Skip to main content

Home/ CUPE Health Care/ Group items tagged p4p

Rss Feed Group items tagged

Filter: All | Bookmarks | Topics Simple Middle
Irene Jansen

Private health contractor's staff told to cut 999 calls to meet targets | Society | The... - 0 views

www.guardian.co.uk/...te-health-contractor-999-calls

NHS it ems primary care privatization serco quality staffing p4p

shared by Irene Jansen on 28 Jan 13 - No Cached
  • Call handlers staffing an out-of-hours GP service run by the private contractor Serco have been told to make new checks before calling 999 when they receive what appear to be emergency cases in order to cut down the number of referrals they make to the ambulance service.
  • a management email to staff describing how they should manipulate their computer system in order to meet targets set down in the company's contract on 999 responses.
  • replace skilled clinicians with call-handlers without medical training who follow a computer-generated script to assess patients. The move triggered a fourfold increase in ambulance call-outs.
  • ...3 more annotations...
  • Staff have expressed concern that this might delay an ambulance in a real emergency and that the new system is not sophisticated enough to distinguish between urgent and less serious cases.
  • The Guardian revealed last year that whistleblowers believed the company was putting patients at risk and falsifying data.
  • too few staff to operate safely
Irene Jansen

Bonuses for docs do little to improve diabetes care - 0 views

mobile.reuters.com/...idUSBRE83P14D20120426

p4p canada us

shared by Irene Jansen on 01 May 12 - No Cached
  • Small financial incentives aimed at getting physicians to make sure their diabetic patients receive recommended routine exams may not lead to changes in doctors' behavior, according to a new study
  • pay-for-performance arrangements
  • offer money to physicians who achieve certain goals that are known to improve patients' health, reduce errors or save money
  • ...6 more annotations...
  • Dr. Tara Kiran, the lead author of the study from St. Michael's Hospital and the University of Toronto.
  • "Rates of recommended testing increased gradually from 2006 to 2008, but it was not really associated with the incentive code,"
  • Her results showed that the number of people who met the guidelines for all routine exams rose from 16 percent in 2000 to 27 percent in 2008, but the annual increase after the incentive became available was similar to what it was before doctors could earn the bonus.
  • Pay-for-performance programs have not shown much success in other settings, either.For example, an incentive program involving 252 hospitals in the United States had no impact on patients' health (see Reuters report of March 28, 2012).
  • Shifting doctors' offices to a "medical home," which attempts to be more comprehensive and accessible in providing care for patients, seems to make a bigger difference
  • "We're nibbling around the edges with these kinds of small incentive payments when it comes to improving primary care delivery," he said. "We're not addressing the issue of: how do we redesign the way we provide primary care?"
Irene Jansen

Baseball Forbids Pay for Performance - A Lesson for Healthcare? | Open Medicine - 0 views

blog.openmedicine.ca/333

shared by Irene Jansen on 15 May 12 - No Cached
  • Baseball pays huge attention to statistical performance indicators, but shies away from target-based payment. Health care basically ignores tonnes of statistical evidence but many are rushing headlong towards target-based payment.
  • health care and health are way too complex to make it work as well as it might in baseball. The link between what providers do and patient outcomes is not nearly so linear and immediately tangible as the relationship between a team’s on-base-plus-slugging average and the number of runs scored. Moreover, you can’t pay for performance unless the indicators are unambiguous and simple to measure. It’s easy to measure whether you’ve done Pap tests or ordered mammograms. It’s hard to measure whether you’ve helped a frail elderly person with four chronic conditions avoid complications over a ten-year period. That’s why P4P typically pays for the former and has no clue about how to reward the latter.
  • The result? Health care frequently pays extra for achieving targets that require no special skill or effort, and have little impact on the health of really sick patients.
Irene Jansen

