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.
table that charts list comparision
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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0
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