|Coming Soon To The Nursing Profession: P4P
You think P4P programs are working well now, just wait
until the nurses jump in. That’s the message from Diane Scott,
RN, and author of "Pay-for-Performance: A Nursing Perspective,"
appearing in Nurses First, a publication of the Center for American
Currently, the nursing role in P4P is in its infancy and not totally defined.
That’s because the current P4P system
doesn’t take into account the skills nurses bring to the table as
those skills are difficult to measure, said Dr. Jack Needleman, an
associate professor in the UCLA School of Public Health.
The Centers for Medicare and Medicaid Services (CMS) did not design P4P performance standards specifically with nursing in mind.
Linda Aiken, an RN at the Center for Health Outcomes and
Policy Research, University of Pennsylvania, said there is growing
evidence about the contributions that nurses could make in P4P
initiatives, yet most managers are not familiar with the available
Nurses are not a focus of current initiatives and there
are a few examples of specific incentives that reward nurses for higher
productivity and quality or cost savings, she added.
According to the Agency for Healthcare Research and
Quality (AHRQ), as healthcare providers rapidly implement P4P programs
designed for meeting pre-established quality targets, they are now
examining how nursing could contribute to their programs’
In May 2006 a briefing sponsored by the Alliance for
Health Reform and Robert Wood Johnson Foundation set out to define the
role of nursing as it contributes to quality and high performance.
The National Quality Forum (NQF) did likewise. In an
attempt to create a set of nursing standards for use in inpatient
hospital settings, it developed the "Consensus Standards for
This project endorsed a set of 15 nursing-sensitive
consensus standards to enhance the "evidence and understanding of the
relationship between nursing-related system characteristics and patient
care processes and outcomes."
"Succinctly measuring and defining nursing care
performance and quality will be instrumental in rewarding quality
within any pay-for-performance initiatives," Scott wrote.
Address: Center for American Nurses, 8515 Georgia Ave., Suite 400, Silver Spring, MD 20910-3492; (301) 628-5243, http://centerforamericannurses.org.