British Columbia - The Globe and Mail - 0 views

m.theglobeandmail.com/...article2328994

pbf p4p bc

shared by Irene Jansen on 07 Feb 12 - No Cached
  • B.C. health authorities were hit with nearly $7-million in penalties by the provincial government last year for failing to meet waiting-time targets for hip, knee and cataract surgery.
  • The money, in the form of withheld payments, went to general revenue
  • “It’s a significant amount of money, and it’s been quite successful at getting people to pay attention to wait lists,” said Les Vertesi, head of B.C.’s Health Services Purchasing Organization, the patient-focused funding arm of the government, which has taken over responsibility for meting out non-performance sanctions.
  • ...4 more annotations...
  • For health authorities to avoid a financial penalty, 90 per cent of their hip patients must be treated within 26 weeks, 90 per cent of knee patients within 26 weeks, and 90 per cent of cataract patients within 16 weeks.
  • there is a drawback to the way the penalties are applied, Dr. Vertesi said
  • They are all or nothing, he said, meaning a health authority that falls only a few patients short of the targets is liable to be subject to the full holdback.
  • “It’s not that there shouldn’t be any consequences, but they are a very blunt tool. If you’re not careful and use them in the wrong way, you may get results you don’t want.” Published on Monday, Feb. 06, 2012 10:46PM EST
Irene Jansen

Glazier et al. All the Right Intentions but Few of the Desired Results: Lessons on Acce... - 2 views

www.longwoods.com/...23041

ontario primary care doctors capitation payment methods chc p4p excellent

shared by Irene Jansen on 19 Sep 12 - No Cached
  • The common elements of reform include organizing physicians into groups with shared responsibilities, inter-professional teams, electronic health records, changes to physician reimbursement, incentive and bonus payments for certain services, after-hours coverage requirements, and telehealth and teletriage services.
  • Ontario's initiatives have been substantially different from those of other provinces in the scope, size of investment and structural changes that have been implemented.
  • These models have the same requirements for evening and weekend clinics, and for their physicians to be on call to an after-hours, nurse-led teletriage service.
  • ...10 more annotations...
  • Despite this increased attachment, the chance of being seen in a timely way did not improve. Ontario's primary care models require evening and weekend clinics and on-call duties, and penalize practices for out-of-group primary care visits; therefore, these findings are unexpected. While many factors are likely involved, Ontario's auditor general noted two major faults: not establishing mechanisms for ongoing monitoring and evaluation, and not enforcing practices' contractual obligations, especially for after-hours care
  • The access bonus is reduced by outside primary care use but not by emergency department visits. Physicians responding rationally to such a financial incentive would logically direct their patients away from walk-in clinics and toward emergency departments. The access bonus also strongly discourages healthcare groups from working together to provide late evening and night coverage because all parties would lose financially. An incentive that costs more than $50 million annually should be structured to align better with health system needs.
  • A recent systematic review found insufficient evidence to support or not support the use of financial incentives to improve the quality of care (Scott et al. 2011).
  • In Ontario, there was little relationship between incentive payments and changes in diabetes care (Kiran et al. 2012), nor were there substantial improvements in most aspects of preventive care despite substantial incentives (Hurley et al. 2011). Similar cautionary tales about pay-for-performance can be found elsewhere in the health system (Jha et al. 2012).
  • Ontario adjusts capitation for only age and sex, whereas most other jurisdictions further adjust for expected healthcare needs, patient complexity and/or socioeconomic disparities (e.g., the Johns Hopkins Adjusted Clinical Groups http://www.acg.jhsph.org/). That may be why Ontario's primary care capitation models have attracted healthier and wealthier practices (Glazier et al. 2012).
  • Community health centres care for disadvantaged populations with superior outcomes (Glazier et al. 2012; Russell et al. 2009) and could play a larger role in Ontario's health system.
  • Unlike some other jurisdictions (National Health Service Information Centre for Health and Social Care 2012), Ontario has no routine measurement of primary care at the practice, group or community levels. It has no organized structures, such as the Divisions of General Practice in Australia (Australian Department of Health and Ageing 2012) or the Divisions of Family Practice in British Columbia (2010), that can help practices come together to improve care. It has also failed to hold practices accountable for their contractual obligations, including after-hours clinics.
  • Ontario's reforms occurred in the absence of routine measurement of primary care within practices, groups or communities and with limited accountability for how funds were spent.
  • Access to primary care has proven to be challenging in Canada, leaving it behind many developed countries in timely access and after-hours care, and more dependent than most on the use of emergency departments (Schoen et al. 2007).
  • A strong primary care system is consistently associated with better and more equitable health outcomes, higher patient satisfaction and lower costs (Starfield et al. 2005).
1 - 5 of 5
Showing 20▼ items per page