Improving on-time surgical starts: the impact of implementing pre-OR timeouts and performance pay.

PubMed

Martin, Luke; Langell, John

2017-11-01

Operating room (OR) time is expensive. Underutilized OR time negatively impacts efficiency and is an unnecessary cost for hospitals. The purpose of this study was to evaluate the impact of a pre-OR timeout and performance pay incentive on the frequency of on-time, first surgical starts. At a single Veterans Affairs Medical Center, we implemented a pre-OR timeout in the form of a safety-briefing checklist and a modest performance pay incentive for on-time starts (>90% compliance) for attending surgeons. Data were collected on all first-start cases beginning before implementation in 2008 and continued through 2015. Each year, an average of 960 first starts occurred across nine surgical divisions. Before implementation of either the timeout or pay incentive, only 15% of cases started on time, and by 2015, greater than 72% were on time (P < 0.001). Over the study period, there were significant improvements in on-time starts (P = 0.01), of delays <15 min (P = 0.01), and of delays 16 to 30 min (P = 0.04). The trends for delays of 31 to 60 min or >60 min were not significant (P = 0.31; P = 0.81). Assuming a loss of 7 min per case for delays <15 min and 20 min per case for delays of 16 to 30 min, the total OR time saved from implementing these measures was 37,556 min. At an estimated cost of $20/min, gross savings from this project were $751,120. Implementation of a pre-OR timeout and performance pay for on-time starts significantly improves OR utilization and reduces unnecessary costs. Published by Elsevier Inc.

Pay for performance: will dentistry follow?

PubMed

Voinea-Griffin, Andreea; Fellows, Jeffrey L; Rindal, Donald B; Barasch, Andrei; Gilbert, Gregg H; Safford, Monika M

2010-04-28

"Pay for performance" is an incentive system that has been gaining acceptance in medicine and is currently being considered for implementation in dentistry. However, it remains unclear whether pay for performance can effect significant and lasting changes in provider behavior and quality of care. Provider acceptance will likely increase if pay for performance programs reward true quality. Therefore, we adopted a quality-oriented approach in reviewing those factors which could influence whether it will be embraced by the dental profession. The factors contributing to the adoption of value-based purchasing were categorized according to the Donabedian quality of care framework. We identified the dental insurance market, the dental profession position, the organization of dental practice, and the dental patient involvement as structural factors influencing the way dental care is practiced and paid for. After considering variations in dental care and the early stage of development for evidence-based dentistry, the scarcity of outcome indicators, lack of clinical markers, inconsistent use of diagnostic codes and scarcity of electronic dental records, we concluded that, for pay for performance programs to be successfully implemented in dentistry, the dental profession and health services researchers should: 1) expand the knowledge base; 2) increase considerably evidence-based clinical guidelines; and 3) create evidence-based performance measures tied to existing clinical practice guidelines. In this paper, we explored factors that would influence the adoption of value-based purchasing programs in dentistry. Although none of these factors were essential deterrents for the implementation of pay for performance programs in medicine, the aggregate seems to indicate that significant changes are needed before this type of program could be considered a realistic option in dentistry.

Pay for performance in orthopaedic surgery.

PubMed

Pierce, Read G; Bozic, Kevin J; Bradford, David S

2007-04-01

In recent decades American medicine has undergone tremendous changes. Numerous reimbursement and systems approaches to controlling medical inflation and improving quality have failed to provide cost-effective, high-quality health care in most circumstances. Public and private payers are currently implementing pay for performance, a new reimbursement method linking physician pay to evidence of adherence to performance measures, to constrain costs, encourage efficiency, and maximize value for health care dollars. High-quality research regarding pay for performance and its impact is scarce, particularly in orthopaedic surgery. Although supporters argue pay for performance will remedy the fragmented, costly delivery of health services in the United States, skeptics raise concerns about disagreement over quality guidelines, financial implications for providers and hospitals, inadequate infrastructure, public reporting, system gaming, and physician support. Our survey of orthopaedic surgeons reveals limited understanding of pay for performance, marked skepticism of nonphysician stakeholders' intentions, and a strong desire for greater clinician involvement in shaping the pay for performance movement. As pay for performance will likely be a long-term change that will have an impact on every orthopaedic surgeon, clinician awareness and participation will be fundamental in creating successful pay for performance programs.

Full cost accounting as a tool for the financial assessment of Pay-As-You-Throw schemes: a case study for the Panorama municipality, Greece.

PubMed

Karagiannidis, Avraam; Xirogiannopoulou, Anna; Tchobanoglous, George

2008-12-01

In the present paper, implementation scenarios of a Pay-As-You-Throw program were developed and analyzed for the first time in Greece. Firstly, the necessary steps for implementing a Pay-As-You-Throw program were determined. A database was developed for the needs of the full cost accounting method, where all financial and waste-production data were inserted, in order to calculate the unit price of charging for four different implementation scenarios of the "polluter-pays" principle. For each scenario, the input in waste management cost was estimated, as well as the total waste charges for households. Finally, a comparative analysis of the results was performed.

Using performance-based pay to improve the quality of teachers.

PubMed

Lavy, Victor

2007-01-01

Tying teachers' pay to their classroom performance should, says Victor Lavy, improve the current educational system both by clarifying teaching goals and by attracting and retaining the most productive teachers. But implementing pay for performance poses many practical challenges, because measuring individual teachers' performance is difficult. Lavy reviews evidence on individual and school-based incentive programs implemented in recent years both in the United States and abroad. Lavy himself evaluated two carefully designed programs in Israel and found significant gains in student and teacher performance. He observes that research evidence suggests, although not conclusively, that pay-for-performance incentives can improve teachers' performance, although they can also lead to unintended and undesired consequences, such as teachers' directing their efforts exclusively to rewarded activities. Lavy also offers general guidelines for designing effective programs. He emphasizes that the system must measure true performance in a way that minimizes random variation as well as undesired and unintended consequences. It must align performance with ultimate outcomes and must be monitored closely to discourage gaming if not outright fraud in measured output. Goals should be attainable. Incentives should balance individual rewards with school incentives, fostering a cooperative culture but not at the expense of free riding. All teachers should be eligible for the incentive offered, but only a subset of teachers should be rewarded in practice. If too many teachers are rewarded, teachers may not need to exert much extra effort to benefit. Many of the practical challenges faced by performance-related pay, Lavy says, can be addressed through careful design of the system. He emphasizes that setting up a performance-related pay system that works is not a one-time task. Even with the best preparation, initial implementation is likely to be problematic. But if the effort is seen as ongoing, it should be possible to make progress gradually in developing incentives that motivate the desired teaching behaviors and that will be perceived by teachers as fair and accurate.

Toward a More Comprehensive Model of Teacher Pay. Research Brief

ERIC Educational Resources Information Center

National Center on Performance Incentives, 2008

2008-01-01

In "Toward a More Comprehensive Model of Teacher Pay"--a paper presented at the February 2008 National Center on Performance Incentives research to policy conference--Julia Koppich examines recent policy initiatives implementing new approaches to teacher pay. Her discussion focuses on four current initiatives: ProComp in Denver, Toledo…

Characteristics and Determinants of Teacher-Designed Pay for Performance Plans: Evidence from Texas' Governor's Educator Excellence Grant (GEEG) Program. Working Paper 2008-26

ERIC Educational Resources Information Center

Taylor, Lori L.; Springer, Matthew G.; Ehlert, Mark

2008-01-01

This study describes the teacher pay for performance plans designed and implemented by the public schools participating in the Governor's Educator Excellence Grant (GEEG) program in Texas. GEEG is a federally funded, incentive pay program that awarded non-competitive grants, ranging from $60,000 to $220,000 each year for three years, to 99 Texas…

Teacher Evaluation in China: Latest Trends and Future Directions

ERIC Educational Resources Information Center

Liu, Shujie; Zhao, Decheng

2013-01-01

With the implementation of teacher performance pay in 2009 in China, teacher performance evaluation has become a heated topic. This research study follows up on two previous studies of teacher evaluation in China and continues the dialog by analyzing the latest trends in the context of teacher performance pay. There were two sources of information…

Paying It Forward: A Technical Assistance Guide for Developing and Implementing Performance-Based Scholarships. The Performance-Based Scholarship Demonstration

ERIC Educational Resources Information Center

Welbeck, Rashida; Ware, Michelle; Cerna, Oscar; Valenzuela, Ireri

2014-01-01

Difficulties in paying for college and in maintaining good academic performance are two major hurdles to college graduation for low-income students. In recent years, state and federal budgets for postsecondary education have been cut significantly, limiting the options policymakers, education leaders, and communities have to improve rates of…

Evaluation of the Teacher Incentive Fund: Implementation and Early Impacts of Pay-for-Performance after One Year. NCEE 2014-4019

ERIC Educational Resources Information Center

Max, Jeffrey; Constantine, Jill; Wellington, Alison; Hallgren, Kristin; Glazerman, Steven; Chiang, Hanley; Speroni, Cecilia

2014-01-01

The Teacher Incentive Fund (TIF) provides grants to support performance-based compensation systems for teachers and principals in high-need schools. The study measures the impact of pay-for-performance bonuses as part of a comprehensive compensation system within a large, multisite random assignment study design. The treatment schools were to…

Evaluation of the Teacher Incentive Fund: Implementation and Impacts of Pay-for-Performance after Two Years. NCEE 2015-4020

ERIC Educational Resources Information Center

Chiang, Hanley; Wellington, Alison; Hallgren, Kristin; Speroni, Cecilia; Herrmann, Mariesa; Glazerman, Steven; Constantine, Jill

2015-01-01

The Teacher Incentive Fund (TIF) provides grants to support performance-based compensation systems for teachers and principals in high-need schools. The study measures the impact of pay-for-performance bonuses as part of a comprehensive compensation system within a large, multisite random assignment study design. The treatment schools were to…

Pay for performance in the natural gas industry

DOE Office of Scientific and Technical Information (OSTI.GOV)

Geske, L.D.

1989-08-17

An effective way for a gas utility to gain flexibility in dealing with the new gas market is through the implementation of an employee compensation program - especially for management-level employees - that ties their pay to the attainment of the company's strategic goals. A survey of several gas utilities with pay-for-performance programs reported several advantages of the programs: they direct management's focus onto key areas that affect bottom-line performance, help build team effort, give the company the ability to change direction rapidly, and aid in keeping talented employees. Most companies agreed that the minimum incentive payout was 12-15% ofmore » base pay levels for adequate motivation.« less

Effect of pay for performance on the management and outcomes of hypertension in the United Kingdom: interrupted time series study

PubMed Central

Serumaga, Brian; Ross-Degnan, Dennis; Avery, Anthony J; Elliott, Rachel A; Majumdar, Sumit R; Zhang, Fang

2011-01-01

Objective To assess the impact of a pay for performance incentive on quality of care and outcomes among UK patients with hypertension in primary care. Design Interrupted time series. Setting The Health Improvement Network (THIN) database, United Kingdom. Participants 470 725 patients with hypertension diagnosed between January 2000 and August 2007. Intervention The UK pay for performance incentive (the Quality and Outcomes Framework), which was implemented in April 2004 and included specific targets for general practitioners to show high quality care for patients with hypertension (and other diseases). Main outcome measures Centiles of systolic and diastolic blood pressures over time, rates of blood pressure monitoring, blood pressure control, and treatment intensity at monthly intervals for baseline (48 months) and 36 months after the implementation of pay for performance. Cumulative incidence of major hypertension related outcomes and all cause mortality for subgroups of newly treated (treatment started six months before pay for performance) and treatment experienced (started treatment in year before January 2001) patients to examine different stages of illness. Results After accounting for secular trends, no changes in blood pressure monitoring (level change 0.85, 95% confidence interval −3.04 to 4.74, P=0.669 and trend change −0.01, −0.24 to 0.21, P=0.615), control (−1.19, −2.06 to 1.09, P=0.109 and −0.01, −0.06 to 0.03, P=0.569), or treatment intensity (0.67, −1.27 to 2.81, P=0.412 and 0.02, −0.23 to 0.19, P=0.706) were attributable to pay for performance. Pay for performance had no effect on the cumulative incidence of stroke, myocardial infarction, renal failure, heart failure, or all cause mortality in both treatment experienced and newly treated subgroups. Conclusions Good quality of care for hypertension was stable or improving before pay for performance was introduced. Pay for performance had no discernible effects on processes of care or on hypertension related clinical outcomes. Generous financial incentives, as designed in the UK pay for performance policy, may not be sufficient to improve quality of care and outcomes for hypertension and other common chronic conditions. PMID:21266440

Implementation and Impacts of Pay-for-Performance: The 2010 Teacher Incentive Fund (TIF) Grantees after Two Years. NCEE Study Snapshot. NCEE 2015-4022

ERIC Educational Resources Information Center

National Center for Education Evaluation and Regional Assistance, 2015

2015-01-01

The Teacher Incentive Fund (TIF) provides grants to support performance-based compensation systems for teachers and principals in high-need schools. The study measures the impact of pay-for-performance bonuses as part of a comprehensive compensation system within a large, multisite random assignment study design. The treatment schools were to…

Evaluation of the Teacher Incentive Fund: Final Report on Implementation and Impacts of Pay-for-Performance across Four Years: Executive Summary. NCEE 2018-4005

ERIC Educational Resources Information Center

Chiang, Hanley; Speroni, Cecilia; Herrmann, Mariesa; Hallgren, Kristin; Burkander, Paul; Wellington, Alison

2017-01-01

The Teacher Incentive Fund (TIF) provides grants to support performance-based compensation systems for teachers and principals in high-need schools. The study measures the impact of pay-for-performance bonuses as part of a comprehensive compensation system within a large, multisite random assignment study design. The treatment schools were to…

Evaluation of the Teacher Incentive Fund: Final Report on Implementation and Impacts of Pay-for-Performance across Four Years. NCEE 2018-4004

ERIC Educational Resources Information Center

Chiang, Hanley; Speroni, Cecilia; Herrmann, Mariesa; Hallgren, Kristin; Burkander, Paul; Wellington, Alison

2017-01-01

The Teacher Incentive Fund (TIF) provides grants to support performance-based compensation systems for teachers and principals in high-need schools. The study measures the impact of pay-for-performance bonuses as part of a comprehensive compensation system within a large, multisite random assignment study design. The treatment schools were to…

Evaluation of the Teacher Incentive Fund: Implementation and Early Impacts of Pay-for-Performance after One Year. Executive Summary. NCEE 2014-4020

ERIC Educational Resources Information Center

Max, Jeffrey; Constantine, Jill; Wellington, Alison; Hallgren, Kristin; Glazerman, Steven; Chiang, Hanley; Speroni, Cecilia

2014-01-01

The Teacher Incentive Fund (TIF) provides grants to support performance-based compensation systems for teachers and principals in high-need schools. The study measures the impact of pay-for-performance bonuses as part of a comprehensive compensation system within a large, multisite random assignment study design. The treatment schools were to…

Quality Measures in Stroke

PubMed Central

Poisson, Sharon N.; Josephson, S. Andrew

2011-01-01

Stroke is a major public health burden, and accounts for many hospitalizations each year. Due to gaps in practice and recommended guidelines, there has been a recent push toward implementing quality measures to be used for improving patient care, comparing institutions, as well as for rewarding or penalizing physicians through pay-for-performance. This article reviews the major organizations involved in implementing quality metrics for stroke, and the 10 major metrics currently being tracked. We also discuss possible future metrics and the implications of public reporting and using metrics for pay-for-performance. PMID:23983840

Evaluating the impact of a new pay system on nurses in the UK.

