This ICR is
approved on the understanding that AHRQ will explicitly acknowledge
study limitations, including but not limited to: (1) the fact that
patient perspectives were not elicited, (2) this study employs a
case-study methodology with no "control" comparison group and is
therefore limited in the extent to which it can detect the
influence of these incentive programs as opposed to, say, quality
improvement efforts in general (e.g. widely publicized clinical
practice recommendations), (3) selection bias and the use of a
purposive sample, (4) the potential confounding effects of health
plans on physician/practice performance and the inability of this
study to assess physician management that may happen at the health
plan level as opposed to the group plan level. To increase the
utility of these study results, AHRQ also agrees to make the
following changes to the semi-structured interviews: (5) Because
the analysis of unrewarded but important clinical activities is an
important dimension to assess in this study, questions that
explicitly ask about these will be included in the semi-structured
interview script and will be derived from the literature and
commonly-used quality measures (e.g. HEDIS, NCQA, guidelines issued
from professional groups, etc.). In advance of the interview, AHRQ
will develop a list of clinical activities that are important but
not rewarded and ask why they were not picked as part of the
incentives program; (6) AHRQ will add more detail about how they
will probe the structure and evolution of these incentive programs
with regard to why Montefiore decided to stratify incentives based
on physician performance and patient compliance as this question
could yield information that would be of interest to health
economists and has not been asked in previous studies of financial
incentives; (7) AHRQ will include a question in the semi-structured
interview scripts to inquire about any decisions to exclude certain
practices/clinics or individual physicians from incentive programs
and why those decisions were made; (8) As a follow-up question to
the first question in section V of the semi-structured interview,
AHRQ will ask practices that have chosen not to participate in the
financial incentive program why they made that decision. With
regard to the analysis of clinical data, AHRQ agrees to (9) analyze
data on patient caseload and caseload shifting and (10) AHRQ will
also measure provider performance on the aforementioned important
but unrewarded clinical activities to the extent possible: to the
extent that data are not collected on these measures, this will be
acknowledged as a study limitation. Further, (11) because of the
study limitations and case study approach employed in this study,
AHRQ will explicitly acknowledge in public reports that the point
estimates discovered in these two particular incentive programs
cannot be generalized to the universe of safety-net settings.
Generalizations will be limited to the value of the conceptual
framework. (12) When asking about the racial/ethnic composition of
the patient population in the semi-structured interviews, the OMB
race/ethnicity standards will be used. (13) And when the study has
been completed, AHRQ agrees to share survey response rates with
OMB.
Inventory as of this Action
Requested
Previously Approved
06/30/2010
36 Months From Approved
240
0
0
114
0
0
0
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The pay-for-quality (P4Q) Evaluation
is a multi-method research project designed to evaluate the
implementation and impact of P4Q programs on physicians across
three programs operating in health care safety net settings. The
P4Q programs participating in the evaluation are offering their
healthcare providers financial incentives to achieve predefined
quality targets. Data collected as part of this evaluation will
have direct operational relevance to payers and providers regarding
the value and challenges of P4Q programs in safety net settings.
The P4Q evaluation is designed to assess whether P4Q programs in
such settings improve quality on the measures that are the focus of
the programs and also whetherthe programs lead to unintended
consequences. The P4Q evaluation will also seek to identify design
and implementation practices that are likely to increase as well as
decrease the risks of negative outcomes resulting from the
implementation of P4Q programs in safety net settings.
On behalf of this Federal agency, I certify that
the collection of information encompassed by this request complies
with 5 CFR 1320.9 and the related provisions of 5 CFR
1320.8(b)(3).
The following is a summary of the topics, regarding
the proposed collection of information, that the certification
covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a
benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control
number;
If you are unable to certify compliance with any of
these provisions, identify the item by leaving the box unchecked
and explain the reason in the Supporting Statement.
Supporting Statement Revised.doc
ACC Public Comment.pdf
Evaluation of the Implementation and Impact of Pay-for-Quality Programs