Pay for Performance Measures

Listed below are the current Pay-For-Performance Measures used by several private and government payers.

Process Payers
  • Heart Failure Care Processes
  • Acute Myocardial Infarction (AMI) Processes
  • Pneumonia Care Processes
  • Surgical Care Infection Prevention
CMS Measures
  • Patient experience with MD communication
  • Patient experience with RN communication
  • Patient experience with responsiveness of staff
  • Patient experience with discharge planning and instruction
H-CAHPS Measures
  • Deploying Rapid response teams
Triggers Program
  • Reducing surgical site infection – colorectal population
  • Reducing surgical site infections – GYN/hysterectomy population
  • Reducing surgical site infections – orthopaedic trauma population
  • Reducing nosicomial catheter related urinary tract infections
  • Preventing central line-associated bloodstream infections
  • Preventing ventilator associated pneumonia
  • Preventing pressure ulcers
  • Reducing MRSA infections
  • Preventing harm from high alert-medications
  • Preventing adverse drug events
  • Reducing surgical complications
  • Board of Directors training on quality and safety
  • Assessment of culturally/linguistically appropriate services
  • Assessment of health disparities

These Pay-for-Performance measures are in fact processes where improvement efforts can be directed. Because they are processes, any improvement effort should focus on: reduction in the variation of economic and clinical outcomes associated with each process. Improvements can be realized by redesigning the process, which requires better communication among medical professionals, their patients, and the patient’s family. Improved processes foster transparency, are economically efficient, and provide clinically consistent, quality patient care.

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