PubMed

Buchan, James; Ball, Jane

2011-01-01

This study examines the impact of implementing a new pay system (Agenda for Change) on nursing staff in the National Health Service (NHS) in the UK. This new pay system covered approximately 400,000 nursing staff. Its objectives were to improve the delivery of patient care as well as staff recruitment, retention and motivation. The new system aimed to provide a simplified approach to pay determination, with a more systematic use of agreed job descriptions and job evaluation to 'price' individual jobs, linked to a new career development framework. Secondary analysis of survey data. Analysis of results of large-scale surveys of members of the Royal College of Nursing of the United Kingdom (RCN) to assess the response of nurses to questions about the implementation process itself and their attitude to pay levels. The results demonstrated that there was some positive change after implementation of Agenda for Change in 2006, mainly some time after implementation, and that the process of implementation itself raised expectations that were not fully met for all nurses. There were clear indications of differential impact and reported experiences, with some categories of nurse being less satisfied with the process of implementation. The overall message is that a national pay system has strengths and weaknesses compared to the local systems used in other countries and that these benefits can only be maximised by effective communication, adequate funding and consistent management of the system. How nurses' pay is determined and delivered can be a major satisfier and incentive to nurses if the process is well managed and can be a factor in supporting clinical practice, performance and innovation. This study highlights that a large-scale national exercise to reform the pay system for nurses is a major undertaking, carries risk and will take significant time to implement effectively. © 2010 Blackwell Publishing Ltd.

Weighing the Merits. Several States Are implementing Pay-for-Performance Plans

ERIC Educational Resources Information Center

McCabe, Melissa

2005-01-01

Some 37.1 percent of education spending was earmarked for teachers in 2001-02, according to the American Federation of Teachers, and most of that money was paid out using traditional compensation systems. But as expectations for accountability increase, a handful of states are looking to pay-for-performance systems to attract quality…

Making Sense of Performance Pay: Sensemaking and Sensegiving in Teachers' Implementation of Compensation Reform

ERIC Educational Resources Information Center

Herbert, Karen Shellberg

2010-01-01

Teacher compensation reforms have been on the rise in recent years, yet research has yet to fully demonstrate how teachers interpret these policies and how they may influence their instructional practices and professional decisions. This qualitative study of a performance pay program in an urban district in Texas drew on cognitive approaches to…

Implementation of electronic medical records

PubMed Central

Greiver, Michelle; Barnsley, Jan; Glazier, Richard H.; Moineddin, Rahim; Harvey, Bart J.

2011-01-01

Abstract Objective To study the effect of electronic medical record (EMR) implementation on preventive services covered by Ontario’s pay-for-performance program. Design Prospective double-cohort study. Participants Twenty-seven community-based family physicians. Setting Toronto, Ont. Intervention Eighteen physicians implemented EMRs, while 9 physicians continued to use paper records. Main outcome measure Provision of 4 preventive services affected by pay-for-performance incentives (Papanicolaou tests, screening mammograms, fecal occult blood testing, and influenza vaccinations) in the first 2 years of EMR implementation. Results After adjustment, combined preventive services for the EMR group increased by 0.7%, a smaller increase than that seen in the non-EMR group (P = .55, 95% confidence interval −2.8 to 3.9). Conclusion When compared with paper records, EMR implementation had no significant effect on the provision of the 4 preventive services studied. PMID:21998246

The Trouble with Pay for Performance.

ERIC Educational Resources Information Center

Young, I. Phillip

2003-01-01

Structured interviews with 575 administrators and supervisors in 6 school districts finds 8 impediments to school board implementation of an effective merit pay system for these employees: Lack of knowledge, teacher heritage, supervisor's ability, supervisor's motivation, managerial prerogatives, amount of rewards, and type of rewards. Offers…

Ethnic disparities in coronary heart disease management and pay for performance in the UK.

PubMed

Millett, Christopher; Gray, Jeremy; Wall, Martin; Majeed, Azeem

2009-01-01

Few pay for performance schemes have been subject to rigorous evaluation, and their impact on disparities in chronic disease management is uncertain. To examine disparities in coronary heart disease management and intermediate clinical outcomes within a multiethnic population before and after the introduction of a major pay for performance initiative in April 2004. Comparison of two cross-sectional surveys using electronic general practice records. Thirty-two family practices in south London, United Kingdom (UK). Two thousand eight hundred and ninety-one individuals with coronary heart disease registered with participating practices in 2003 and 3,101 in 2005. Percentage achievement by ethnic group of quality indicators in the management of coronary heart disease The proportion of patients reaching national treatment targets increased significantly for blood pressure (51.2% to 58.9%) and total cholesterol (65.7% to 73.8%) after the implementation of a major pay for performance initiative in April 2004. Improvements in blood pressure control were greater in the black group compared to whites, with disparities evident at baseline being attenuated (black 54.8% vs. white 58.3% reaching target in 2005). Lower recording of blood pressure in the south Asian group evident in 2003 was attenuated in 2005. Statin prescribing remained significantly lower (p < 0.001) in the black group compared with the south Asian and white groups after the implementation of pay for performance (black 74.8%, south Asian 83.8%, white 80.2% in 2005). The introduction of pay for performance incentives in UK primary care has been associated with better and more equitable management of coronary heart disease across ethnic groups.

Develop a PWL System for Dense Graded Hot Mix Asphalt Construction, Including Pay Factors

DOT National Transportation Integrated Search

2015-01-01

This research project developed a PWL system that the Nevada DOT can effectively implement on the construction of dense graded HMA mixtures. The PWL system includes pay factors that are based on pavement performance indicators such as rutting and cra...

Characterization and effectiveness of pay-for-performance in ophthalmology: a systematic review.

PubMed

Herbst, Tim; Emmert, Martin

2017-06-05

To identify, characterize and compare existing pay-for-performance approaches and their impact on the quality of care and efficiency in ophthalmology. A systematic evidence-based review was conducted. English, French and German written literature published between 2000 and 2015 were searched in the following databases: Medline (via PubMed), NCBI web site, Scopus, Web of Knowledge, Econlit and the Cochrane Library. Empirical as well as descriptive articles were included. Controlled clinical trials, meta-analyses, randomized controlled studies as well as observational studies were included as empirical articles. Systematic characterization of identified pay-for-performance approaches (P4P approaches) was conducted according to the "Model for Implementing and Monitoring Incentives for Quality" (MIMIQ). Methodological quality of empirical articles was assessed according to the Critical Appraisal Skills Programme (CASP) checklists. Overall, 13 relevant articles were included. Eleven articles were descriptive and two articles included empirical analyses. Based on these articles, four different pay-for-performance approaches implemented in the United States were identified. With regard to quality and incentive elements, systematic comparison showed numerous differences between P4P approaches. Empirical studies showed isolated cost or quality effects, while a simultaneous examination of these effects was missing. Research results show that experiences with pay-for-performance approaches in ophthalmology are limited. Identified approaches differ with regard to quality and incentive elements restricting comparability. Two empirical studies are insufficient to draw strong conclusions about the effectiveness and efficiency of these approaches.

Using Student Test Scores to Award Merit Pay: A Look at the 2012 Pay-for-Performance Program for Idaho Schools

ERIC Educational Resources Information Center

Storie, Gary; Denner, Peter R.

2015-01-01

In the fall of 2012, Idaho implemented a plan to award bonus pay to schools whose students demonstrated academic growth based on the Betebenner (2008) method. This study examined the relationship of the amount of bonus paid to a school, the percentage of students from low income families associated with a school, and the location of the school…

State adoption of nursing home pay-for-performance.

PubMed

Werner, Rachel M; Tamara Konetzka, R; Liang, Kevin

2010-06-01

Whereas numerous policies have been adopted to improve quality of care in nursing homes over the past several decades-with varying degrees of success-health care payment has been a largely untapped but potentially powerful policy tool to improve quality of care. Recently, however, payers have invested significant resources in the development and implementation of pay-for-performance (P4P) programs for nursing homes. The authors present results from a survey of state Medicaid agencies documenting the use and structure of P4P in nursing homes. Although the number of states that are implementing nursing home P4P is growing, the structure of these incentives varies across states, and little evidence exists to guide the planning or implementation of these initiatives.

Teamwork Key for Pilot Plans on Teacher Pay

ERIC Educational Resources Information Center

Sawchuk, Stephen

2008-01-01

A variety of federally financed grants based on performance pay are providing insights into how districts and teachers can collaborate to implement sustainable programs designed to improve teaching and learning. The question of whether those Teacher Incentive Fund grants will yield measurably higher student achievement, applicant pools with…

Reinforcing Productivity in a Job-Skills Training Program for Unemployed Substance-Abusing Adults.

PubMed

Subramaniam, Shrinidhi; Everly, Jeffrey J; Silverman, Kenneth

2017-05-01

Chronically unemployed adults may benefit from intensive job-skills training; however, training programs do not always reliably engage participants in mastering skills. This study examined effects of voucher reinforcement for performance on a job-skills training program in the therapeutic workplace. Participants were four unemployed, substance abusing adults who earned monetary vouchers for working on programs targeting typing skills. Participants were exposed to two payment conditions that differed in whether or not pay was dependent on performance in a within-subject reversal design. In the productivity-pay condition, participants earned $8.00 per hour for attending the workplace plus a bonus for performance. In the base-pay condition, participants were paid an hourly wage that was equivalent to the total hourly earnings from the previous productivity-pay condition. Participants completed less work on the typing programs in the base- than the productivity-pay condition, but the amount of time spent in the workroom and the accuracy and rate of typing were not affected by the pay manipulation. All participants reported preferring base pay over productivity pay. Explicit reinforcement of productivity maintains consistent work in training programs, but more aspects of productivity pay need to be refined for effective, efficient, and socially valid implementation with unemployed, substance-abusing adults.

Reinforcing Productivity in a Job-Skills Training Program for Unemployed Substance-Abusing Adults

PubMed Central

Subramaniam, Shrinidhi; Everly, Jeffrey J.; Silverman, Kenneth

2017-01-01

Chronically unemployed adults may benefit from intensive job-skills training; however, training programs do not always reliably engage participants in mastering skills. This study examined effects of voucher reinforcement for performance on a job-skills training program in the therapeutic workplace. Participants were four unemployed, substance abusing adults who earned monetary vouchers for working on programs targeting typing skills. Participants were exposed to two payment conditions that differed in whether or not pay was dependent on performance in a within-subject reversal design. In the productivity-pay condition, participants earned $8.00 per hour for attending the workplace plus a bonus for performance. In the base-pay condition, participants were paid an hourly wage that was equivalent to the total hourly earnings from the previous productivity-pay condition. Participants completed less work on the typing programs in the base- than the productivity-pay condition, but the amount of time spent in the workroom and the accuracy and rate of typing were not affected by the pay manipulation. All participants reported preferring base pay over productivity pay. Explicit reinforcement of productivity maintains consistent work in training programs, but more aspects of productivity pay need to be refined for effective, efficient, and socially valid implementation with unemployed, substance-abusing adults. PMID:28824954

New York City's School-Wide Bonus Pay Program: Early Evidence from a Randomized Trial. Working Paper 2009-02

ERIC Educational Resources Information Center

Springer, Matthew G.; Winters, Marcus A.

2009-01-01

In this paper, we examine the impact of New York City's School-Wide Performance Bonus Program (SPBP) on student outcomes and the school learning environment. The SPBP is a pay-for-performance program that was implemented in approximately 200 K-12 public schools midway into the 2007-08 school year. Participating schools can earn bonus awards of up…

Social patterns of pay systems and their associations with psychosocial job characteristics and burnout among paid employees in Taiwan.

PubMed

Yeh, Wan-Yu; Cheng, Yawen; Chen, Chiou-Jung

2009-04-01

Today, performance-based pay systems, also known as variable pay systems, are commonly implemented in workplaces as a business strategy to improve workers' performance and reduce labor costs. However, their impact on workers' job stress and stress-related health outcomes has rarely been investigated. By utilizing data from a nationally representative sample of paid employees in Taiwan, we examined the distribution of variable pay systems across socio-demographic categories and employment sectors. We also examined the associations of pay systems with psychosocial job characteristics (assessed by Karasek's Demand-Control model) and self-reported burnout status (measured by the Chinese version of the Copenhagen Burnout Inventory). A total of 8906 men and 6382 women aged 25-65 years were studied, and pay systems were classified into three categories, i.e., fixed salary, performance-based pay (with a basic salary), and piece-rated or time-based pay (without a basic salary). Results indicated that in men, 57% of employees were given a fixed salary, 24% were given a performance-based pay, and 19% were remunerated through a piece-rated or time-based pay. In women, the distributions of the 3 pay systems were 64%, 20% and 15%, respectively. Among the three pay systems, employees earning through a performance-based pay were found to have the longest working hours, highest level of job control, and highest percentage of workers who perceived high stress at work. Those remunerated through a piece-rated/time-based pay were found to have the lowest job control, shortest working hours, highest job insecurity, lowest potential for career growth, and lowest job satisfaction. The results of multivariate regression analyses showed that employees earning through performance-based and piece-rated pay systems showed higher scores for personal burnout and work-related burnout, as compared to those who were given fixed salaries, after adjusting for age, education, marital status, employment grade, job characteristics, and family care workloads. As variable pay systems have gained in popularity, findings from this study call for more attention on the tradeoff between the widely discussed management advantages of such pay systems and the health burden they place on employees.

Model Plan of Merit Pay in Ferment

ERIC Educational Resources Information Center

Honawar, Vaishali

2008-01-01

Denver's performance-pay system for teachers has long been hailed as a model, in good part because it was jointly conceived and implemented by the school district and the local teachers' union. However, that collaborative spirit is now in jeopardy, with union and district leaders engaged in a protracted battle over proposed changes to the system.…

Pay for performance in neonatal-perinatal medicine--will the quality of health care improve in the neonatal intensive care unit? A business model for improving outcomes in the neonatal intensive care unit.

PubMed

Spitzer, Alan R

2010-03-01

Because neonatal medicine is such an expensive contributor to health care in the United States--with a small population of infants accounting for very high health care costs--there has been a fair amount of attention given to this group of patients. An idea that has received increasing attention in this discussion is pay for performance. This article discusses the concept of pay for performance, examines what potential benefits and risks exist in this model, and investigates how it might achieve the desired goals if implemented in a thoughtful way. Copyright 2010 Elsevier Inc. All rights reserved.

The role of disease management in pay-for-performance programs for improving the care of chronically ill patients.

PubMed

Beich, Jeff; Scanlon, Dennis P; Ulbrecht, Jan; Ford, Eric W; Ibrahim, Ibrahim A

2006-02-01

To date, pay-for-performance programs targeting the care of persons with chronic conditions have primarily been directed at physicians and provide an alternative to health plan-sponsored chronic disease management (DM) programs. Both approaches require similar infrastructure, and each has its own advantages and disadvantages for program implementation. Pay-for-performance programs use incentives based on patient outcomes; however, an alternative system might incorporate measures of structure and process. Using a conceptual framework, the authors explore the variation in 50 diabetes DM programs using data from the 2002 National Business Coalition on Health's eValue8 Request for Information (RFI). The authors raise issues relevant to the assignment of accountability for patient outcomes to either health plans or physicians. They analyze the association between RFI scores measuring structures and processes, and HEDIS diabetes intermediate outcome measures. Finally, the strengths and weaknesses of using the RFI scores as an alternative metric for pay-for-performance programs are discussed.

