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 ...

Featured Careers & Jobs in EMS

 

 

 

 

 

 

 

 

 

Get JEMS in Your Inbox

 

Fire EMS Blogs


Blogger Browser

Today's Featured Posts

 

EMS Airway Clinic

The Evolution of Civilian High Threat Medical Guidelines

How mass killing events have proven a need for new guidelines.
More >

Multimedia Thumb

British Medics Bid Farewell to Afghanistan Base

Medical team and troops leave Camp Bastion.
Watch It >


Multimedia Thumb

Plane Crash at Wichita Airport

Small plane crashes into airport safety building.
Watch It >


Multimedia Thumb

Authorities Investigate Firefighters at Arizona EMS Call

Confrontation caught on video involving Glendale firefighters.
Watch It >


Multimedia Thumb

Radio Problems for New York Medics

Medic’s radio failed during a call with an armed patient.
Watch It >


Multimedia Thumb

Ottawa Shooting Incident

Solider is shot by gunman at national memorial in Ottawa.
More >


Multimedia Thumb

Life Link III Trauma Tactics Conference in Minnesota

Conference was designed to enhance the skills of providers of all levels, covering rescue and prehospital situations, to transport and in-hospital treatment.
More >


Multimedia Thumb

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

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


Multimedia Thumb

LMA MAD Nasal™

Needle-free intranasal drug delivery.
Watch It >


Multimedia Thumb

Braun Ambulances' EZ Door Forward

Helps to create a safer ambulance module.
Watch It >


More Product Videos >