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A one-of-a-kind Minnesota Department of Human Services (DHS) program that provides nursing homes additional payment for quality improvement projects shows promise for encouraging overall nursing home quality improvement, according to a study published this month in the journal Health Affairs.
Researchers analyzed the impact that the Performance-based Incentive Payment Program (PIPP) has had on care quality in participating nursing homes. The only program of its kind in the nation, PIPP supports nursing homes, individually or in collaboration with other nursing homes, in taking initiative to identify their specific problems, using evidence-based solutions and evaluating outcomes.
Minnesota Masonic Home in Bloomington, for example, has been involved in projects targeting falls reduction, intense training and coaching in compassionate care and improving the quality of life for residents with hearing loss. Other nursing homes have focused on appropriate use of psychotropic drugs, reduced incontinence, improved mobility, better skin care, fewer hospitalizations and increased discharges from facilities to community settings.
DHS has been moving increasingly towards making the quality of services provided a key element of its payments. In the last two years DHS has used this strategy across the department, including its new Medicaid ACOs, long term care services and with child care providers. Nursing facility quality measures are available in the Minnesota Nursing Home Report Card.
“We know from our own reports that this performance incentive program has improved care and patient experience at participating nursing homes,” Human Services Commissioner Lucinda Jesson said. “This outside finding confirms that creating incentives through payment raises the quality of services.”
The study looked at four rounds of PIPP funding from October 2007 to October 2010 for 66 projects at 174 facilities. Nursing facilities contract with DHS to earn time-limited performance incentive payments of up to 5 percent of their operating payment rate. PIPP combines a $6.7 million state share of Medicaid with an equal federal match and private-pay nursing home resources for total funding of $18 million each year. Since it started in 2006, PIPP has supported 102 projects involving 225 facilities.
The study measured the quality of facilities participating in PIPP and non-participating facilities with a composite score representing multiple dimensions of clinical care. While the facilities had similar scores initially, PIPP facilities exhibited a significant increase in quality after PIPP funding and continued to have significantly higher quality scores than facilities not in the program. The study found that PIPP facilities not only progressed toward their PIPP performance targets but improved quality in areas outside the focus of their PIPP projects.
Firm conclusions about PIPP’s impact cannot be reached because facilities self-select to be in the program, the report authors said. However, “early findings indicate the program shows promise for incentivizing nursing home quality improvement, both in facility-identified areas of concern and overall,” according to the report.
“PIPP emerged in, and is unique to, Minnesota, a state that has been a leader in long-term care policy as evidenced by its top ranking on the AARP scorecard report,” the authors said, referring to Minnesota’s number one ranking in a 2011 state scorecard on long-term services and supports for older adults, people with physical disabilities and family caregivers. However, “other considerations suggest that additional states might successfully introduce PIPP programs, either alone or in combination with conventional pay-for-performance,” the authors said.
The study was sponsored by the federal Agency for Healthcare Research and Quality and conducted by professors and staff of the Indiana University Center for Aging Research, the Regenstrief Institute, Harvard Medical School, Purdue University, the University of Minnesota and the Minnesota Department of Human Services.
More information on the PIPP program is available in a fact sheet on the DHS website.