Pay-for-Performance Incentives Might Improve Compliance - @ JEMS.com


Pay-for-Performance Incentives Might Improve Compliance

 

 
 
 

Keith Wesley, MD, FACEP | | Tuesday, February 10, 2009


Review of: Whyte BS, Ansley R: "Pay for Performance Improves Rural EMS Quality Investment in Prehospital Care." Prehospital Emergency Care. 12(4):495-7, 2008.

The Science

This paramedic service in southeastern Minnesota opted to provide monetary incentives for protocol compliance to determine if such incentives would improve compliance. During the study, and previously, they provided routine quality improvement including run review, educational programs and remediation of providers failing to meet specific benchmarks. Dr. Whyte decided to concentrate on the following specific benchmarks and provide the corresponding monetary incentives for compliance:

  1. Administration of aspirin to all non-traumatic adult chest pain -- $100
  2. Performance of 12-lead in chest pain -- $100
  3. Appropriate treatment of traumatic hip pain -- $100
  4. Documentation of the onset of CVA stroke symptoms -- $100
  5. Completion of run reports within three hours following the call -- $200
  6. Chute time of less than 90 seconds -- $400

Post-incentive run reports were completed within three hours 99.7% of the time, with 21 of 24 providers meeting the goal 100% of the time. Before the incentive, reports were completed within three hours 64% of the time, with only two of 23 providers meeting the goal 100% of the time. The out-of-chute goal of less than 90 seconds was met 98.7% of the time, compared with 90.1% before the incentive. Aspirin use in adult non-traumatic chest pain improved from 68% to 96.3%, and electrocardiogram (ECG) performance in this group improved from 43% to 87.8%. Documentation of the time of onset of symptoms in stroke patients improved from 97% to 100%, and the assessment of and intervention for pain in traumatic hip pain patients improved from 56% to 100%.

Dr. Whyte concluded that monetary incentives improved protocol compliance and could be used to improve patient care.

The Street

Finally, we're beginning to recognize that EMS is a business. In business, we reward excellence. For too long, we've viewed quality improvement as the stick instead of the carrot. The carrot for most services has simply been a "Job Well Done!" memo or your picture on the Hall of Fame. But in these harsh economic times, memos and pictures don't put food on the table. Recruitment and retention in EMS continues to plague us when the average EMT can make more flipping burgers. And while they're flipping burgers, they're provided monetary incentives for customer satisfaction. So why not do the same in EMS?

Should this pay-for-performance incentive be the norm? I don't know. Even Dr. Whyte argues that the potential for abuse, such as when a medic may be overly aggressive with morphine for the hypotensive hip fracture in pursuit of obtaining the incentive. But before my readers start their flame throwers, let me pull back the curtain on medicine in general. In the ED, I'm paid by performance. If I don't document my care consistently with the level of service, then the billing company can't bill appropriately and I suffer a negative monetary incentive. If my hospital doesn't meet state and federal benchmarks in quality, we risk the loss of Medicare funding.

Creating an environment that rewards excellence is preferable to one that concentrates on punishing underperformance. The form of that reward should be consistent with the needs of the employees. If movie tickets or a pizza party will do it; then fine.

As Dr. Whyte explains succinctly in this study, it s vital that the program have close oversight to ensure there are no moral abuses and that the benchmarks being rewarded result in improved patient care and efficient service operation.




Connect: Have a thought or feedback about this? Add your comment now
Related Topics: Leadership and Professionalism, Research, Training

 
What's Your Take? Comment Now ...

Buyer's Guide Featured Companies

Featured Careers & Jobs in EMS

Get JEMS in Your Inbox

 

Fire EMS Blogs


Blogger Browser

Today's Featured Posts

 

EMS Airway Clinic

Improving Survival from Cardiac Arrest Using ACD-CPR + ITD

Using active compression-decompression CPR with an ITD has been shown to improve 1-year survival from cardiac arrest by 33%.
More >

Multimedia Thumb

Philadelphia Fire Department Apologizes for Medic’s Jab at Police

Union head calls photos a slap in the face of officers.
Watch It >


Multimedia Thumb

D.C. Fire and EMS Crews Blame New Technology for Patient’s Death

Delayed response blamed on recurring dispatch problems.
Watch It >


Multimedia Thumb

Suspect Steals, Crashes Maryland Ambulance

One killed, others injured in Prince George’s County crash.
Watch It >


Multimedia Thumb

Tennessee Trench Rescue

Worker pulled from Roane County worksite.
More >


Multimedia Thumb

Time’s Ebola Firefighters

Doctors, nurses and others saluted for fighting virus.
More >


Multimedia Thumb

Car Strikes Manhattan Pedestrians

Seven people hurt when car jumps curb.
More >


Multimedia Thumb

The AmbuBus®, Bus Stretcher Conversion Kit - EMS Today 2013

AmbuBus®, Bus Stretcher all-hazards preparedness & response tool
Watch It >


Multimedia Thumb

Field Bridge Xpress ePCR on iPad, Android, Kindle Fire

Sneak peek of customizable run forms & more.
Watch It >


Multimedia Thumb

LMA MAD Nasal™

Needle-free intranasal drug delivery.
Watch It >


More Product Videos >