1. Payment Reform/Medicare Reform/Cost Containment Group V

2. Problem Statement A pay-for-performance program should be implemented to improve the quality of transitions between hospitals and other care settings for the elderly

3. Problem Statement Lack of continuity –Multiple providers across settings –Information transfer incomplete or inadequate –Implementation of a consistent care plan Patient preferences often not observed Perverse payment incentives

4. Rationale Quality indicators for the elderly exist that have been shown to improve outcomes Pay-for-performance can be designed to reward information transfer, reduce hospitalizations, and improve patient satisfaction

5. Proposed Policy Change Develop expanded set of quality indicators to monitor the transition of care Phases of implementation: 1.Develop common reporting mechanism for all providers 2.Pay for participation for reporting indicators 3.Pay for performance for high performers

6. Stakeholders Consumer advocates: AARP Payors: Medicare/Medicaid/Private insurers Representatives of provider settings: –Hospital Organizations –Nursing homes/assisted living –Skilled Nursing Facilities –Home health agencies Practitioners: NPs, physicians, nurses, rehab, SW

7. Stakeholder Perspectives Consumer: most likely will support Consumer advocates: May like it but also worry about providers dropping out and restricting access. Payors: Administrative burden but may save costs in the long run Providers/Practitioners: Reporting issue; rewards adequate? Who gets them? Cookbook medicine?

8. Plan of Action Multi-stakeholder engagement to listen for concerns and refine idea Build coalition and involve stakeholders in performance measure development Develop implementation strategy Negotiate timeline and specific tasks Meet with congressional staff