Paying health workers for performance in Battagram district, Pakistan

PubMed Central

2011-01-01

Background There is a growing interest in using pay-for-performance mechanisms in low and middle-income countries in order to improve the performance of health care providers. However, at present there is a dearth of independent evaluations of such approaches which can guide understanding of their potential and risks in differing contexts. This article presents the results of an evaluation of a project managed by an international non-governmental organisation in one district of Pakistan. It aims to contribute to learning about the design and implementation of pay-for-performance systems and their impact on health worker motivation. Methods Quantitative analysis was conducted of health management information system (HMIS) data, financial records, and project documents covering the period 2007-2010. Key informant interviews were carried out with stakeholders at all levels. At facility level, in-depth interviews were held, as were focus group discussions with staff and community members. Results The wider project in Battagram had contributed to rebuilding district health services at a cost of less than US$4.5 per capita and achieved growth in outputs. Staff, managers and clients were appreciative of the gains in availability and quality of services. However, the role that the performance-based incentive (PBI) component played was less clear--PBI formed a relatively small component of pay, and did not increase in line with outputs. There was little evidence from interviews and data that the conditional element of the PBIs influenced behaviour. They were appreciated as a top-up to pay, but remained low in relative terms, and only slightly and indirectly related to individual performance. Moreover, they were implemented independently of the wider health system and presented a clear challenge for longer term integration and sustainability. Conclusions Challenges for performance-based pay approaches include the balance of rewarding individual versus team efforts; reflecting process and outcome indicators; judging the right level of incentives; allowing for very different starting points and situations; designing a system which is simple enough for participants to comprehend; and the tension between independent monitoring and integration in a national system. Further documentation of process and cost-effectiveness, and careful examination of the wider impacts of paying for performance, are still needed. PMID:21982330

Evaluation of the Teacher Incentive Fund: Implementation and Impacts of Pay-for-Performance after Three Years. NCEE 2016-4004

ERIC Educational Resources Information Center

Wellington, Alison; Chiang, Hanley; Hallgren, Kristin; Speroni, Cecilia; Herrmann, Mariesa; Burkander, Paul

2016-01-01

Research indicates that effective teachers are critical to raising student achievement. However, there is little evidence about the best ways to improve teacher effectiveness, or how schools that serve the students most in need can attract and retain effective teachers. Traditional salary schedules, which pay teachers based on their years of…

The business end of health information technology. Can a fully integrated electronic health record increase provider productivity in a large community practice?

PubMed

De Leon, Samantha; Connelly-Flores, Alison; Mostashari, Farzad; Shih, Sarah C

2010-01-01

Electronic health records (EHRs) are expected to transform and improve the way medicine is practiced. However, providers perceive many barriers toward implementing new health information technology. Specifically, they are most concerned about the potentially negative impact on their practice finances and productivity. This study compares the productivity of 75 providers at a large urban primary care practice from January 2005 to February 2009, before and after implementing an EHR system, using longitudinal mixed model analyses. While decreases in productivity were observed at the time the EHR system was implemented, most providers quickly recovered, showing increases in productivity per month shortly after EHR implementation. Overall, providers had significant productivity increases of 1.7% per month per provider from pre- to post-EHR adoption. The majority of the productivity gains occurred after the practice instituted a pay-for-performance program, enabled by the data capture of the EHRs. Coupled with pay-for-performance, EHRs can spur rapid gains in provider productivity.

Governor's Educator Excellence Grant (GEEG) Program: Year Three Evaluation Report. Policy Evaluation Report

ERIC Educational Resources Information Center

Springer, Matthew G.; Lewis, Jessica L.; Podgursky, Michael J.; Ehlert, Mark W.; Taylor, Lori L.; Lopez, Omar S.; Peng, Art

2009-01-01

The Governor's Educator Excellence Grant (GEEG) program was federally- and state-funded and provided three-year grants to schools to design and implement performance pay plans from the 2005-06 to 2007-08 school years. GEEG was implemented in 99 high poverty, high performing Texas public schools. This report builds on the previous GEEG evaluation…

Evaluation of the Teacher Incentive Fund: Implementation and Impacts of Pay-for-Performance after Three Years. Executive Summary. NCEE 2016-4005

ERIC Educational Resources Information Center

Wellington, Alison; Chiang, Hanley; Hallgren, Kristin; Speroni, Cecilia; Herrmann, Mariesa; Burkander, Paul

2016-01-01

Research indicates that effective teachers are critical to raising student achievement. However, there is little evidence about the best ways to improve teacher effectiveness, or how schools that serve the students most in need can attract and retain effective teachers. Traditional salary schedules, which pay teachers based on their years of…

What Today's Educational Technology Needs: Defensible Evaluations and Realistic Implementation.

ERIC Educational Resources Information Center

Roweton, William E.; And Others

It is argued that in order to make computer assisted instruction effective in the schools, educators should pay more attention to implementation issues (including modifying teacher attitudes, changing classroom routines, and offering realistic technical training and support) and to producing understandable product and performance evaluations.…

Minnesota's Nursing Facility Performance-Based Incentive Payment Program: An Innovative Model for Promoting Care Quality

ERIC Educational Resources Information Center

Cooke, Valerie; Arling, Greg; Lewis, Teresa; Abrahamson, Kathleen A.; Mueller, Christine; Edstrom, Lisa

2010-01-01

Purpose: Minnesota's Nursing Facility Performance-Based Incentive Payment Program (PIPP) supports provider-initiated projects aimed at improving care quality and efficiency. PIPP moves beyond conventional pay for performance. It seeks to promote implementation of evidence-based practices, encourage innovation and risk taking, foster collaboration…

The Cost of Pay Equity in Public and Private Employment.

ERIC Educational Resources Information Center

National Committee on Pay Equity, Washington, DC.

Implementing the principle of equal pay for work of comparable value, usually called "pay equity" or "comparable worth," should not be a major problem for either the public or private sectors. Information was analyzed from a survey of 24 State and local public sector employers involved in the implementation of pay equity, telephone interviews with…

Incentives and control in primary health care: findings from English pay-for-performance case studies.

PubMed

McDonald, Ruth; Harrison, Stephen; Checkland, Kath

2008-01-01

The authors' aim was to investigate mechanisms and perceptions of control following the implementation of a new "pay-for-performance" contract (the new General Medical Services, or GMS, contract) in general practice. This article was based on an in-depth qualitative case study approach in two general practices in England. A distinction is emerging amongst ostensibly equal partners between those general practitioners conducting and those subject to surveillance. Attitudes towards the contract were largely positive, although discontent was higher in the practice which employed a more intensive surveillance regime and greater amongst nurses than doctors. The sample was small and opportunistic. Further research is required to examine the longer-term effects as new contractual arrangements evolve. Increased surveillance and feedback mechanisms associated with new pay-for-performance schemes have the potential to constrain and shape clinical practice. The paper highlights the emergence of new tensions within and between existing professional groupings.

Using social marketing to manage population health performance.

PubMed

Rothschild, Michael L

2010-09-01

Population health can be affected by implementing pay-for-performance measures with key players. From a social marketing perspective, people (both consumers and managers) have choices and will do what they perceive enhances their own self-interest. The bottom-up focus of social marketing begins with an understanding of the people whose behaviors are targeted. Desired behavior results when people perceive that they will get more value than the cost of behaving and when the resulting offer is perceived to be better than what is obtainable through alternative choices. Incentives should be offered to consumers; managers should receive motivation for their own behavior and understand how to motivate relevant consumers. Pay can be monetary or nonmonetary, tangible or intangible. Everyone is paid for performance. Some are paid well enough to behave as desired; others are offered a poor rate of pay and choose not to behave.

Exploring the effect of at-risk case management compensation on hospital pay-for-performance outcomes: tools for change.

PubMed

Granata, Randy L; Hamilton, Karen

2015-01-01

Acute care nurse case managers are charged with compliance oversight, managing throughput, and ensuring safe care transitions. Leveraging the roles of nurse case managers and social workers during care transitions translates into improved fiscal performance under the Affordable Care Act. This article aims to equip leaders in the field of case management with tools to facilitate the alignment of case management systems with hospital pay-for-performance measures. A quality improvement project was implemented at a hospital in south Alabama to examine the question: for acute care case managers, what is the effect of key performance indictors using an at-risk compensation model in comparison to past nonincentive models on hospital readmissions, lengths of stay, and patient satisfaction surrounding the discharge process. Inpatient acute care hospital. The implementation of an at-risk compensation model using key performance indicators, Lean Six Sigma methodology, and Creative Health Care Management's Relationship-Based Care framework demonstrated reduced length of stay, hospital readmissions, and improved patient experiences. Regulatory changes and new models of reimbursement in the acute care environment have created the perfect storm for case management leaders. Hospital fiscal performance is dependent on effective case management processes and the ability to optimize scarce resources. The quality improvement project aimed to further align case management systems and structures with hospital pay-for-performance measures. Tools for change were presented to assist leaders with the change acceleration process.

Pay-for-performance as a method to establish the business case for quality.

PubMed

Wheeler, John R C; White, Bert; Rauscher, Simone; Nahra, Tammie A; Reiter, Kristin L; Curtin, Kathleen M; Damberg, Cheryl L

2007-01-01

One of the major reasons providers give for not implementing promising quality-enhancing interventions (QEI) is that no "business case" for quality has been made. This article clarifies the concepts of the business case for quality and the related economic case for quality and identifies the perspectives of the various actors in health care financing, production, and consumption decisions. A methodology to evaluate the business case for quality from the perspective of payers and providers is presented. The article then uses implemented QEIs to show how a pay-for-performance (P4P) program can alter the business cases for payers and providers. Specifically, the P4P programs described in this article allow a provider to implement a QEI with the financial alignment of the payer in order to achieve financial and non-financial benefits. In some cases, providers and payers may be able to establish P4P programs providing net benefits for both parties.

Value-Added and Other Methods for Measuring School Performance. Working Paper 2008-17

ERIC Educational Resources Information Center

Meyer, Robert H.; Christian, Michael S.

2008-01-01

One of the central challenges of designing and implementing a performance pay program is developing an approach for determining which schools, teachers, and administrators have performed well enough to have earned a bonus. The U.S. Department of Education's Teacher Incentive Fund (TIF) program provides grantees substantial latitude to create…

Cost savings in a hospital clinical laboratory with a pay-for-performance incentive program for supervisors.

PubMed

Winkelman, J W; Aitken, J L; Wybenga, D R

1991-01-01

A pay-for-performance incentive program for clinical laboratory supervisors was developed and implemented at Brigham and Women's Hospital (Boston, Mass). It provides monetary rewards to personnel who directly produce cost savings in their area of responsibility. This reward system is new to the hospital laboratory but is commonly used in industry. Substantial true cost savings over and above previously established stringent budgets were achieved, 11% of which was returned to first-line supervisors in the form of a bonus. The program expanded the scope of professionalism for supervisors to include fiscal management.

29 CFR 1650.110 - Implementation of salary offset.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Labor Regulations Relating to Labor (Continued) EQUAL EMPLOYMENT OPPORTUNITY COMMISSION DEBT COLLECTION... established pay intervals from an employee's current pay account, unless the employee and the Commission agree... only from basic pay, special pay, incentive pay, retired pay, retainer pay or in the case of an...

Pay for performance programs in Australia: a need for guiding principles.

PubMed

Scott, Ian A

2008-11-01

Pay-for-performance (P4P) programs which reward clinical providers with incentive payments based on one or more measures of quality of care are now common in the United States and the United Kingdom and it is likely they will attract increasing interest in Australia. However, empirical evidence demonstrating effectiveness of such programs is limited and many existing programs have not had rigorous outcome evaluation. To maximise success, future P4P programs should incorporate the lessons and insights obtained from previous experience. Based on a review of published trials, program evaluations and position statements, the following principles that may guide future program design and implementation were synthesised: 1) formulate a rationale and a business case for P4P; 2) use established evidence-based performance measures; 3) use rigorous and verifiable methods of data collection and analysis; 4) define performance targets using absolute and relative thresholds; 5) use rewards that are sufficient, equitable and transparent; 6) address appropriateness of provider responses and avoid perverse incentives; 7) implement communication and feedback strategies; 8) use existing organisational structures to implement P4P programs; 9) attribute credit for performance to participants in ways that foster population-based perspectives; and 10) invest in outcomes and health service research. Recommendations flowing from these principles relevant to Australian settings are provided.

What New York City's Experiment with Schoolwide Performance Bonuses Tells Us about Pay for Performance. Research Brief

ERIC Educational Resources Information Center

Li, Jennifer

2011-01-01

In the 2007-2008 school year, the New York City Department of Education (NYCDOE) and the United Federation of Teachers (UFT) implemented the Schoolwide Performance Bonus Program (SPBP). With funding from The Fund for Public Schools and the National Center on Performance Incentives, researchers from the RAND Corporation and Vanderbilt University…

Achieving equal pay for comparable worth through arbitration.

PubMed

Wisniewski, S C

1982-01-01

Traditional "women's jobs" often pay relatively low wages because of the effects of institutionalized stereotypes concerning women and their role in the work place. One way of dealing with sex discrimination that results in job segregation is to narrow the existing wage differential between "men's jobs" and "women's jobs." Where the jobs are dissimilar on their face, this narrowing of pay differences involves implementing the concept of "equal pay for jobs of comparable worth." Some time in the future, far-reaching, perhaps even industrywide, reductions in male-female pay differentials may be achieved by pursuing legal remedies based on equal pay for comparable worth. However, as the author demonstrates, immediate, albeit more limited, relief for sex-based pay inequities found in specific work places can be obtained by implementing equal pay for jobs of comparable worth through the collective bargaining and arbitration processes.

Participating physician preferences regarding a pay-for-performance incentive design: a discrete choice experiment.

PubMed

Chen, Tsung-Tai; Lai, Mei-Shu; Chung, Kuo-Piao

2016-02-01

To determine whether the magnitude of incentives or other design attributes should be prioritized and the most important attributes, according to physicians, of the diabetes P4P (pay-for-performance) program design. We implemented a discrete choice experiment (DCE) to elicit the P4P incentive design-related preferences of physicians. All of the physicians (n = 248) who participated in the diabetes P4P program located in the supervisory area of the northern regional branch of the Bureau of National Health Insurance in 2009 were included. The response rate was ∼ 60%. Our research found that the bonus type of incentive was the most important attribute, followed by the incentive structure and the investment magnitude. Physicians may feel that good P4P designs are more important than the magnitude of the investment by the insurer. The two most important P4P designs include providing the bonus type of incentive and using pay-for-excellence plus pay-for-improvement. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

The Buck Stops Here: Tying What Students Learn to What Educators Earn

ERIC Educational Resources Information Center

Slotnik, William J.

