| P4P Could
Take From Poor, Give To Rich
As popular and vital as P4P is becoming, planned
nationwide implementation of institutional bonuses mandated under
federal health care reform threatens to act as a "reverse Robin Hood"
on hospitals inless affluent regions of the country.
Those hospitals face the possibility of losing
funding
to healthcare facilities in more affluent areas of the country,
according to a study published in the academic journal PLoS Medicine.
Dr. Jan Blustein of the Robert F. Wagner Graduate
School
of Public Service at New York University was the lead author of
"Hospital Performance, the Local Economy, and the Local Workforce."
Blustein and her research team focused on heart
disease
by examining data provided by 2,705 hospitals to the Centers for
Medicare and Medicaid Service (CMS) from 2004 to 2007.
Though P4P assumes that providers have the
resources to
improve performance in a short time frame, "the prevailing distribution
of resources in the U.S. health care system makes it difficult for some
providers to operate effectively as it is," the authors said. "Payment
based on performance may worsen inequalities for hospitals in
under-resourced areas … with the government acting as a sort
of
‘reverse Robin Hood.’"
P4P has been used in the United States in a
piecemeal
fashion. Now, however, the nation is poised to evaluate hospitals in
Medicare’s value-based purchasing (VBP) program, and to
reward
those that improve quality and cut costs. The first wave of evaluation
under this federal mandate is slated to begin in 2012.
Address: PLoS Medicine, Public Library of Science,
1160
Battery Street, Koshland Building, East, Suite 100, San Francisco, CA
94111; (415) 624-1200, www.plosone.org.
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