title: A hospital payment system with incentives for improvement in quality of care: first lessons.
abstract: A demonstration program of five member hospitals of the Rochester Area Hospitals Corporation in Rochester, New York, is introducing two major changes into traditional quality assurance programs in hospitals: (1) a shift of focus from structure and process to outcomes and (2) replacement of punitive approaches with a positive, reward-oriented approach. Relying on the MedisGroups information system to measure outcomes and on statistical techniques to identify variations in hospitals' performance, the demonstration offers financial awards in the form of a payment adjustment incorporated into the hospital reimbursement system, based on each hospital's outcomes compared to both an external and a local standard. The authors report the first experiences with the demonstration and the prospects for continuous improvement of quality of care.
authors.affiliation: Rochester Area Hopitals Corporation, New York.
authors.forename: S E
authors.initials: SE
authors.lastname: Hartman
authors.forename: D B
authors.initials: DB
authors.lastname: Mukamel
authors.forename: R J
authors.initials: RJ
authors.lastname: Panzer
mesh_terms: D016206:Databases, Bibliographic; D004059:Diffusion of Innovation; D006764:Hospitals, Community / Q000191:economics*; D006801:Humans; D007373:Interinstitutional Relations; D009042:Motivation; D009518:New York; D010043:Outcome and Process Assessment, Health Care; D010865:Pilot Projects; D011367:Professional Staff Committees; D011785:Quality Assurance, Health Care / Q000191:economics*; D012051:Reimbursement Mechanisms; D012456:Salaries and Fringe Benefits