2010-01-01

Performance pay can be implemented in ways that are helpful to students and teachers, or it can repeat the mistakes of the past. To avoid these mistakes, initiatives must address the district factors that affect schools. There are six cornerstones for compensation reform: 1) Performance-based compensation is a systemic reform; 2) Compensation…

Evaluation of the Teacher Incentive Fund: Implementation and Impacts of Pay-for-Performance after Two Years

ERIC Educational Resources Information Center

Chiang, Hanley; Wellington, Alison; Hallgren, Kristin; Speroni, Cecilia; Herrmann, Mariesa; Glazerman, Steven; Constantine, Jill

2016-01-01

Recent efforts to attract and retain effective educators and to improve teaching practices have focused on reforming evaluation and compensation systems for teachers and principals. In 2006, Congress established the Teacher Incentive Fund (TIF), which provides grants to support performance-based compensation systems for teachers and principals in…

Early Implementation Experiences of the 2010 Teacher Incentive Fund Grantees. NCEE Study Snapshot. NCEE 2014-4021

ERIC Educational Resources Information Center

National Center for Education Evaluation and Regional Assistance, 2014

2014-01-01

The Teacher Incentive Fund (TIF) provides grants to support performance-based compensation systems for teachers and principals in high-need schools. The study measures the impact of pay-for-performance bonuses as part of a comprehensive compensation system within a large, multisite random assignment study design. The treatment schools were to…

Evaluation of the Teacher Incentive Fund: Implementation and Early Impacts of Pay-for-Performance after One Year

ERIC Educational Resources Information Center

Max, Jeffrey; Constantine, Jill; Wellington, Alison; Hallgren, Kristin; Glazerman, Steven; Chiang, Hanley; Speroni, Cecilia

2015-01-01

Recent efforts to attract and retain effective educators and to improve teaching practices have focused on reforming evaluation and compensation systems for teachers and principals. In 2006, Congress established the Teacher Incentive Fund (TIF), which provides grants to support performance-based compensation systems for teachers and principals in…

Impacts of Performance Pay under the Teacher Incentive Fund: Study Design Report

ERIC Educational Resources Information Center

Glazerman, Steven; Chiang, Hanley; Wellington, Alison; Constantine, Jill; Player, Dan

2011-01-01

The body of research on the design, implementation, and effects of performance-based compensation systems has influenced the design and evaluation of the 2010 Teacher Incentive Fund (TIF) grants. In the sections presented here, the authors describe the key components of 2010 TIF grants and the conceptual framework for the evaluation. The remainder…

A Comparison of the Managerial Characteristics of Mid-Grade Navy Unrestricted Line Officers

DTIC Science & Technology

1989-12-01

policy-making lvel , but who have some say in how policy will be implemented and consider- able involvement in carrying out the implementation." Gartaganis...survey subheadings: business/management, communica- tions/language, education, fine and performing arts, health, history, mathematics and science...three pay grades, the heaviest concentration of the war- fare officers’ academic degrees was in mathematics and science. The submariners had the

Pay-for-performance in a community substance abuse clinic

PubMed Central

Vandrey, Ryan; Stitzer, Maxine L.; Acquavita, Shauna P.; Quinn-Stabile, Patricia

2011-01-01

Pay-for-performance (P4P) strategies improve employee productivity and morale in business settings and are increasingly being implemented in medical care settings. This study investigated whether P4P could improve treatment utilization and retention at a community drug treatment clinic. Counselors had the opportunity to earn cash bonuses based on therapy attendance rates of individual clients as well as the quarterly retention rates of their caseload. Using a pre-post study design, average therapy sessions attended during the first month of treatment increased from 4.6 sessions prior to the intervention to 5.5 sessions per client during the intervention. The 90-day client retention rate increased from 40% to 53%. Additional analyses suggest that the improvement in 90-day retention was mediated by the increase in attendance during the first month of treatment. This project demonstrates that implementing a P4P incentive program in community drug abuse treatment clinics is feasible and effective at improving utilization and retention. PMID:21489739

Leaders' experiences and perceptions implementing activity-based funding and pay-for-performance hospital funding models: A systematic review.

PubMed

Baxter, Pamela E; Hewko, Sarah J; Pfaff, Kathryn A; Cleghorn, Laura; Cunningham, Barbara J; Elston, Dawn; Cummings, Greta G

2015-08-01

Providing cost-effective, accessible, high quality patient care is a challenge to governments and health care delivery systems across the globe. In response to this challenge, two types of hospital funding models have been widely implemented: (1) activity-based funding (ABF) and (2) pay-for-performance (P4P). Although health care leaders play a critical role in the implementation of these funding models, to date their perspectives have not been systematically examined. The purpose of this systematic review was to gain a better understanding of the experiences of health care leaders implementing hospital funding reforms within Organisation for Economic Cooperation and Development countries. We searched literature from 1982 to 2013 using: Medline, EMBASE, CINAHL, Academic Search Complete, Academic Search Elite, and Business Source Complete. Two independent reviewers screened titles, abstracts and full texts using predefined criteria. We included 2 mixed methods and 12 qualitative studies. Thematic analysis was used in synthesizing results. Five common themes and multiple subthemes emerged. Themes include: pre-requisites for success, perceived benefits, barriers/challenges, unintended consequences, and leader recommendations. Irrespective of which type of hospital funding reform was implemented, health care leaders described a complex process requiring the following: organizational commitment; adequate infrastructure; human, financial and information technology resources; change champions and a personal commitment to quality care. Crown Copyright © 2015. Published by Elsevier Ireland Ltd. All rights reserved.

Evaluation of the Teacher Incentive Fund: Implementation and Impacts of Pay-for-Performance after Two Years. Executive Summary. NCEE 2015-4021

ERIC Educational Resources Information Center

Chiang, Hanley; Wellington, Alison; Hallgren, Kristin; Speroni, Cecilia; Herrmann, Mariesa; Glazerman, Steven; Constantine, Jill

2015-01-01

Recent efforts to attract and retain effective educators and to improve teaching practices have focused on reforming evaluation and compensation systems for teachers and principals. In 2006, Congress established the Teacher Incentive Fund (TIF), which provides grants to support performance-based compensation systems for teachers and principals in…

Implementation and Impacts of Pay-for-Performance: The 2010 Teacher Incentive Fund (TIF) Grantees after Three Years. NCEE Study Snapshot. NCEE 2016-2006

ERIC Educational Resources Information Center

Wellington, Alison; Chiang, Hanley; Hallgren, Kristin; Speroni, Cecilia; Herrmann, Mariesa; Burkander, Paul

2016-01-01

The Teacher Incentive Fund (TIF) provides grants to support performance-based compensation systems for teachers and principals in high-need schools. The goal of the grants is to increase the number of high-performing teachers in high-need schools by rewarding educators for improving students' achievement. The report on which this snapshot is based…

The effects of pay for performance on disparities in stroke, hypertension, and coronary heart disease management: interrupted time series study.

PubMed

Lee, John Tayu; Netuveli, Gopalakrishnan; Majeed, Azeem; Millett, Christopher

2011-01-01

The Quality and Outcomes Framework (QOF), a major pay-for-performance programme, was introduced into United Kingdom primary care in April 2004. The impact of this programme on disparities in health care remains unclear. This study examines the following questions: has this pay for performance programme improved the quality of care for coronary heart disease, stroke and hypertension in white, black and south Asian patients? Has this programme reduced disparities in the quality of care between these ethnic groups? Did general practices with different baseline performance respond differently to this programme? Retrospective cohort study of patients registered with family practices in Wandsworth, London during 2007. Segmented regression analysis of interrupted time series was used to take into account the previous time trend. Primary outcome measures were mean systolic and diastolic blood pressure, and cholesterol levels. Our findings suggest that the implementation of QOF resulted in significant short term improvements in blood pressure control. The magnitude of benefit varied between ethnic groups with a statistically significant short term reduction in systolic BP in white and black but not in south Asian patients with hypertension. Disparities in risk factor control were attenuated only on few measures and largely remained intact at the end of the study period. Pay for performance programmes such as the QOF in the UK should set challenging but achievable targets. Specific targets aimed at reducing ethnic disparities in health care may also be needed.

Pay Equity Act (No. 34 of 1987), 29 June 1987.

PubMed

1987-01-01

This document contains major provisions of Ontario, Canada's 1987 Pay Equity Act. The Act seeks to redress systemic gender discrimination in compensation for work performed by employees in "female job classes" and applies to all private sector employers in Ontario with 10 or more employees, all public sector employers, and the employees of applicable employers. The Act continues to apply even if an employer subsequently reduces the number of employees below 10. The Act calls for identification of systemic gender discrimination in compensation through comparisons between female job classes and male job classes in terms of compensation and value of work performed, which is a composite of skill, effort, and responsibility normally required. Pay equity is deemed achieved when the job rate for the female job class is at least equal to the rate for a male job class in the same establishment. If there is no male job class to use for comparison, pay equity is achieved when the female job rate is at least equal to the job rate of a male job class in the same establishment that, at the time of comparison, had a higher job rate while performing work of lower value than the female job class. Differences in compensation between a female and a male job class are allowed if they result from a formal seniority system that does not discriminate on basis of gender, a temporary training or development assignment equally available to males and females, a specified merit compensation plan, actions taken as the result of a gender-neutral reevaluation process, or a skills shortage leading to a temporary inflation in compensation. Pay equity will not be achieved by reducing any employee's compensation. The Act establishes a Pay Equity Commission to oversee implementation.

The impact of a pay-for-performance system on timing to hip fracture surgery: experience from the Lazio Region (Italy)

PubMed Central

2013-01-01

Background A tariff modulation mechanisms has been introduced in some Italian regions with the aim of reducing inappropriate admissions and improving quality of care. In response to a regional act, hospitals in Lazio adopted a clinical pathway for elderly patients with hip fracture and introduced a compensation system based on the quality of health care, as in a pay-for-performance model. The objective of the present study was to compare the proportion of surgery for hip fracture performed within 48 hours of admission among Lazio hospitals according to different payment systems, before and after the implementation of the regional act. Methods A retrospective cohort study of patients aged 65 years and over, residing in the Lazio region and admitted to an acute care hospital for hip fracture before (1 July 2008 - 30 June 2009) and after (1 July 2010 - 30 June 2011) the pay-for-performance act. The proportion of surgeries performed within 48 h of hospital arrival was calculated. An adjusted multivariate regression analysis was applied to assess the effect of hospital payment type on the likelihood of surgery within 48 h of hospital arrival. Results The share of patients with hip fracture that had surgery within 48 hours was 11.7% before the introduction of the pay-for-performance act and 22.2% after. The proportion of early hip fracture operations increased after the pay-for-performance act, regardless of hospital payment type. The largest increase of surgery within 48 h occurred in private hospitals (adjusted Relative Risk = 2.80, p < 0.001). Conclusions The introduction of a compensation system based on health care quality is associated with improved quality of care for elderly patients with hip fracture, especially in hospitals that only use the Diagnosis Related Group system. PMID:24099264

Performance Pay and Teacher Motivation: Separating Myth from Reality

ERIC Educational Resources Information Center

Hulleman, Chris S.; Barron, Kenneth E.

2010-01-01

This article draws on research from outside of education to evaluate some common myths about performance pay and to consider future directions for designing and evaluating performance pay systems in K-12 education. The five common myths surrounding performance pay include: (1) Performance pay systems improve performance; (2) Performance pay…

Economic Assessment: A Model for Assessing Ability to Pay.

ERIC Educational Resources Information Center

Andre, Patricia; And Others

1978-01-01

Accurate assessment of the client's ability to pay is the cornerstone to fee collections in any service organization. York County Counseling Services implemented a new method of fee assessment and collection based on the principles of providing a service worth paying for, accurate assessment of ability to pay, and a budget-payment system. (Author)

Notification: Audit of the U.S. Environmental Protection Agency's Implementation of Do Not Pay Requirements

EPA Pesticide Factsheets

Project #OA-FY13-0391, August 26, 2013. The EPA's OIG plans to begin preliminary research for an audit ofthe agency's implementation ofthe Do Not Pay requirements outlined in the Improper Payments Elimination and Recovery Improvement Act of 2012.

Implementation Processes and Pay for Performance in Healthcare: A Systematic Review.

PubMed

Kondo, Karli K; Damberg, Cheryl L; Mendelson, Aaron; Motu'apuaka, Makalapua; Freeman, Michele; O'Neil, Maya; Relevo, Rose; Low, Allison; Kansagara, Devan

2016-04-01

Over the last decade, various pay-for-performance (P4P) programs have been implemented to improve quality in health systems, including the VHA. P4P programs are complex, and their effects may vary by design, context, and other implementation processes. We conducted a systematic review and key informant (KI) interviews to better understand the implementation factors that modify the effectiveness of P4P. We searched PubMed, PsycINFO, and CINAHL through April 2014, and reviewed reference lists. We included trials and observational studies of P4P implementation. Two investigators abstracted data and assessed study quality. We interviewed P4P researchers to gain further insight. Among 1363 titles and abstracts, we selected 509 for full-text review, and included 41 primary studies. Of these 41 studies, 33 examined P4P programs in ambulatory settings, 7 targeted hospitals, and 1 study applied to nursing homes. Related to implementation, 13 studies examined program design, 8 examined implementation processes, 6 the outer setting, 18 the inner setting, and 5 provider characteristics. Results suggest the importance of considering underlying payment models and using statistically stringent methods of composite measure development, and ensuring that high-quality care will be maintained after incentive removal. We found no conclusive evidence that provider or practice characteristics relate to P4P effectiveness. Interviews with 14 KIs supported limited evidence that effective P4P program measures should be aligned with organizational goals, that incentive structures should be carefully considered, and that factors such as a strong infrastructure and public reporting may have a large influence. There is limited evidence from which to draw firm conclusions related to P4P implementation. Findings from studies and KI interviews suggest that P4P programs should undergo regular evaluation and should target areas of poor performance. Additionally, measures and incentives should align with organizational priorities, and programs should allow for changes over time in response to data and provider input.

Impact of Appointment-Based Medication Synchronization on Proportion of Days Covered for Chronic Medications.

PubMed

Dao, Nancy; Lee, Sun; Hata, Micah; Sarino, Lord

2018-05-22

Appointment-based medication synchronization (ABMS) programs have been associated with increased adherence and persistence to chronic medications. Adherence to statin therapy, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and non-insulin antidiabetic medications (NIDM) are used to determine a health plan's Centers for Medicare and Medicaid Services (CMS) Star Rating under a pay-for-performance model. The objective of this study was to evaluate the impact of implementing an ABMS program on overall pharmacy adherence measures for statins, ACEI/ARBs, and NIDM, as presented through the Electronic Quality Improvement Platform for Plans and Pharmacies (EQuIPP©) platform. This retrospective, pre-post ABMS program study evaluated EQuIPP© generated adherence performance measures, represented as proportion of days covered (PDC), 6-months before and 6- and 12-months after the ABMS service for statin therapy, ACEIs/ARBs, and NIDM. All adherence measures showed statistically significant improvement in PDC percentage post ABMS implementation, except for NIDM percentage in 6-months post-ABMS service. This study shows that a comprehensive medication synchronization program can enhance adherence measures that are important to health plans to increase CMS Star Rating under a pay-for-performance model.

A comparison of pay-as-bid and marginal pricing in electricity markets

NASA Astrophysics Data System (ADS)

Ren, Yongjun

This thesis investigates the behaviour of electricity markets under marginal and pay-as-bid pricing. Marginal pricing is believed to yield the maximum social welfare and is currently implemented by most electricity markets. However, in view of recent electricity market failures, pay-as-bid has been extensively discussed as a possible alternative to marginal pricing. In this research, marginal and pay-as-bid pricing have been analyzed in electricity markets with both perfect and imperfect competition. The perfect competition case is studied under both exact and uncertain system marginal cost prediction. The comparison of the two pricing methods is conducted through two steps: (i) identify the best offer strategy of the generating companies (gencos); (ii) analyze the market performance under these optimum genco strategies. The analysis results together with numerical simulations show that pay-as-bid and marginal pricing are equivalent in a perfect market with exact system marginal cost prediction. In perfect markets with uncertain demand prediction, the two pricing methods are also equivalent but in an expected value sense. If we compare from the perspective of second order statistics, all market performance measures exhibit much lower values under pay-as-bid than under marginal pricing. The risk of deviating from the mean is therefore much higher under marginal pricing than under pay-as-bid. In an imperfect competition market with exact demand prediction, the research shows that pay-as-bid pricing yields lower consumer payments and lower genco profits. This research provides quantitative evidence that challenges some common claims about pay-as-bid pricing. One is that under pay-as-bid, participants would soon learn how to offer so as to obtain the same or higher profits than what they would have obtained under marginal pricing. This research however shows that, under pay-as-bid, participants can at best earn the same profit or expected profit as under marginal pricing. A second common claim refuted by this research is that pay-as-bid does not provide correct price signals if there is a scarcity of generation resources. We show that pay-as-bid does provide a price signal with such characteristics and furthermore argue that the price signal under marginal pricing with gaming may not necessarily be correct since it would then not reflect a lack of generation capacity but a desire to increase profit.

