Relationship of pay-for-performance and provider pay.

BACKGROUND: Policymakers and health care leaders search for a payment model to balance the interests of providers, patients, and payers. This has shifted reimbursement from a fee-for-service (FFS) to pay-for-performance (P4P) model. The FFS model of reimbursement may lead to provider overuse. The P4P model incentivizes quality, not quantity, of care. However, the payer's reimbursement shift to P4P has not affected compensation of individual providers. OBJECTIVES: To explore the effects of payment compensation models on provider behavior and employment. DATA SOURCES: CINAHL, Cochrane, and EBSCO databases were searched. To ensure accuracy, a PRISMA flow diagram was used. A thematic analysis was performed using 52 articles. CONCLUSIONS: Four themes emerged: health care as an economic anomaly, the ability to incentivize value, ethics, and provider-employer-payer alignment. Basic economic principles are distorted in health care because of payment layers and competing goals. Although payment structure affects health care provider (HCP) performance, the correlation is not understood. There is a lack of knowledge on several key areas: 1) HCP behavioral research, 2) how employment may be influencing existing HCP attitudes and actions, 3) how nurse practitioners (NPs) differ from physicians, and 4) P4P outcome data. There is also a lack of literature involving NP's and reimbursement. IMPLICATIONS FOR PRACTICE: Nurse practitioners must be included in compensation model research. Payment reform should address all individual HCP compensation. Reforms will be limited if focus remains on payer-organization reform and ignores HCP compensation. As HCPs, it is imperative to understand how payers reimburse services to establish guiding principles for equitable and ethical compensation negotiations.

Development of an Interprofessional Home Healthcare Management Service: Within an Urban Housing Development.

In response to the need for increased access to primary care services for a low-income, at-risk community, two local universities partnered with a nonprofit Housing and Urban Development affiliated provider of affordable housing to launch a primary care clinic within an urban public housing community. Although the establishment of this clinic represented progress in meeting many healthcare needs of the target population, an interprofessional team also identified a need for the initiation of a new home-based service line. The goal of this project was to establish an innovative, sustainable, and cost-effective healthcare delivery method that would improve the health of this population. The project focused on a literature review, needs-assessment, and development of a comprehensive medical home visit program to serve the homebound, frail elderly, and other at-risk adults with complex medical conditions who reside in this community. The medical needs of potential recipients were assessed by conducting interviews with key support staff including a health service coordinator, health advocates, and housing provider service coordinators. Residents were also interviewed using a newly developed health perception and information survey. The data derived from the needs-assessment and pertinent literature were used to draft an initial program guideline. Because the needs-assessment indicated this population would not derive maximum benefit from a traditional house calls program, the project team developed a Home Healthcare Management service with an expanded scope to provide enhanced care coordination, house visits (medical and nonmedical), and community outreach.