Discussion
The desire to transform the United States healthcare system from one that promotes higher volumes of care at higher costs to one that promotes high-quality care at reduced costs led to the idea of pay for performance and public-reporting quality initiatives. (Calikoglu 2012) Studies have shown patient benefits resulting from pay for performance initiatives to be varied, and one of the key determinants in that variation is the healthcare setting itself. Another key determinant is the design of the pay for performance incentive, such as what aspect of performance is awarded, as well as the size of the reward. Studies have also shown that public reporting initiatives, or requiring hospitals and physicians to provide data on their own performance, have been effective in reducing preventable injuries in the hospital setting. (Leake 2010) There are two types of pay-for-performance initiatives that have been implemented in recent years: processed-based performance measures and outcome-based performance measures. Processed-based performance measures indicate whether protocols were followed in specific situations. For instance, whether or not patients with acute myocardial infarction received aspirin upon arrival to the emergency department is a process-based measure. Outcome-based performance, however, is measured based on patient outcomes, mortality rates, for example. Studies have shown that patients gain the most value from pay-for-performance initiatives in the hospital setting. The two main studies corroborating this claim are Maryland’s Quality-Based Reimbursement Program (QBRP) and the Center for Medicaid and Medicare Services’ study entitled High Quality Incentive Demonstration (HQID). In 2008, Maryland launched its QBRP, which provided financial incentives (both rewards and penalties) to Maryland hospitals in an attempt to encourage improvements in