An Evaluation of Performance Thresholds in Nursing Home Pay-for-Performance.

Publisher: Blackwell Country of Publication: United States NLM ID: 0053006 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1475-6773 (Electronic) Linking ISSN: 00179124 NLM ISO Abbreviation: Health Serv Res Subsets: MEDLINE

Publication: Malden, MA : Blackwell
Original Publication: Chicago, Hospital Research and Educational Trust.

Quality Indicators, Health Care*; Nursing Homes/*statistics & numerical data ; Reimbursement, Incentive/*statistics & numerical data; Certification ; Humans ; Medicaid ; United States

Objective: Performance thresholds are commonly used in pay-for-performance (P4P) incentives, where providers receive a bonus payment for achieving a prespecified target threshold but may produce discontinuous incentives, with providers just below the threshold having the strongest incentive to improve and providers either far below or above the threshold having little incentive. We investigate the effect of performance thresholds on provider response in the setting of nursing home P4P.
Data Sources: The Minimum Data Set (MDS) and Online Survey, Certification, and Reporting (OSCAR) datasets.
Study Setting and Design: Difference-in-differences design to test for changes in nursing home performance in three states that implemented threshold-based P4P (Colorado, Georgia, and Oklahoma) versus three comparator states (Arizona, Tennessee, and Arkansas) between 2006 and 2009.
Principal Findings: We find that those farthest below the threshold (i.e., the worst-performing nursing homes) had the largest improvements under threshold-based P4P while those farthest above the threshold worsened. This effect did not vary with the percentage of Medicaid residents in a nursing home.
Conclusions: Threshold-based P4P may provide perverse incentives for nursing homes above the performance threshold, but we do not find evidence to support concerns about the effects of performance thresholds on low-performing nursing homes.
(© Health Research and Educational Trust.)

Health Econ. 2011 Jul;20(7):783-801. (PMID: 20578255)
J Am Geriatr Soc. 1997 Aug;45(8):1002-10. (PMID: 9256855)
JAMA. 2005 Oct 12;294(14):1788-93. (PMID: 16219882)
Health Serv Res. 2005 Oct;40(5 Pt 1):1318-34. (PMID: 16174136)
Psychiatr Serv. 1998 Feb;49(2):229-33. (PMID: 9575011)
Med Care Res Rev. 2008 Aug;65(4):514-27. (PMID: 18369236)
Health Serv Res. 2013 Aug;48(4):1393-414. (PMID: 23398330)
JAMA. 1994 Feb 2;271(5):358-62. (PMID: 8283585)
J Long Term Care Adm. 1996 Summer;24(2):11-6. (PMID: 10162433)
Rand J Econ. 2010 Spring;41(1):64-91. (PMID: 21667575)
J Am Geriatr Soc. 1997 Aug;45(8):994-1001. (PMID: 9256854)
J Gerontol A Biol Sci Med Sci. 1999 Nov;54(11):M546-53. (PMID: 10619316)
J Gerontol. 1994 Jul;49(4):M174-82. (PMID: 8014392)
Med Care Res Rev. 2010 Jun;67(3):364-77. (PMID: 19923629)
Annu Rev Public Health. 1993;14:545-84. (PMID: 8323602)
Gerontologist. 2007 Feb;47(1):108-15. (PMID: 17327546)

K24 AG047908 United States AG NIA NIH HHS; R01 AG034182 United States AG NIA NIH HHS

Keywords: Performance-based thresholds*; long-term care*; nursing home quality*; pay-for-performance*; quality of care*

Date Created: 20160303 Date Completed: 20170516 Latest Revision: 20220310

20231215

PMC5134156

10.1111/1475-6773.12467

26932527