title: Rewarding excellence and efficiency in Medicare payments.
abstract: Medicare could become an innovative leader in using financial incentives to reward health care providers for providing excellent and efficient care throughout a patient's illness. This article examines the variations in cost and quality in the provision of episodes of care and describes how a pay-for-performance payment system could be designed to narrow those variations and serve as a transition to a new Medicare payment policy that would align physicians' incentives with improvements in both quality and efficiency. In particular, Medicare could stimulate greater efficiency by developing new payment methods that are neither pure fee-for-service nor pure capitation, beginning with a pay-for-performance payment system that rewards quality and efficiency and moving to a blended fee-for-service and case-rate system.
authors: The Commonwealth Fund, New York, New York 10021, USA. dk@cmwf.org
authors: Karen
authors: K
authors: Davis
authors: Stuart
authors: S
authors: Guterman
mesh_terms: D017598:Efficiency, Organizational; D006801:Humans; D006278:Medicare / Q000191:economics*; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D012052:Reimbursement, Incentive / Q000458:organization & administration*; D014481:United States
references: N Engl J Med. 2006 Nov 2;355(18):1895-902
references: 17079763
references: N Engl J Med. 2006 Nov 2;355(18):1845-7
references: 17079757
references: Health Aff (Millwood). 2006 Nov-Dec;25(6):w457-75
references: 16987933
references: Health Aff (Millwood). 2007 Jan-Feb;26(1):142-53
references: 17211023
references: N Engl J Med. 2007 Feb 1;356(5):486-96
references: 17259444
references: N Engl J Med. 2007 Feb 1;356(5):515-7
references: 17259445
references: N Engl J Med. 2007 Mar 15;356(11):1166-8
references: 17360996
references: Health Aff (Millwood). 2003 Nov-Dec;22(6):8-10
references: 14649428
references: Harv Bus Rev. 2004 Jun;82(6):64-76, 136
references: 15202288
references: Health Care Financ Rev. 2004 Summer;25(4):119-41
references: 15493448
references: Health Care Financ Rev. 1986;(Spec No):45-55
references: 10311926
references: Health Aff (Millwood). 2004;Suppl Variation:VAR19-32
references: 15471777
references: Inquiry. 2004-2005 Winter;41(4):376-90
references: 15835597
references: Health Aff (Millwood). 2006 Mar-Apr;25(2):w34-47
references: 16464904
references: Med Care Res Rev. 2006 Feb;63(1 Suppl):29S-48S
references: 16688923
references: N Engl J Med. 2006 Sep 28;355(13):e14
references: 16990378
references: Ann Intern Med. 2006 Nov 7;145(9):695-9
references: 17088584