28 CFR 545.25 - Eligibility for performance pay.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Eligibility for performance pay. 545.25... WORK AND COMPENSATION Inmate Work and Performance Pay Program § 545.25 Eligibility for performance pay. (a) An inmate may receive performance pay for accomplishments in one or more of the following areas...

28 CFR 545.26 - Performance pay provisions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... month that the inmate was working. Performance pay may not be awarded retroactively. (d) An inmate is... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Performance pay provisions. 545.26... WORK AND COMPENSATION Inmate Work and Performance Pay Program § 545.26 Performance pay provisions. (a...

28 CFR 545.22 - Institution work and performance pay committee.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Institution work and performance pay... INSTITUTIONAL MANAGEMENT WORK AND COMPENSATION Inmate Work and Performance Pay Program § 545.22 Institution work... Institution Inmate Work and Performance Pay Committee to administer the institution's work and performance pay...

5 CFR 9901.342 - Performance payouts.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Performance payouts. 9901.342 Section... PERSONNEL SYSTEM (NSPS) Pay and Pay Administration Performance-Based Pay § 9901.342 Performance payouts. (a) Overview. (1) The NSPS pay system will be a performance-based pay system and will result in a distribution...

36 CFR 1202.52 - How do I pay?

Code of Federal Regulations, 2010 CFR

2010-07-01

... 36 Parks, Forests, and Public Property 3 2010-07-01 2010-07-01 false How do I pay? 1202.52 Section... REGULATIONS IMPLEMENTING THE PRIVACY ACT OF 1974 Individual Access to Records § 1202.52 How do I pay? You must pay by check or money order. Make your check or money order payable to the National Archives and...

Career Ladders and the Professionalization of Teaching: Down the Up Staircase.

ERIC Educational Resources Information Center

Dunwell, Robert R.

School systems interested in improving teacher performance, effectiveness, and job satisfaction while reducing turnover rates might do better to seek ways to enhance the intrinsic rewards of teaching rather than implement such extrinsic motivators as merit pay plans and career ladders. A review of the research literature brings several important…

Teamwork and Literacy: Learning from a Skills-Poor Position.

ERIC Educational Resources Information Center

Hart-Landsberg, Sylvia; Reder, Stephen

A study examined the roles of literacy and teamwork in an automotive parts manufacturing company that was restructuring to implement a "high-performance" model of team organization, worker responsibility for quality control, and a pay-for-knowledge compensation system. The study focused on the formal and informal educational practices from which…

[Pay for performance (P4P). Long-term effects and perspectives].

PubMed

Schrappe, M; Gültekin, N

2011-02-01

After 10 years of experience and research, a wide array of results on evaluation and long-term effects of pay for performance (P4P) programs have been published. These data do not only give insight into most of the problems of implementation, but also into aspects which, in part, may attenuate the high expectations at the beginning of the discussion. P4P programs exhibit a ceiling effect, some improvements are reversed after incentives are cancelled, and improvements show opportunity costs as absent improvements for indicators, which are not object to financial incentives (in some cases for the same disease). These observations can be explained by the hypothesis that P4P programs have characteristics of fee-for-service reimbursement, if symmetric information is available for insurance and provider. P4P programs are local instruments. While integration of healthcare is considered as an important issue, they should be combined with programs and incentives which foster further vertical and horizontal integration. For Germany, further research in the implementation and effects of P4P programs is necessary.

5 CFR 9701.342 - Performance pay increases.

Code of Federal Regulations, 2011 CFR

2011-01-01

... pools and may adjust those amounts based on overall levels of organizational performance or contribution... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Performance pay increases. 9701.342... HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Performance-Based Pay § 9701.342...

28 CFR 345.59 - Inmate performance pay.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Inmate performance pay. 345.59 Section... INDUSTRIES (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.59 Inmate performance pay. Inmate workers for FPI may also receive Inmate Performance Pay for participation in programs where this award is made...

Pay for performance in commercial HMOs.

PubMed

Rosenthal, Meredith B; Landon, Bruce E; Normand, Sharon-Lise T; Frank, Richard G; Epstein, Arnold M

2006-11-02

Pay for performance has increasingly become the subject of intense interest and debate, both of which have been heightened as the Centers for Medicare and Medicaid Services moves closer to adopting this approach for Medicare. Although many claims have been made for the effectiveness of this approach, the extent of its national penetration remains unknown. We surveyed a sample of 252 health maintenance organizations (HMOs) (response rate, 96%) drawn from 41 metropolitan areas across the nation about use of pay for performance. We determined the prevalence of pay-for-performance programs, detailed the features of such programs, and examined the adoption of pay for performance as a function of the characteristics of both the health plans and markets. More than half the HMOs, representing more than 80% of persons enrolled, use pay for performance in their provider contracts. Of the 126 health plans with pay-for-performance programs, nearly 90% had programs for physicians and 38% had programs for hospitals. Use of pay for performance was statistically associated with geographic region, use of primary care providers (PCPs) as gatekeepers, use of capitation to pay PCPs, and whether the plans themselves received bonuses or penalties according to performance. Pay for performance is now commonly used by HMOs, especially those that are situated to assign responsibility for a particular patient to a PCP or medical group. As the design of Medicare with pay for performance moves forward, it will be important to leverage the early experience of pay for performance in the commercial market. Copyright 2006 Massachusetts Medical Society.

Paying for quality not quantity: a wisconsin health maintenance organization proposes an incentive model for reimbursement of chiropractic services.

PubMed

Pursel, Kevin J; Jacobson, Martin; Stephenson, Kathy

2012-07-01

The purpose of this study is to describe a reimbursement model that was developed by one Health Maintenance Organization (HMO) to transition from fee-for-service to add a combination of pay for performance and reporting model of reimbursement for chiropractic care. The previous incentive program used by the HMO provided best-practice education and additional reimbursement incentives for achieving the National Committee for Quality Assurance Back Pain Recognition Program (NCQA-BPRP) recognition status. However, this model had not leveled costs between doctors of chiropractic (DCs). Therefore, the HMO management aimed to develop a reimbursement model to incentivize providers to embrace existing best-practice models and report existing quality metrics. The development goals included the following: it should (1) be as financially predictable as the previous system, (2) cost no more on a per-member basis, (3) meet the coverage needs of its members, and (4) be able to be operationalized. The model should also reward DCs who embraced best practices with compensation, not simply tied to providing more procedures, the new program needed to (1) cause little or no disruption in current billing, (2) be grounded achievable and defined expectations for improvement in quality, and (3) be voluntary, without being unduly punitive, should the DC choose not to participate in the program. The generated model was named the Comprehensive Chiropractic Quality Reimbursement Methodology (CCQRM; pronounced "Quorum"). In this hybrid model, additional reimbursement, beyond pay-for-procedures will be based on unique payment interpretations reporting selected, existing Physician Quality Reporting System (PQRS) codes, meaningful use of electronic health records, and achieving NCQA-BPRP recognition. This model aims to compensate providers using pay-for-performance, pay-for-quality reporting, pay-for-procedure methods. The CCQRM reimbursement model was developed to address the current needs of one HMO that aims to transition from fee-for-service to a pay-for-performance and quality reporting for reimbursement for chiropractic care. This model is theoretically based on the combination of a fee-for-service payment, pay for participation (NCQA Back Pain Recognition Program payment), meaningful use of electronic health record payment, and pay for reporting (PQRS-BPMG payment). Evaluation of this model needs to be implemented to determine if it will achieve its intended goals. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

Ethnic Disparities in Diabetes Management and Pay-for-Performance in the UK: The Wandsworth Prospective Diabetes Study

PubMed Central

Millett, Christopher; Gray, Jeremy; Saxena, Sonia; Netuveli, Gopalakrishnan; Khunti, Kamlesh; Majeed, Azeem

2007-01-01

Background Pay-for-performance rewards health-care providers by paying them more if they succeed in meeting performance targets. A new contract for general practitioners in the United Kingdom represents the most radical shift towards pay-for-performance seen in any health-care system. The contract provides an important opportunity to address disparities in chronic disease management between ethnic and socioeconomic groups. We examined disparities in management of people with diabetes and intermediate clinical outcomes within a multiethnic population in primary care before and after the introduction of the new contract in April 2004. Methods and Findings We conducted a population-based longitudinal survey, using electronic general practice records, in an ethnically diverse part of southwest London. Outcome measures were prescribing levels and achievement of national treatment targets (HbA1c ≤ 7.0%; blood pressure [BP] < 140/80 mm Hg; total cholesterol ≤ 5 mmol/l or 193 mg/dl). The proportion of patients reaching treatment targets for HbA1c, BP, and total cholesterol increased significantly after the implementation of the new contract. The extents of these increases were broadly uniform across ethnic groups, with the exception of the black Caribbean patient group, which had a significantly lower improvement in HbA1c (adjusted odds ratio [AOR] 0.75, 95% confidence interval [CI] 0.57–0.97) and BP control (AOR 0.65, 95% CI 0.53–0.81) relative to the white British patient group. Variations in prescribing and achievement of treatment targets between ethnic groups present in 2003 were not attenuated in 2005. Conclusions Pay-for-performance incentives have not addressed disparities in the management and control of diabetes between ethnic groups. Quality improvement initiatives must place greater emphasis on minority communities to avoid continued disparities in mortality from cardiovascular disease and the other major complications of diabetes. PMID:17564486

Ethnic disparities in diabetes management and pay-for-performance in the UK: the Wandsworth Prospective Diabetes Study.

PubMed

Millett, Christopher; Gray, Jeremy; Saxena, Sonia; Netuveli, Gopalakrishnan; Khunti, Kamlesh; Majeed, Azeem

2007-06-01

Pay-for-performance rewards health-care providers by paying them more if they succeed in meeting performance targets. A new contract for general practitioners in the United Kingdom represents the most radical shift towards pay-for-performance seen in any health-care system. The contract provides an important opportunity to address disparities in chronic disease management between ethnic and socioeconomic groups. We examined disparities in management of people with diabetes and intermediate clinical outcomes within a multiethnic population in primary care before and after the introduction of the new contract in April 2004. We conducted a population-based longitudinal survey, using electronic general practice records, in an ethnically diverse part of southwest London. Outcome measures were prescribing levels and achievement of national treatment targets (HbA1c < or = 7.0%; blood pressure [BP] < 140/80 mm Hg; total cholesterol < or = 5 mmol/l or 193 mg/dl). The proportion of patients reaching treatment targets for HbA1c, BP, and total cholesterol increased significantly after the implementation of the new contract. The extents of these increases were broadly uniform across ethnic groups, with the exception of the black Caribbean patient group, which had a significantly lower improvement in HbA1c (adjusted odds ratio [AOR] 0.75, 95% confidence interval [CI] 0.57-0.97) and BP control (AOR 0.65, 95% CI 0.53-0.81) relative to the white British patient group. Variations in prescribing and achievement of treatment targets between ethnic groups present in 2003 were not attenuated in 2005. Pay-for-performance incentives have not addressed disparities in the management and control of diabetes between ethnic groups. Quality improvement initiatives must place greater emphasis on minority communities to avoid continued disparities in mortality from cardiovascular disease and the other major complications of diabetes.

5 CFR 9701.342 - Performance pay increases.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Performance pay increases. 9701.342 Section 9701.342 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT... HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Performance-Based Pay § 9701.342...

Managing pay for performance: aligning social science research with budget predictability.

PubMed

Rosenau, Pauline Vaillancourt; Lal, Lincy S; Lako, Christiaan

2012-01-01

Managers and policymakers are seeking practical guidelines for assessing the outcomes of emerging pay-for-performance (P4P) programs. Evaluations of P4P programs published to date are mixed-some are confusing-and methodological problems with them are common. This article first identifies and summarizes obstacles to implementing effective P4P programs. Second, it describes results from social science research going back several decades to support evidence-based P4P best practices. Among the findings from this research, the zero-sum and "earn it back" P4P incentive systems have important drawbacks and may be counterproductive, neither reducing health system costs nor improving quality. The research suggests that punishing participants for low performance may further reduce individuals' performance, especially when involvement is required. We suggest that optimal P4P systems are those that reward all participants for performance improvements. Third, the article links P4P design to budgetary considerations. P4P program designs that provide incentives while improving quality and reducing costs are critical if budget neutrality is a priority for the organization and its resources are limited. In these types of P4P designs, cost calculations are straightforward: The greater the participation, the higher the savings. The article concludes by recommending an evidence-based P4P approach for practitioners that can be implemented without large upfront investment. More research on this topic is also advised.

Developing physician pay arrangements: the cash and care equation.

PubMed

Levitch, J H

1998-11-01

Developing physician compensation packages that help a healthcare organization meet its business objectives while satisfying physician pay expectations requires new ways of linking pay to physician performance. Such compensation arrangements specifically should include pay tied to defined performance standards, compensation linked to group performance, performance incentives based on realistic, achievable goals, work performance measured by common criteria, and similar pay ensured for similar work. Final pay arrangements also should include items that are sometimes overlooked, such as fully delineated job responsibilities, performance measures aligned correctly with performance areas, and the value of benefits considered in the cash compensation levels.

Transparency and Accountability: "Implementing a Postsecondary Institution Rating System That Empowers Students While Avoiding Unintended Consequences"

ERIC Educational Resources Information Center

Harmon, Tim; Cielinski, Anna

2014-01-01

In an economy that increasingly demands postsecondary credentials to access high-paying jobs with the potential for career advancement, students need comprehensive and reliable information to make better college and career choices. This need has prompted a vigorous national dialogue about the best way to provide information on the performance of…

5 CFR 430.401 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Law 107-296, the Homeland Security Act of 2002; November 25, 2002), which provides a higher aggregate... calendar year up to the rate for level I of the Executive Schedule under 5 U.S.C. 5307(a) and 5 CFR 530.203... Performance Appraisal Certification for Pay Purposes § 430.401 Purpose. (a) This subpart implements 5 U.S.C...

A probability metric for identifying high-performing facilities: an application for pay-for-performance programs.

