Can Financial Incentives Solve Persistent Senior-Health Issues?

By Jane Farrell

A unique, interview-style study has zeroed in on financial and educational issues that need more attention as older adults go from hospital to rehabilitation centers to home – and too often back again.

A team of researchers from Johns Hopkins University found that the participants in the interviews called for better attention in preventing errors in prescribing and taking drugs; better communication among health care providers at hospital, rehab center and home; the elimination of delays in planning discharges; and better patient education.

The study was based on in-depth interviews of 18 physicians and two home health care agency administrators, all of whom are experienced in coordinating care of older adults.

These participants also cautioned that “pay-for-performance” goals and educational interventions need more study to determine their value.

The Affordable Care Act emphasizes the improvement of “care transitions” and has established a financial incentive program to motivate better coordination. But the new Johns Hopkins study indicates that providers aren’t clear about how the incentives will be designed. They’re also concerned that the wrong outcomes or processes will be measured.

“For a pay-for-performance strategy to be successful and improve patient care, health care providers must have a voice in the design process,” says report lead author Alicia I. Arbaje, M.D., M.P.H., director of transitional care research and assistant professor of medicine at Johns Hopkins Bayview Medical Center and the Johns Hopkins University School of Medicine. “Currently, health care providers have concerns about pay for performance that need to be considered.”

The study, “Excellence in Transitional Care of Older Adults and Pay-for-Performance: Perspectives of Health Care Professionals,” was published in The Joint Commission Journal on Quality and Patient Safety.

In their analysis, the Johns Hopkins team says that care transitions remain “common, complicated, costly and potentially hazardous for older adults.” Inadequate transitional care often leads to rehospitalization and complications.

The researchers believe that their study is the first to examine the value of financial incentives from the point of view of front-line health-care professionals.

Arbaje said that training may be needed to help health-care providers “understand their role during transitions. Without this education, it is difficult to design pay-for-performance strategies with an end result of good patient care.”