Medicare Incentive Programs Hampered by Flawed Design

Medicare Incentive Programs Hampered by Flawed Design

Rachel Werner to Modern Healthcare Mag: Rewards May Be Too Small

Medicare quality-improvement incentives for nursing homes aren't working because those reward programs aren't structured correctly, said LDI Senior Fellow Rachel Werner in an interview with Modern Healthcare magazine.


LDI Senior Fellow Rachel Werner, MD, PhD, is an Associate Professor of both Medicine at the Perelman School of Medicine and Health Care Management at the Wharton School.

Werner, MD, PhD, is the Associate Chief for Research at Penn's Perelman School of Medicine's Division of General Internal Medicine, and Core Investigator with the Veterans Administration Health Services Research and Development Service (HSR&D) Center for Health Equity Research and Promotion (CHERP). She studies incentive-based health care payment systems.
Lack of improvement
The article by Modern Healthcare New York Bureau Chief Melanie Evans said the latest comparative analysis found that incentivized nursing homes "largely did not improve when compared with nursing homes that did not get incentives."

The piece went on to report that the number of avoidable hospital visits and number of safety violations at incentivized nursing homes "were no better'; that there was no improvement in "removing catheters on time"; and that "patients were just as likely to get bed sores."

Amount of payments
The size of Medicare nursing home incentive payments has been a topic of much debate but most agree that if payments are too low they will not produce nursing home change and if they are too high much of the money may be wasted. Recent Medicare demonstration projects offered incentive amounts between 1 and 2%.

"Nobody knows where the sweet spot is," Werner told the magazine, noting that the country has had  "lots of experience with 2% and it doesn't work."