PubMed

Shwartz, Michael; Peköz, Erol A; Burgess, James F; Christiansen, Cindy L; Rosen, Amy K; Berlowitz, Dan

2014-12-01

Two approaches are commonly used for identifying high-performing facilities on a performance measure: one, that the facility is in a top quantile (eg, quintile or quartile); and two, that a confidence interval is below (or above) the average of the measure for all facilities. This type of yes/no designation often does not do well in distinguishing high-performing from average-performing facilities. To illustrate an alternative continuous-valued metric for profiling facilities--the probability a facility is in a top quantile--and show the implications of using this metric for profiling and pay-for-performance. We created a composite measure of quality from fiscal year 2007 data based on 28 quality indicators from 112 Veterans Health Administration nursing homes. A Bayesian hierarchical multivariate normal-binomial model was used to estimate shrunken rates of the 28 quality indicators, which were combined into a composite measure using opportunity-based weights. Rates were estimated using Markov Chain Monte Carlo methods as implemented in WinBUGS. The probability metric was calculated from the simulation replications. Our probability metric allowed better discrimination of high performers than the point or interval estimate of the composite score. In a pay-for-performance program, a smaller top quantile (eg, a quintile) resulted in more resources being allocated to the highest performers, whereas a larger top quantile (eg, being above the median) distinguished less among high performers and allocated more resources to average performers. The probability metric has potential but needs to be evaluated by stakeholders in different types of delivery systems.

Willingness to participate and Pay for a proposed national health insurance in St. Vincent and the grenadines: a cross-sectional contingent valuation approach.

PubMed

Adams, Rosmond; Chou, Yiing-Jenq; Pu, Christy

2015-04-09

Numerous Caribbean countries are considering implementing National Health Insurance (NHI) and pooling resources to finance their health sectors. Based on this increased interest in health insurance, we investigated the willingness to participate and to pay for NHI in St. Vincent and the Grenadines, an upper-middle-income Caribbean country. Four hundred heads of household in St. Vincent and the Grenadines were interviewed in August 2012 and September 2012. The samples were selected through simple random sampling, including the stratification of rural, semiurban, and urban communities to ensure the representativeness of the sample. A contingent valuation method with a pretested interviewer-led questionnaire was used. Respondents were presented with a hypothetical NHI plan. Chi-squared analysis was performed to identify factors that are associated with the willingness to participate. Multiple logistic regression was used to explore the factors that influence respondents' willingness to pay. In total, 69.5% (n = 278) of the respondents indicated that they were willing to participate in the proposed NHI plan, of whom 72.3% were willing to pay for the first bid (EC$50). When the bid was reduced to EC$25, all of the remaining respondents who indicated they were willing to participate were willing to pay this lowered bid. Overall, the respondents were willing to pay EC$77.83 (US$28.83) per month for each person to enroll in the NHI plan. Age, income, and having some form of health insurance were significantly associated with a willingness to participate in the plan. A higher socioeconomic status was the principal determinant factor for the willingness to participate. This is similar to studies on developing economies. The government can use these findings to guide the successful implementation of the proposed NHI program. People with a lower socioeconomic status must be engaged from the start of and throughout the development process to enhance their understanding of and participation in the plan.

50 CFR 510.9 - Uniform pay guidelines.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 50 Wildlife and Fisheries 11 2012-10-01 2012-10-01 false Uniform pay guidelines. 510.9 Section 510.9 Wildlife and Fisheries MARINE MAMMAL COMMISSION IMPLEMENTATION OF THE FEDERAL ADVISORY COMMITTEE ACT § 510.9 Uniform pay guidelines. (a) Compensation of members and staff of, and consultants to the...

50 CFR 510.9 - Uniform pay guidelines.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 50 Wildlife and Fisheries 9 2011-10-01 2011-10-01 false Uniform pay guidelines. 510.9 Section 510.9 Wildlife and Fisheries MARINE MAMMAL COMMISSION IMPLEMENTATION OF THE FEDERAL ADVISORY COMMITTEE ACT § 510.9 Uniform pay guidelines. (a) Compensation of members and staff of, and consultants to the...

50 CFR 510.9 - Uniform pay guidelines.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 50 Wildlife and Fisheries 11 2014-10-01 2014-10-01 false Uniform pay guidelines. 510.9 Section 510.9 Wildlife and Fisheries MARINE MAMMAL COMMISSION IMPLEMENTATION OF THE FEDERAL ADVISORY COMMITTEE ACT § 510.9 Uniform pay guidelines. (a) Compensation of members and staff of, and consultants to the...

50 CFR 510.9 - Uniform pay guidelines.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 50 Wildlife and Fisheries 11 2013-10-01 2013-10-01 false Uniform pay guidelines. 510.9 Section 510.9 Wildlife and Fisheries MARINE MAMMAL COMMISSION IMPLEMENTATION OF THE FEDERAL ADVISORY COMMITTEE ACT § 510.9 Uniform pay guidelines. (a) Compensation of members and staff of, and consultants to the...

50 CFR 510.9 - Uniform pay guidelines.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 50 Wildlife and Fisheries 7 2010-10-01 2010-10-01 false Uniform pay guidelines. 510.9 Section 510.9 Wildlife and Fisheries MARINE MAMMAL COMMISSION IMPLEMENTATION OF THE FEDERAL ADVISORY COMMITTEE ACT § 510.9 Uniform pay guidelines. (a) Compensation of members and staff of, and consultants to the...

4 CFR 5.4 - Pay administration.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 4 Accounts 1 2010-01-01 2010-01-01 false Pay administration. 5.4 Section 5.4 Accounts GOVERNMENT ACCOUNTABILITY OFFICE PERSONNEL SYSTEM COMPENSATION § 5.4 Pay administration. The provisions of chapter 55 of title 5, U.S. Code and the Office of Personnel Management implementing regulations apply to Government...

Comparing the implementation consequences of the immunisation and emergency department health targets in New Zealand.

PubMed

Tenbensel, Tim; Chalmers, Linda; Willing, Esther

2016-09-19

Purpose Over the last decade there has been considerable debate about the merits of targets as a policy instrument. The purpose of this paper is to examine the implementation of two health targets that were cornerstones of New Zealand health policy between 2009 and 2012: immunisation rates for two-year-olds, and time to treatment, discharge or admission in hospital emergency departments. Design/methodology/approach For each policy target, the authors selected four case-study districts and conducted two waves of key-informant interviews (113 in total) with clinical and management staff involved in target implementation. Findings Despite almost identical levels of target achievement, the research reveals quite different mixes of positive and negative implementation consequences. The authors argue that the differences in implementation consequences are due to the characteristics of the performance measure; and the dynamics of the intra-organisational and inter-organisational implementation context. Research limitations/implications The research is based on interviews with clinical and management staff involved in target implementation, and this approach does not address the issue of effort substitution. Practical implications While literature on health targets pays attention to the attributes of target measures, the paper suggests that policymakers considering the use of targets pay more attention to broader implementation contexts, including the possible impact of, and effects on related services, organisations and staff. Originality/value The research focuses specifically on implementation consequences, as distinct from target success and/or changes in clinical and health outcomes. The paper also adopts a comparative approach to the study of target implementation.

28 CFR 551.108 - Performance pay.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 28 Judicial Administration 2 2014-07-01 2014-07-01 false Performance pay. 551.108 Section 551.108 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT MISCELLANEOUS Pretrial Inmates § 551.108 Performance pay. The Warden may approve a pretrial inmate for performance pay...

28 CFR 551.108 - Performance pay.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 28 Judicial Administration 2 2012-07-01 2012-07-01 false Performance pay. 551.108 Section 551.108 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT MISCELLANEOUS Pretrial Inmates § 551.108 Performance pay. The Warden may approve a pretrial inmate for performance pay...

28 CFR 551.108 - Performance pay.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Performance pay. 551.108 Section 551.108 Judicial Administration BUREAU OF PRISONS, DEPARTMENT OF JUSTICE INSTITUTIONAL MANAGEMENT MISCELLANEOUS Pretrial Inmates § 551.108 Performance pay. The Warden may approve a pretrial inmate for performance pay...

75 FR 9544 - Inmate Work and Performance Pay Program

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-03

... inmate may receive performance pay only for that portion of the month that the inmate was working... Inmate Work and Performance Pay Program AGENCY: Bureau of Prisons, Justice. ACTION: Proposed rule... work and performance pay by removing redundant language and provisions that relate solely to staff...

An Application of the Equal Pay Act to Higher Education.

ERIC Educational Resources Information Center

Green, Debra H.

1981-01-01

The applicability of legal principles governing equal pay and sex discrimination in university settings is discussed. The most objective mechanism that a university can utilize to achieve compliance with the Equal Pay Act would be implementation of a salary system that relies on experience, formal education, and time in grade. (MLW)

What can the past of pay-for-performance tell us about the future of Value-Based Purchasing in Medicare?

PubMed

Ryan, Andrew M; Damberg, Cheryl L

2013-06-01

The Medicare program has implemented pay-for-performance (P4P), or Value-Based Purchasing, for inpatient care and for Medicare Advantage plans, and plans to implement a program for physicians in 2015. In this paper, we review evidence on the effectiveness of P4P and identify design criteria deemed to be best practice in P4P. We then assess the extent to which Medicare's existing and planned Value-Based Purchasing programs align with these best practices. Of the seven identified best practices in P4P program design, the Hospital Value-Based Purchasing program is strongly aligned with two of the best practices, moderately aligned with three, weakly aligned with one, and has unclear alignment with one best practice. The Physician Value-Based Purchasing Modifier is strongly aligned with two of the best practices, moderately aligned with one, weakly aligned with three, and has unclear alignment with one of the best practices. The Medicare Advantage Quality Bonus Program is strongly aligned with four of the best practices, moderately aligned with two, and weakly aligned with one of the best practices. We identify enduring gaps in P4P literature as it relates to Medicare's plans for Value-Based Purchasing and discuss important issues in the future of these implementations in Medicare. Copyright © 2013 Elsevier Inc. All rights reserved.

Texas Educator Excellence Grant (TEEG) Program: Year Three Evaluation Report. Policy Evaluation Report

ERIC Educational Resources Information Center

Springer, Matthew G.; Lewis, Jessica L.; Podgursky, Michael J.; Ehlert, Mark W.; Gronberg, Timothy J.; Hamilton, Laura S.; Jansen, Dennis W.; Stecher, Brian M.; Taylor, Lori L.; Lopez, Omar S.; Peng, Art

2009-01-01

The Texas Educator Excellence Grant (TEEG) program was state-funded and provided annual grants to schools to design and implement performance pay plans during the 2006-07 to 2009-10 school year. This report builds on the previous TEEG evaluation reports, presenting findings from three years of the TEEG program. Overall, the report discusses the…

Peer norm guesses and self-reported attitudes towards performance-related pay.

PubMed

Georgantzis, Nikolaos; Vasileiou, Efi; Kotzaivazoglou, Iordanis

2017-01-01

Due to a variety of reasons, people see themselves differently from how they see others. This basic asymmetry has broad consequences. It leads people to judge themselves and their own behavior differently from how they judge others and others' behavior. This research, first, studies the perceptions and attitudes of Greek Public Sector employees towards the introduction of Performance-Related Pay (PRP) systems trying to reveal whether there is a divergence between individual attitudes and guesses on peers' attitudes. Secondly, it is investigated whether divergence between own self-reported and peer norm guesses could mediate the acceptance of the aforementioned implementation once job status has been controlled for. This study uses a unique questionnaire of 520 observations which was designed to address the questions outlined in the preceding lines. Our econometric results indicate that workers have heterogeneous attitudes and hold heterogeneous beliefs on others' expectations regarding a successful implementation of PRP. Specifically, individual perceptions are less skeptical towards PRP than are beliefs on others' attitudes. Additionally, we found that managers are significantly more optimistic than lower rank employees regarding the expected success of PRP systems in their jobs. However, they both expect their peers to be more negative than they themselves are.

Peer norm guesses and self-reported attitudes towards performance-related pay

PubMed Central

Vasileiou, Efi; Kotzaivazoglou, Iordanis

2017-01-01

Due to a variety of reasons, people see themselves differently from how they see others. This basic asymmetry has broad consequences. It leads people to judge themselves and their own behavior differently from how they judge others and others’ behavior. This research, first, studies the perceptions and attitudes of Greek Public Sector employees towards the introduction of Performance-Related Pay (PRP) systems trying to reveal whether there is a divergence between individual attitudes and guesses on peers’ attitudes. Secondly, it is investigated whether divergence between own self-reported and peer norm guesses could mediate the acceptance of the aforementioned implementation once job status has been controlled for. This study uses a unique questionnaire of 520 observations which was designed to address the questions outlined in the preceding lines. Our econometric results indicate that workers have heterogeneous attitudes and hold heterogeneous beliefs on others’ expectations regarding a successful implementation of PRP. Specifically, individual perceptions are less skeptical towards PRP than are beliefs on others’ attitudes. Additionally, we found that managers are significantly more optimistic than lower rank employees regarding the expected success of PRP systems in their jobs. However, they both expect their peers to be more negative than they themselves are. PMID:28414737

Pay for Performance.

ERIC Educational Resources Information Center

LaFee, Scott

1999-01-01

Top school administrators and school boards across the country are increasingly employing a private-sector incentive: bonus pay for improved (school) performance. Connecticut, Texas, and North Carolina have merit-pay clauses in superintendents' contracts. This article discusses pay-for-performance criteria, increased job expectations, and ethical…

District Awards for Teacher Excellence (D.A.T.E.) Program: Final Evaluation Report. [Executive Summary

ERIC Educational Resources Information Center

Springer, Matthew G.; Lewis, Jessica L.; Ehlert, Mark W.; Podgursky, Michael J.; Crader, Gary D.; Taylor, Lori L.; Gronberg, Timothy J.; Jansen, Dennis W.; Lopez, Omar S.; Stuit, David A.

2010-01-01

District Awards for Teacher Excellence (D.A.T.E.) is a state-funded program in Texas that provides grants to districts for the implementation of locally-designed incentive pay plans. All districts in the state are eligible to receive grants, but participation is voluntary. D.A.T.E. incentive pay plans were first implemented in Texas districts…

District Awards for Teacher Excellence (D.A.T.E.) Program: Final Evaluation Report. Policy Evaluation Report

ERIC Educational Resources Information Center

Springer, Matthew G.; Lewis, Jessica L.; Ehlert, Mark W.; Podgursky, Michael J.; Crader, Gary D.; Taylor, Lori L.; Gronberg, Timothy J.; Jansen, Dennis W.; Lopez, Omar S.; Stuit, David A.

2010-01-01

District Awards for Teacher Excellence (D.A.T.E.) is a state-funded program in Texas that provides grants to districts for the implementation of locally-designed incentive pay plans. All districts in the state are eligible to receive grants, but participation is voluntary. D.A.T.E. incentive pay plans were first implemented in Texas districts…

Incentive Design and Quality Improvements: Evidence from State Medicaid Nursing Home Pay-for-Performance Programs.

PubMed

Konetzka, R Tamara; Skira, Meghan M; Werner, Rachel M

2018-01-01

Pay-for-performance (P4P) programs have become a popular policy tool aimed at improving health care quality. We analyze how incentive design affects quality improvements in the nursing home setting, where several state Medicaid agencies have implemented P4P programs that vary in incentive structure. Using the Minimum Data Set and the Online Survey, Certification, and Reporting data from 2001 to 2009, we examine how the weights put on various performance measures that are tied to P4P bonuses, such as clinical outcomes, inspection deficiencies, and staffing levels, affect improvements in those measures. We find larger weights on clinical outcomes often lead to larger improvements, but small weights can lead to no improvement or worsening of some clinical outcomes. We find a qualifier for P4P eligibility based on having few or no severe inspection deficiencies is more effective at decreasing inspection deficiencies than using weights, suggesting simple rules for participation may incent larger improvement.

The Impact of a Pay-for-Performance Program on Central Line-Associated Blood Stream Infections in Pennsylvania.

