Understanding the impact of pay for performance on safety net facilities

The combined forces of high cost and limited quality in health care have resulted in a search for strategies to generate greater value in the health care system. One proposal generating interest is pay-for-performance (P4P) and at this point a variety of programs are running. However the early results are mixed and there is some evidence that these programs may disproportionately impact safety net hospitals. This project seeks to more clearly define unintended consequences of the P4P movement as it relates to safety net hospitals and the vulnerable populations they serve. The objectives of this project are two-fold. First, to clarify barriers to desired performance on selected process metrics tracked by the Hospital Compare system and second to assess the impact of P4P programs on some key disease entities of critical importance, but which currently are not an area of focus in P4P programs. Study sites include the emergency departments of two academic, urban, tertiary medical centers -- Grady Memorial Hospital and Emory University Hospital. These facilities exist in the same city and have the same ED physician pool serving both facilities. However, the EDs have disparate economic and ethnic populations. Grady Memorial Hospital serves a largely poor, minority, and uninsured population while Emory University Hospital has a broader payer mix. To achieve the goals of this project a combination of chart review, matched controls, process mapping, and time sensitive modeling of patient flow through the ED based upon chief complaint will be used. If P4P programs are to have broad success it is important to have an in-depth understanding of the success as well as the failure of such programs for certain vulnerable populations. The key product coming from this project will be a clearer definition of where these programs may create problems for these populations such that strategies may be developed to ensure the success of the facilities serving these patients and the physicians functioning within them.

Grant Details

Amount Awarded $196,918.00

Awarded on: 11/18/2008

Time frame: 12/1/2008 - 8/31/2011

Grant Number: 65456


Emory University, School of Medicine

1648 Pierce Drive
Atlanta, 30322-0001


Leon L. Haley
Project Director


Robin R. Hemphill
Project Director


Debra E. Houry
Project Director