Obstetrics/Gynecology

Summary by Website Contributor Rachel Thompson

 

Pay for performance is an emerging presence in the field of Obstetrics and Gynecology in the United States that is not yet widely researched or implemented. The attitude surrounding P4P in the literature shows that professional organizations within the field are encouraging their members to educate themselves surrounding possible new value-based payment models. The American College of Obstetrics and Gynecology is urging OB-GYNs to be actively involved in the shift to P4P occurring nationwide (476). The Society of Gynecologic Oncology has created a task force to define quality metrics within the field in order to align these with national metrics (480). Their members are also being encouraged to become aware of new changes to payment models for their field. A survey of practicing urogynecologists showed that knowledge of P4P in the field is currently limited and that the attitudes and knowledge of physicians will impact the success of P4P programs in the subspecialty (478).  In other countries, P4P metrics have been implemented within the field of Ob/Gyn (477, 479, 481). A study in South Korea showed that P4P metrics have improved quality of care in Ob/gyn particularly when there are well-defined P4P metrics in place (477).

Obstetrics/Gynecology Literature

(181) Erekson EA, Sung VW, Myers DL. Pay for Performance: what the urogynecologist should know. Journal of Internal Urogynecology. 2008: 19, 1039-1041.

PMID: 18629563

Summary:

  • As a subspecialty, urogynecology must prepare for P4P.
  • Outlines current outcome measurement schemes that might be used to measure quality performance and P4P reimbursement in urogynecology.
  • Offers advice for developing P4P measures, and some possible challenges the subspecialty faces with implementation.

Significance to Literature:

Subspecialties need to begin preparing for P4P.

 

 

(430) Hale DS. Pay for Performance - Are You Prepared? Female Pelvic Med Reconstr Surg. 2016 May-Jun;22(3):123-5. doi: 10.1097/SPV.0000000000000234.

PMID: 26825402

Summary:

  • Quality summary of the history of quality reporting and incentive-based reimbursement from its initiation with the Tax Relief and Health Care Act of 2006 to what lies ahead with the signing of MACRA in 2015
  • Author expresses concern that while policy makers understand the changes implemented by the Physician Quality Reporting System (PQRS) and now MACRA, clinicians do not
    • A 2013 poll of American Urogynecologic Society (AUGS) members showed that only 20% knew what PQRS was; which is troubling because penalties for data collection went into effect in the same year
  • Acceptable outcome measures are not available for many specialties, including urogynecology, and measure development cannot be acquired at the speed CMS has been demanding
  • Two studies in the same journal issue focused on the practice patterns of highly successful urogynecologic surgeons represent the response to National Quality Forum (NQF) for more data to support new quality measures

Significance to Literature:

Subspecialty physicians need to be actively engaged in quality measure development and APMs instead of ignoring the policy changes, letting others dictate policy and pay.

 

 

(476) George KE. Value-Based Payments in Obstetrics and Gynecology. ACOG Committee Opinion No. 477. 2018.

PMID: 30045210

Summary:

  • As healthcare payment systems are shifting, it is important for ob-gyns to understand how value-based payments will impact their practice and their patients.
  • Value based payments in ob-gyn must account for the scope of the practice so that providers are compensated for both primary care services and specialty services.
  • As advocates for women’s health, ob-gyns should ensure that new metrics maintain quality care, particularly for our most vulnerable patients.

Significance to Literature:

The American College of Obstetricians and Gynecologists is urging ob-gyns to be actively involved in the shift in payment and delivery systems that is occurring nationwide.

 

 

(477) Ju Kim S, Han K T, Kim SJ, Park EC. Pay-for-performance reduces healthcare spending and improves quality of care: Analysis of target and non-target obstetrics and gynecology surgeries. International Journal for Quality in Health Care, 2017: 29(2), 222-227.

PMID: 28407094

Summary:

  • Pre and post-operative OB antibiotic use metrics were studied in 535,289 hospitalizations across 506 Korean hospitals to assess the effectiveness of the Value Incentive Program (Korea’s national P4P program).
  • Decreased length of stay, decreased readmission rate, and increased quality of treatment were found at hospitals with better condition-specific performance on metrics such as antibiotic use.
  • Institutions with publicly higher quality grades were incentivized to continue developing specific quality measures of their own. A spill-over effect was seen with high performing hospitals extending antibiotic metrics to other surgery types.

Significance to Literature:

Performance on well-defined, specific P4P metrics within hospital systems are linked to improvements in broader quality of care categories.

 

 

(478) Erekson, EA, Sung VW, & Clark MA. Pay-for-performance: a survey of specialty providers in urogynecology. The Journal of reproductive medicine, 2011: 56, 3.

PMID: 21366120

Summary:

  • A survey of 212 practicing urogynecologists showed that a minority of participant had significant understanding (9%) or some understanding (23%) of P4P and that 76% felt that there is not enough data currently available to create appropriate performance measures.
  • 50.9% of physicians felt that P4P would increase healthcare costs for patients.
  • 86.4% of written comments (27.8% of all participants) were negative, with physicians expressing concern about insurance company motivations, unaccounted co-morbidities skewing performance results, and penalties for high risk patients.

Significance to Literature:

The attitude and knowledge of Urogynecologists about P4P will impact the success of P4P programs in this subspecialty.

 

 

(479) Das A, Gopalan SS, Chandramohan D. Effect of pay for performance to improve quality of maternal and child care in low-and middle-income countries: a systematic review. BMC Public Health, 2016: 16(1), 321.

PMID: 27074711

Summary:

  • P4P improved antenatal processes and had a weak effect on outcome measures for maternal and neonatal patients in low- and middle-income countries (review of literature from Rwanda, Egypt, Democratic Republic of Congo, the Philippines, Burundi).
  • P4P was not shown to improve structural quality, customer satisfaction, or out of pocket expenses.
  • Institutional quality and support for physicians is critical for P4P programs to yield improved maternal outcomes.

Significance to Literature:

P4P incentives for both physicians and their institutions could improve prenatal and antenatal outcomes by improving physicians’ abilities to achieve metrics.

 

 

(480) Cohn DE, Ko E, Meyer LA, Wright JD, Temkin SM, Foote J, Havrilesky LJ. The “value” of value in gynecologic oncology practice in the United States: Society of Gynecologic Oncology evidence-based review and recommendations. Gynecologic oncology, 2017: 145(1), 185-191.

PMID: 28258763

Summary:

  • It is important to define the value of care prior to establishing value-based metrics for physician performance.
  • The Society of Gynecologic Oncology has created a Quality and Outcomes Taskforce to define quality metrics and to ensure the alignment of these with national metrics.

Significance to Literature:

The Society of Gynecologic Oncology is encouraging its members to be aware of new changes to value-based payment models and the ongoing development of field-specific appropriate metrics.

 

 

(481) Chimhutu V, Lindkvist I, Lange S. When incentives work too well: locally implemented pay for performance (P4P) and adverse sanctions towards home birth in Tanzania-a qualitative study. BMC health services research, 2014: 14(1), 23.

PMID: 24438556

Summary:

  • 28 interviews of healthcare workers in Tanzania were interviewed to determine the effectiveness of P4P measures that have been implemented at their local level without significant aid from the national government.
  • The interviewees reported that pregnant women were threatened with fines and loss of healthcare access if they had home births because this would decrease the P4P reimbursement for the hospitals.
  • P4P increased the quantity of in-hospital deliveries but not the quality of obstetric care that was provided.

Significance to Literature:

The incentives of P4P can unintentionally or intentionally result in coercion of patients into compliance if the reimbursements are highly valued.