Pay-for-Performance
The Blue Cross Blue Shield of Michigan Hospital Pay-for-Performance Program recognizes short-term acute care hospitals in peer groups 1 through 4 for achievements and improvements in quality and efficiency. In 2012 the program will pay hospitals, in aggregate, an additional 5 percent of statewide inpatient and outpatient operating payments - more than $190 million statewide.
Sixty percent of each hospital's P4P score is based on quality, including participation in selected collaborative quality initiatives. The remaining 40 percent is based on efficiency. Hospitals must also meet a patient-safety prequalifying condition to be eligible to participate in the program. The following table summarizes the program structure and weights.
2012 Program Components and Weights |
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|---|---|---|---|---|
Prequalifying condition |
0% |
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Quality: 60% |
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Quality indicators |
20% - 52% |
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Collaborative quality initiatives |
8% - 40% |
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Efficiency: 40% |
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Cost-per-case |
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Comparison to statewide mean |
25% |
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Comparison to inflation index |
15% |
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The P4P program structure and measures are developed with input from a P4P Hospital Workgroup. The P4P rate a hospital earns, based on its 2012 performance, will be applied to its inpatient and outpatient operating payments effective July 1, 2013.
Blue Cross also offers a P4P program specific to small, rural hospitals (peer group 5). This program determines 6 percentage points of a hospital's total inpatient and outpatient payment rate. The program requires hospitals to demonstrate a commitment to patient safety and achieve performance benchmarks for quality measures most relevant to small hospitals, such as the CMS ER quality indicators. Hospitals must also participate in quality improvement initiatives, including the Michigan Critical Access Hospital Quality Network, the MHA Keystone initiative on Hospital Associated Infections, and the MHA Keystone Surgery initiative.
