One increasingly popular trend, used both by the Centers for Medicaid and Medicare Services and by third-party payers, attempts to address variation in quality and performance through the use of PFP programs. Individuals or organizations entering PFP agreements are essentially compensated through one of two mechanisms: a straight bonus that rewards providers with additional payments for achieving stipulated performance targets or placement of a percentage of contracted provider revenue that is directly at risk if these targets are not met.
At Massachusetts General Hospital and Harvard Medical School, in Boston, MA, a radiology PFP program was used to assess its impact on RTAT for all departmental reports from 11 subspecialty divisions. Study periods were 3 months before (baseline period) and immediately after (immediate period) the introduction of the program and 2 years later after the program had terminated (post period).
Three RTAT components were evaluated for individual radiologists and for each radiology division: examination completion (C) to final signature (F), C to preliminary signature (P), and P to F. "Mean C-F, C-P, and P-F for all reports decreased significantly from baseline to immediate to post period, with the largest effect on the P-F component," said Giles W.L. Boland, MD, lead author of the study. RTAT decreased by approximately two-thirds (62 percent) between the baseline and post period.
"Rapid completion and ready availability of final radiology reports is considered an essential and important clinical quality metric. PFP incentives designed to motivate academic radiologists to alter their behavior and perform expeditious finalized signature of preliminary reports appear to be successful," said Boland.