PubMed

Bastian, Nathaniel D; Kang, Hyojung; Nembhard, Harriet B; Bloschichak, Andrew; Griffin, Paul M

2016-01-01

Healthcare associated infections have significantly contributed to the rising cost of hospital care in the United States. The implementation of pay-for-performance (P4P) programs has been one approach to improve quality at a reduced cost. We quantify the impact of Highmark's Quality Blue (QB) hospital P4P program on central line-associated blood stream infections (CLABSI) in Pennsylvania. The impact of years of participation in QB on CLABSI is also evaluated. Data from 149 Pennsylvania hospitals on CLABSI from 2008-2013 are used. Negative binomial regression and fixed effects panel regression are performed. Hospitals participating in QB have 0.727 times the CLABSI as those hospitals that do not participate. Hospitals participating for four or more years have on average 3.13 fewer CLABSI per year compared to those participating for less than four years. Highmark's P4P program has shown improved outcomes with regards to CLABSI, but further research is needed to determine if QB is cost effective.

Incentive Design and Quality Improvements: Evidence from State Medicaid Nursing Home Pay-for-Performance Programs

PubMed Central

Konetzka, R. Tamara; Skira, Meghan M.; Werner, Rachel M.

2017-01-01

Pay-for-performance (P4P) programs have become a popular policy tool aimed at improving health care quality. We analyze how incentive design affects quality improvements in the nursing home setting, where several state Medicaid agencies have implemented P4P programs that vary in incentive structure. Using the Minimum Data Set and the Online Survey, Certification, and Reporting data from 2001 to 2009, we examine how the weights put on various performance measures that are tied to P4P bonuses, such as clinical outcomes, inspection deficiencies, and staffing levels, affect improvements in those measures. We find larger weights on clinical outcomes often lead to larger improvements, but small weights can lead to no improvement or worsening of some clinical outcomes. We find a qualifier for P4P eligibility based on having few or no severe inspection deficiencies is more effective at decreasing inspection deficiencies than using weights, suggesting simple rules for participation may incent larger improvement. PMID:29594189

77 FR 70381 - General Schedule Locality Pay Areas

Federal Register 2010, 2011, 2012, 2013, 2014

2012-11-26

... based on appropriate factors, which may include local labor market patterns, commuting patterns, and the... Implementation The proposed rule will have no effect on existing locality pay area definitions but will prevent...

Long-Term Effects of Teacher Performance Pay: Experimental Evidence from India

ERIC Educational Resources Information Center

Muralidharan, Karthik

2012-01-01

While the idea of teacher performance-pay is increasingly making its way into policy, the evidence on the effectiveness of such programs is both limited and mixed. The central questions in the literature on teacher performance pay to date have been whether teacher performance pay based on test scores can improve student achievement, and whether…

Managing effectively in the downsized organization.

PubMed

Arnold, Edwin; Pulich, Marcia

2003-01-01

Many health care institutions have downsized in recent years for a variety of reasons including cost savings and the need to be proactive in restructuring the organization for more effective performance. In a downsized organization, top management must develop new strategies to enable line managers at all levels to operate effectively. New policies for human resource strategic planning, selective hiring, employee empowerment, training and development, reduction of status distinctions, sharing of appropriate information with employees, and paying for performance must be implemented.

Regulatory Policy and Markets for Energy Storage in North America

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kintner-Meyer, Michael CW

2014-05-14

The last 5 years have been one of the most exciting times for the energy storage industry. We have seen significant advancements in the regulatory process to make accommodations for valuing and monetizing energy storage for what it provides to the grid. The most impactful regulatory decision for the energy storage industry has come from California, where the California Public Utilities Commission issued a decision that mandates procurement requirements of 1.325 GW for energy storage to 3 investor-own utilities in 4 stages: in 2014, 2016, 2018, and 2020. Furthermore, at the Federal level, FERC’s Order 755, requires the transmission operatorsmore » to develop pay for performance tariffs for ancillary services. This has had direct impact on the market design of US competitive wholesale markets and the monetization of fast responding grid assets. While this order is technology neutral, it clearly plays into the fast-responding capability of energy storage technologies. Today PJM, CAISO, MISO, NYISO, and NE-ISO have implemented Order 755 and offer new tariff for regulation services based on pay-for-performance principles. Furthermore, FERC Order 784, issued in July 2013 requires transmission providers to consider speed and accuracy in determining the requirements for ancillary services. In November 2013, FERC issued Order 972, which revises the small generator interconnection agreement which declares energy storage as a power source. This order puts energy storage on par with existing generators. This paper will discuss the implementation of FERC’s Pay for Performance Regulation order at all ISOs in the U.S. under FERC regulatory authority (this excludes ERCOT). Also discussed will be the market impacts and overall impacts on the NERC regulation performance indexes. The paper will end with a discussion on the California and Ontario, Canada procurement mandates and the opportunity that it may present to the energy storage industry.« less

28 CFR 545.26 - Performance pay provisions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... categories as quality of work, quantity of work, initiative, ability to learn, dependability, response to... inmate may receive special bonus pay based on the inmate's exceptional work in a temporary job assignment... WORK AND COMPENSATION Inmate Work and Performance Pay Program § 545.26 Performance pay provisions. (a...

28 CFR 545.26 - Performance pay provisions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... categories as quality of work, quantity of work, initiative, ability to learn, dependability, response to... inmate may receive special bonus pay based on the inmate's exceptional work in a temporary job assignment... WORK AND COMPENSATION Inmate Work and Performance Pay Program § 545.26 Performance pay provisions. (a...

Relationship between organizational factors and performance among pay-for-performance hospitals.

PubMed

Vina, Ernest R; Rhew, David C; Weingarten, Scott R; Weingarten, Jason B; Chang, John T

2009-07-01

The Centers for Medicare & Medicaid Services (CMS)/Premier Hospital Quality Incentive Demonstration (HQID) project aims to improve clinical performance through a pay-for-performance program. We conducted this study to identify the key organizational factors associated with higher performance. An investigator-blinded, structured telephone survey of eligible hospitals' (N = 92) quality improvement (QI) leaders was conducted among HQID hospitals in the top 2 or bottom 2 deciles submitting performance measure data from October 2004 to September 2005. The survey covered topics such as QI interventions, data feedback, physician leadership, support for QI efforts, and organizational culture. More top performing hospitals used clinical pathways for the treatment of AMI (49% vs. 15%, p < 0.01), HF (44% vs. 18%, p < 0.01), PN (38% vs. 13%, p < 0.01) and THR/TKR (56% vs. 23%, p < 0.01); organized into multidisciplinary teams to manage patients with AMI (93% vs. 77%, p < 0.05) and HF (93% vs. 69%, p < 0.01); used order sets for the treatment of THR/TKR (91% vs. 64%, p < 0.01); and implemented computerized physician order entry in the hospital (24.4% vs. 7.9%, p < 0.05). Finally, more top performers reported having adequate human resources for QI projects (p < 0.01); support of the nursing staff to increase adherence to quality indicators (p < 0.01); and an organizational culture that supported coordination of care (p < 0.01), pace of change (p < 0.01), willingness to try new projects (p < 0.01), and a focus on identifying system errors rather than blaming individuals (p < 0.05). Organizational structure, support, and culture are associated with high performance among hospitals participating in a pay-for-performance demonstration project. Multiple organizational factors remain important in optimizing clinical care.

Equivocating on the polluter-pays principle: The consequences for Pakistan.

PubMed

Luken, Ralph A

2009-08-01

The polluter-pays principle has been widely implemented in OECD countries and credited for bring about a significant reduction in pollutant discharge. However, it has had only limited implementation in developing countries. The consequences of not implementing it in developing countries, to the extent they are documented, are limited to estimating the economic damages of environmental degradation. Yet there are several other but seldom documented negative consequences of the failure to implement the polluter-pays principle. These consequences are documented in the case of Pakistan. They include limited construction of effluent treatment plants, heavy dependence on the government and international donors for funding the only two operational common effluent treatment plants, significant operational issues at the two common effluent treatment plants, missed opportunities to build cost-effective common effluent treatment plants and minimal environmental improvements from isolated investments in individual effluent treatment plants in addition to the already documented significant level of environmental degradation due to uncontrolled pollutant discharge.

Implementing Value-Based Payment Reform: A Conceptual Framework and Case Examples.

PubMed

Conrad, Douglas A; Vaughn, Matthew; Grembowski, David; Marcus-Smith, Miriam

2016-08-01

This article develops a conceptual framework for implementation of value-based payment (VBP) reform and then draws on that framework to systematically examine six distinct multi-stakeholder coalition VBP initiatives in three different regions of the United States. The VBP initiatives deploy the following payment models: reference pricing, "shadow" primary care capitation, bundled payment, pay for performance, shared savings within accountable care organizations, and global payment. The conceptual framework synthesizes prior models of VBP implementation. It describes how context, project objectives, payment and care delivery strategies, and the barriers and facilitators to translating strategy into implementation affect VBP implementation and value for patients. We next apply the framework to six case examples of implementation, and conclude by discussing the implications of the case examples and the conceptual framework for future practice and research. © The Author(s) 2015.

Paying for performance in healthcare organisations

PubMed Central

McDonald, Ruth

2014-01-01

Aligning Financial Incentives (FIs) to health policy goals is becoming increasingly popular. In many cases, such initiatives have failed to deliver anticipated benefits. Attributing this to the actions of self-interested and resistant professionals is not an entirely helpful approach. It is important to avoid simplistic assumptions to build knowledge of how and why schemes are implemented in practice to inform future policy in this area. PMID:24639977

Paying for performance in healthcare organisations.

PubMed

McDonald, Ruth

2014-02-01

Aligning Financial Incentives (FIs) to health policy goals is becoming increasingly popular. In many cases, such initiatives have failed to deliver anticipated benefits. Attributing this to the actions of self-interested and resistant professionals is not an entirely helpful approach. It is important to avoid simplistic assumptions to build knowledge of how and why schemes are implemented in practice to inform future policy in this area.

District Awards for Teacher Excellence (D.A.T.E.) Program: Year One Evaluation Report. Policy Evaluation Report. [Executive Summary

ERIC Educational Resources Information Center

Springer, Matthew G.; Lewis, Jessica L.; Podgursky, Michael J.; Ehlert, Mark W.; Taylor, Lori L.; Lopez, Omar S.; Ghoshdastidar, Bonnie; Peng, Art

2010-01-01

The District Awards for Teacher Excellence's (D.A.T.E.'s) first year of implementation in 2008-09 occurred at a time when Texas was operating several state-funded performance pay programs. The three-year Governor's Educator Excellence Grant (G.E.E.G.) program was coming to its expected completion, while the Texas Educator Excellence Grant…

District Awards for Teacher Excellence (D.A.T.E.) Program: Year One Evaluation Report. Policy Evaluation Report

ERIC Educational Resources Information Center

Springer, Matthew G.; Lewis, Jessica L.; Podgursky, Michael J.; Ehlert, Mark W.; Taylor, Lori L.; Lopez, Omar S.; Ghosh-Dastidar, Bonnie; Peng, Art

2010-01-01

District Awards for Teacher Excellence (D.A.T.E.) is a state-funded program in Texas that provides grants to districts for the implementation of locally-designed performance pay plans. All districts in the state are eligible to receive grants, but participation is voluntary. As D.A.T.E. continues in its second year of operation with approximately…

Financial Management. Working for Clean Water: An Information Program for Advisory Groups. Instructor Guide.

ERIC Educational Resources Information Center

Auker, Dennis; And Others

The implementation of water quality programs in the face of rising costs raises many questions for states and local communities, including: How much can taxpayers afford to pay? Who will pay? How can they pay? Described is an hour-long learning session on financial management that is designed to help citizen advisory groups play an integral role…

Pay-for-virtue: an option to improve pay-for-performance?

PubMed

Buetow, Stephen; Entwistle, Vikki

2011-10-01

Pay-for-performance schemes reward standardized professional behaviours associated with effective care. However, they neglect the significance of virtue and devalue and erode professional motivation based on virtue. Pay for training to cultivate virtue, and/or pay-for-virtue, may mitigate these dangers. Although virtue is typically considered its own reward, and the assessment of virtue is problematic, pay-for-virtue could involve (1) stringent checks on the appropriateness of the standardized care currently rewarded by pay-for-performance for individual patients or (2) pay for indicators of virtue. These indicators could be based on virtues identified from a framework of universal virtues and through logical inferences from features of practice. It is possible that pay-for-virtue could ultimately strengthen health professionals' intrinsic motivation for good practice, but this and the broader effects of pay-for-virtue would need careful investigation. © 2011 Blackwell Publishing Ltd.

Multiple effects of performance-contingent pay for wait-persons

PubMed Central

George, James T.; Hopkins, B. L.

1989-01-01

The owners of three restaurants requested help with the pay of waitpersons who were paid by the hour. The waitpersons asked for raises which the owners said they could not afford. This research changed the method of compensating waitpersons by making their pay contingent on dollars of food sold. Increased productivity and increased earnings per hour of work for all of the waitpersons followed the beginning of the performance-contingent pay. Most of the waitpersons also earned increased take-home pay when the performance-contingent pay began. There was little improvement in labor costs per dollar of food sold, a measure of benefit to the owners. The fact that benefits to workers occurred without benefits to owners is contrary to common views about the effects of performance-contingent pay. PMID:16795723

5 CFR 9901.344 - Other performance payments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 3 2011-01-01 2011-01-01 false Other performance payments. 9901.344... SECURITY PERSONNEL SYSTEM (NSPS) Pay and Pay Administration Performance-Based Pay § 9901.344 Other performance payments. (a) The decision to grant other performance payouts, including the amount of such...

Improving health systems performance in low- and middle-income countries: a system dynamics model of the pay-for-performance initiative in Afghanistan.

PubMed

Alonge, O; Lin, S; Igusa, T; Peters, D H

2017-12-01

System dynamics methods were used to explore effective implementation pathways for improving health systems performance through pay-for-performance (P4P) schemes. A causal loop diagram was developed to delineate primary causal relationships for service delivery within primary health facilities. A quantitative stock-and-flow model was developed next. The stock-and-flow model was then used to simulate the impact of various P4P implementation scenarios on quality and volume of services. Data from the Afghanistan national facility survey in 2012 was used to calibrate the model. The models show that P4P bonuses could increase health workers' motivation leading to higher levels of quality and volume of services. Gaming could reduce or even reverse this desired effect, leading to levels of quality and volume of services that are below baseline levels. Implementation issues, such as delays in the disbursement of P4P bonuses and low levels of P4P bonuses, also reduce the desired effect of P4P on quality and volume, but they do not cause the outputs to fall below baseline levels. Optimal effect of P4P on quality and volume of services is obtained when P4P bonuses are distributed per the health workers' contributions to the services that triggered the payments. Other distribution algorithms such as equal allocation or allocations proportionate to salaries resulted in quality and volume levels that were substantially lower, sometimes below baseline. The system dynamics models served to inform, with quantitative results, the theory of change underlying P4P intervention. Specific implementation strategies, such as prompt disbursement of adequate levels of performance bonus distributed per health workers' contribution to service, increase the likelihood of P4P success. Poorly designed P4P schemes, such as those without an optimal algorithm for distributing performance bonuses and adequate safeguards for gaming, can have a negative overall impact on health service delivery systems. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

5 CFR 9901.344 - Other performance payments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... RELATIONS SYSTEMS (DEPARTMENT OF DEFENSE-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF DEFENSE NATIONAL SECURITY PERSONNEL SYSTEM (NSPS) Pay and Pay Administration Performance-Based Pay § 9901.344 Other... officials may make other performance payments to— (1) Reward extraordinary individual performance, as...

