachusetts Center for Health Information and Analysis. Primary independent process measures were the checklist scores and adherence to each of its six core competencies. Primary outcomes were the average weekly rates of new infections, hospitalizations, and deaths in residents and staff. We used a hurdle mixed effects model adjusted for county COVID-19 prevalence to estimate relationships between infection control process measures and rates of new infections or deaths. RESULTS: Both resident and staff infection rates started higher in special focus facilities, then rapidly declined to the same low level in both groups. Adherence to infection control processes, especially proper wearing of PPE and cohorting, was significantly associated with declines in weekly infection and mortality rates. CONCLUSION: This statewide effort could serve as a national model for other states to prevent the devastating effects of pandemics such as COVID-19 in frail NH residents.


Subject(s)
COVID-19/prevention & control , Homes for the Aged/organization & administration , Infection Control/methods , Nursing Homes/organization & administration , COVID-19/mortality , COVID-19 Testing , Checklist , Clinical Audit , Education, Continuing , Humans , Longitudinal Studies , Massachusetts/epidemiology , Prevalence , Reimbursement, Incentive
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