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Home / News & IndustryManaged Care Insight and Analysis
Updated: March 8, 2011
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,

  This article was taken from:
Pay-for-Performance Reporter

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