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Pay-for-Performance and Veteran Care in the VHA and the Community: a Systematic Review

Journal of general internal medicine : JGIM, 2018-07, Vol.33 (7), p.1155-1166 [Peer Reviewed Journal]

Society of General Internal Medicine (This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply) 2018 ;Journal of General Internal Medicine is a copyright of Springer, (2018). All Rights Reserved. ;ISSN: 0884-8734 ;EISSN: 1525-1497 ;DOI: 10.1007/s11606-018-4444-4 ;PMID: 29700789

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Title:
Pay-for-Performance and Veteran Care in the VHA and the Community: a Systematic Review
Author: Kondo, Karli K. ; Wyse, Jessica ; Mendelson, Aaron ; Beard, Gabriella ; Freeman, Michele ; Low, Allison ; Kansagara, Devan
Subjects: Clinical trials ; Community Health Services - economics ; Community Health Services - standards ; Data retrieval ; Delivery of Health Care - economics ; Delivery of Health Care - standards ; Design factors ; Documentation ; Health ; Health care ; Humans ; Internal Medicine ; Maintenance ; Medicine ; Medicine & Public Health ; Pay for performance ; Performance measurement ; Quality assessment ; Reimbursement, Incentive - economics ; Reimbursement, Incentive - standards ; Review Paper ; Systematic review ; United States - epidemiology ; United States Department of Veterans Affairs - economics ; United States Department of Veterans Affairs - standards ; Veterans
Is Part Of: Journal of general internal medicine : JGIM, 2018-07, Vol.33 (7), p.1155-1166
Description: Background Although pay-for-performance (P4P) strategies have been used by the Veterans Health Administration (VHA) for over a decade, the long-term benefits of P4P are unclear. The use of P4P is further complicated by the increased use of non-VHA healthcare providers as part of the Veterans Choice Program. We conducted a systematic review and key informant interviews to better understand the effectiveness and potential unintended consequences of P4P, as well as the implementation factors and design features important in both VHA and non-VHA/community settings. Methods We searched PubMed, PsycINFO, and CINAHL through March 2017 and reviewed reference lists. We included trials and observational studies of P4P targeting Veteran health. Two investigators abstracted data and assessed study quality. We interviewed VHA stakeholders to gain further insight. Results The literature search yielded 1031 titles and abstracts, of which 30 studies met pre-specified inclusion criteria. Twenty-five examined P4P in VHA settings and 5 in community settings. There was no strong evidence supporting the effectiveness of P4P in VHA settings. Interviews with 17 key informants were consistent with studies that identified the potential for overtreatment associated with performance metrics in the VHA. Key informants’ views on P4P in community settings included the need to develop relationships with providers and health systems with records of strong performance, to improve coordination by targeting documentation and data sharing processes, and to troubleshoot the limited impact of P4P among practices where Veterans make up a small fraction of the patient population. Discussion The evidence to support the effectiveness of P4P on Veteran health is limited. Key informants recognize the potential for unintended consequences, such as overtreatment in VHA settings, and suggest that implementation of P4P in the community focus on relationship building and target areas such as documentation and coordination of care.
Publisher: New York: Springer US
Language: English
Identifier: ISSN: 0884-8734
EISSN: 1525-1497
DOI: 10.1007/s11606-018-4444-4
PMID: 29700789
Source: GFMER Free Medical Journals
MEDLINE
PubMed Central
ProQuest Central

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Pay-for-Performance and Veteran Care in the VHA and the Community: a Systematic Review

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