The Effects of Objective Feedback on Performance when Individuals Receive Fixed and Individual Incentive Pay

ERIC Educational Resources Information Center

Johnson, Douglas A.; Dickinson, Alyce M.; Huitema, Bradley E.

2008-01-01

We examined whether objective feedback would enhance performance when individuals were paid monetary incentives. A two-by-two factorial design was used, with 123 college students assigned to incentive pay without feedback, incentive pay with feedback, fixed pay without feedback, or fixed pay with feedback. Participants attended six sessions and…

An Evaluation of Performance Thresholds in Nursing Home Pay-for-Performance.

PubMed

Werner, Rachel M; Skira, Meghan; Konetzka, R Tamara

2016-12-01

Performance thresholds are commonly used in pay-for-performance (P4P) incentives, where providers receive a bonus payment for achieving a prespecified target threshold but may produce discontinuous incentives, with providers just below the threshold having the strongest incentive to improve and providers either far below or above the threshold having little incentive. We investigate the effect of performance thresholds on provider response in the setting of nursing home P4P. The Minimum Data Set (MDS) and Online Survey, Certification, and Reporting (OSCAR) datasets. Difference-in-differences design to test for changes in nursing home performance in three states that implemented threshold-based P4P (Colorado, Georgia, and Oklahoma) versus three comparator states (Arizona, Tennessee, and Arkansas) between 2006 and 2009. We find that those farthest below the threshold (i.e., the worst-performing nursing homes) had the largest improvements under threshold-based P4P while those farthest above the threshold worsened. This effect did not vary with the percentage of Medicaid residents in a nursing home. Threshold-based P4P may provide perverse incentives for nursing homes above the performance threshold, but we do not find evidence to support concerns about the effects of performance thresholds on low-performing nursing homes. © Health Research and Educational Trust.

Pay-for-performance in nursing homes.

PubMed

Briesacher, Becky A; Field, Terry S; Baril, Joann; Gurwitz, Jerry H

2009-01-01

Information on the impact of pay-for-performance programs is lacking in the nursing home setting. This literature review (1980-2007) identified 13 prior examples of pay-for-performance programs in the nursing home setting: 7 programs were active as of 2007, while 6 had been terminated. The programs were mostly short-lived, varied considerably in the choice of performance measures and pay incentives, and evaluations of the impact were rare.

Improving cardiovascular care through outpatient cardiac rehabilitation: an analysis of payment models that would improve quality and promote use.

PubMed

Mead, Holly; Grantham, Sarah; Siegel, Bruce

2014-01-01

Much attention has been paid to improving the care of patients with cardiovascular disease by focusing attention on delivery system redesign and payment reforms that encompass the healthcare spectrum, from an acute episode to maintenance of care. However, 1 area of cardiovascular disease care that has received little attention in the advancement of quality is cardiac rehabilitation (CR), a comprehensive secondary prevention program that is significantly underused despite evidence-based guidelines that recommending its use. The purpose of this article was to analyze the applicability of 2 payment and reimbursement models-pay-for-performance and bundled payments for episodes of care--that can promote the use of CR. We conclude that a payment model combining elements of both pay-for-performance and episodes of care would increase the use of CR, which would both improve quality and increase efficiency in cardiac care. Specific elements would need to be clearly defined, however, including: (a) how an episode is defined, (b) how to hold providers accountable for the care they provider, (c) how to encourage participation among CR providers, and (d) how to determine an equitable distribution of payment. Demonstrations testing new payment models must be implemented to generate empirical evidence that a melded pay-for-performance and episode-based care payment model will improve quality and efficiency.

Paying for what was free: lessons from the New York Times paywall.

PubMed

Cook, Jonathan E; Attari, Shahzeen Z

2012-12-01

In a national online longitudinal survey, participants reported their attitudes and behaviors in response to the recently implemented metered paywall by the New York Times. Previously free online content now requires a digital subscription to access beyond a small free monthly allotment. Participants were surveyed shortly after the paywall was announced and again 11 weeks after it was implemented to understand how they would react and adapt to this change. Most readers planned not to pay and ultimately did not. Instead, they devalued the newspaper, visited its Web site less frequently, and used loopholes, particularly those who thought the paywall would lead to inequality. Results of an experimental justification manipulation revealed that framing the paywall in terms of financial necessity moderately increased support and willingness to pay. Framing the paywall in terms of a profit motive proved to be a noncompelling justification, sharply decreasing both support and willingness to pay. Results suggest that people react negatively to paying for previously free content, but change can be facilitated with compelling justifications that emphasize fairness.

Sustainable business models: systematic approach toward successful ambulatory care pharmacy practice.

PubMed

Sachdev, Gloria

2014-08-15

This article discusses considerations for making ambulatory care pharmacist services at least cost neutral and, ideally, generate a margin that allows for service expansion. The four pillars of business sustainability are leadership, staffing, information technology, and compensation. A key facet of leadership in ambulatory care pharmacy practice is creating and expressing a clear vision for pharmacists' services. Staffing considerations include establishing training needs, maximizing efficiencies, and minimizing costs. Information technology is essential for efficiency in patient care delivery and outcomes assessment. The three domains of compensation are cost savings, pay for performance, and revenue generation. The following eight steps for designing and implementing an ambulatory care pharmacist service are discussed: (1) prepare a needs assessment, (2) analyze existing strengths, weaknesses, opportunities, and threats, (3) analyze service gaps and feasibility, (4) consider financial opportunities, (5) consider stakeholders' interests, (6) develop a business plan, (7) implement the service, and (8) measure outcomes. Potential future changes in national healthcare policy (such as pharmacist provider status and expanded pay for performance) could enhance the opportunities for sustainable ambulatory care pharmacy practice. The key challenges facing ambulatory care pharmacists are developing sustainable business models, determining which services yield a positive return on investment, and demanding payment for value-added services. Copyright © 2014 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

5 CFR 534.402 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay and... contributions to the agency's performance. Performance expectations means the critical and other performance... § 430.303). PRB means Performance Review Board, as described in § 430.310. Rate of basic pay means the...

Pay dispersion and performance in teams.

PubMed

Bucciol, Alessandro; Foss, Nicolai J; Piovesan, Marco

2014-01-01

Extant research offers conflicting predictions about the effect of pay dispersion on team performance. We collected a unique dataset from the Italian soccer league to study the effect of intra-firm pay dispersion on team performance, under different definitions of what constitutes a "team". This peculiarity of our dataset can explain the conflicting evidence. Indeed, we also find positive, null, and negative effects of pay dispersion on team performance, using the same data but different definitions of team. Our results show that when the team is considered to consist of only the members who directly contribute to the outcome, high pay dispersion has a detrimental impact on team performance. Enlarging the definition of the team causes this effect to disappear or even change direction. Finally, we find that the detrimental effect of pay dispersion is due to worse individual performance, rather than a reduction of team cooperation.

Pay Dispersion and Performance in Teams

PubMed Central

Bucciol, Alessandro; Foss, Nicolai J.; Piovesan, Marco

2014-01-01

Extant research offers conflicting predictions about the effect of pay dispersion on team performance. We collected a unique dataset from the Italian soccer league to study the effect of intra-firm pay dispersion on team performance, under different definitions of what constitutes a “team”. This peculiarity of our dataset can explain the conflicting evidence. Indeed, we also find positive, null, and negative effects of pay dispersion on team performance, using the same data but different definitions of team. Our results show that when the team is considered to consist of only the members who directly contribute to the outcome, high pay dispersion has a detrimental impact on team performance. Enlarging the definition of the team causes this effect to disappear or even change direction. Finally, we find that the detrimental effect of pay dispersion is due to worse individual performance, rather than a reduction of team cooperation. PMID:25397615

The effects of pay-for-performance on tuberculosis treatment in Taiwan.

PubMed

Li, Ya-Hsin; Tsai, Wen-Chen; Khan, Mahmud; Yang, Wen-Ta; Lee, Tsuey-Fong; Wu, Yi-Chun; Kung, Pei-Tseng

2010-07-01

In order to make tuberculosis (TB) treatment more effective and to lower the transmission rate of the disease, the Bureau of National Health Insurance (BNHI) in Taiwan implemented the 'Pay-for-Performance on Tuberculosis' programme (P4P on TB) in 2004. This study investigates the effectiveness of the P4P system in terms of cure rate and length of treatment. This retrospective study obtained information on all TB cases in the national data sets of Taiwan for the years 2002 to 2005. The number of cases in pre-P4P years (2002 and 2003) was 25 754, compared with 33 536 in the post-P4P implementation years (2004 and 2005). The effectiveness of the programme was evaluated by comparing the TB cure rate and length of treatment before and after the implementation of the P4P programme, and between participating and non-participating hospitals. Logistic regression analysis was conducted to explore the factors affecting TB patients' cure rate within a 12-month treatment period. The cure rate and the average length of treatment before the implementation of P4P were 46.9% and 256.24 days, respectively, compared with 63.0% and 249.74 days after implementation of P4P. The cure rate and length of treatment in P4P hospitals were 68.1% and 249.13 days, respectively, compared with 42.4% and 53.71 days in non-P4P hospitals. This study found that both the cure rate and average length of treatment for cured cases improved significantly after the implementation of the P4P on TB programme in Taiwan. Compared with non-P4P hospitals, P4P hospitals had significantly better treatment outcomes. Patients' age, income level, the physician density of a patient's place of residence, and whether the hospital has joined the P4P on TB programme are factors affecting the treatment outcomes of TB patients in Taiwan.

Implementation of an Integrated Orthopedic Curriculum to Increase Clinical and Procedural Competency amongst Pediatric Residents

DTIC Science & Technology

2017-04-05

59 MDW/SGVU SUBJECT: Professional Presentation Approval 7 FEB 2016 1. Your paper, entitled Implementation of an Integrated Orthopedic Curriculum... Research Division inay pay for your basic journal publishing charges (to include costs for tables and black and white photos). We cannot pay for...efforts. LnJ.a ~~e.\\- b,.,.,d~Wi LINDA STEEL-GOODWIN;Col, USAF, BSC Director, Clinical Investigations & Research Support Warrior Medics - Mission Ready

The economic value of life: linking theory to practice.

PubMed Central

Landefeld, J S; Seskin, E P

1982-01-01

Human capital estimates of the economic value of life have been routinely used in the past to perform cost-benefit analyses of health programs. Recently, however, serious questions have been raised concerning the conceptual basis for valuing human life by applying these estimates. Most economists writing on these issues tend to agree that a more conceptually correct method to value risks to human life in cost-benefit analyses would be based on individuals.' "willingness to pay" for small changes in their probability of survival. Attempts to implement the willingness-to-pay approach using survey responses or revealed-preference estimates have produced a confusing array of values fraught with statistical problems and measurement difficulties. As a result, economists have searched for a link between willingness to pay and standard human capital estimates and have found that for most individuals a lower bound for valuing risks to life can be based on their willingness to pay to avoid the expected economic losses associated with death. However, while these studies provide support for using individual's private valuation of forgone income in valuing risks to life, it is also clear that standard human capital estimates cannot be used for this purpose without reformulation. After reviewing the major approaches to valuing risks to life, this paper concludes that estimates based on the human capital approach--reformulated using a willingness-to-pay criterion--produce the only clear, consistent, and objective values for use in cost-benefit analyses of policies affecting risks to life. The paper presents the first empirical estimates of such adjusted willingness-to-pay/human capital values. PMID:6803602

28 CFR 545.25 - Eligibility for performance pay.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., is expelled, or otherwise fails attendance requirements of the drug abuse education course or the... have committed a level 100 or 200 series drug- or alcohol-related prohibited act will automatically... shall not ordinarily receive performance pay above the maintenance pay level, or bonus pay, or vacation...

Impact assessment of a pay-for-performance program on breast cancer screening in France using micro data.

PubMed

Sicsic, Jonathan; Franc, Carine

2017-06-01

A voluntary-based pay-for-performance (P4P) program (the CAPI) aimed at general practitioners (GPs) was implemented in France in 2009. The program targeted prevention practices, including breast cancer screening, by offering a maximal amount of €245 for achieving a target screening rate among eligible women enrolled with the GP. Our objective was to evaluate the impact of the French P4P program (CAPI) on the early detection of breast cancer among women between 50 and 74 years old. Based on an administrative database of 50,752 women aged 50-74 years followed between 2007 and 2011, we estimated a difference-in-difference model of breast cancer screening uptake as a function of visit to a CAPI signatory referral GP, while controlling for both supply-side and demand-side determinants (e.g., sociodemographics, health and healthcare use). Breast cancer screening rates have not changed significantly since the P4P program implementation. Overall, visiting a CAPI signatory referral GP at least once in the pre-CAPI period increased the probability of undergoing breast cancer screening by 1.38 % [95 % CI (0.41-2.35 %)], but the effect was not significantly different following the implementation of the contract. The French P4P program had a nonsignificant impact on breast cancer screening uptake. This result may reflect the fact that the low-powered incentives implemented in France through the CAPI might not provide sufficient leverage to generate better practices, thus inviting regulators to seek additional tools beyond P4P in the field of prevention and screening.

The Effect of Pay-for-Performance in Nursing Homes: Evidence from State Medicaid Programs

PubMed Central

Werner, Rachel M; Konetzka, R Tamara; Polsky, Daniel

2013-01-01

Objective Pay-for-performance (P4P) is commonly used to improve health care quality in the United States and is expected to be frequently implemented under the Affordable Care Act. However, evidence supporting its use is mixed with few large-scale, rigorous evaluations of P4P. This study tests the effect of P4P on quality of care in a large-scale setting—the implementation of P4P for nursing homes by state Medicaid agencies. Data Sources/Study Setting 2001–2009 nursing home Minimum Data Set and Online Survey, Certification, and Reporting (OSCAR) datasets. Study Design Between 2001 and 2009, eight state Medicaid agencies adopted P4P programs in nursing homes. We use a difference-in-differences approach to test for changes in nursing home quality under P4P, taking advantage of the variation in timing of implementation across these eight states and using nursing homes in the 42 non-P4P states plus Washington, DC as contemporaneous controls. Principal Findings Quality improvement under P4P was inconsistent. While three clinical quality measures (the percent of residents being physically restrained, in moderate to severe pain, and developed pressure sores) improved with the implementation of P4P in states with P4P compared with states without P4P, other targeted quality measures either did not change or worsened. Of the two structural measures of quality that were tied to payment (total number of deficiencies and nurse staffing) deficiency rates worsened slightly under P4P while staffing levels did not change. Conclusions Medicaid-based P4P in nursing homes did not result in consistent improvements in nursing home quality. Expectations for improvement in nursing home care under P4P should be tempered. PMID:23398330

The effect of pay-for-performance in nursing homes: evidence from state Medicaid programs.

PubMed

Werner, Rachel M; Konetzka, R Tamara; Polsky, Daniel

2013-08-01

Pay-for-performance (P4P) is commonly used to improve health care quality in the United States and is expected to be frequently implemented under the Affordable Care Act. However, evidence supporting its use is mixed with few large-scale, rigorous evaluations of P4P. This study tests the effect of P4P on quality of care in a large-scale setting-the implementation of P4P for nursing homes by state Medicaid agencies. 2001-2009 nursing home Minimum Data Set and Online Survey, Certification, and Reporting (OSCAR) datasets. Between 2001 and 2009, eight state Medicaid agencies adopted P4P programs in nursing homes. We use a difference-in-differences approach to test for changes in nursing home quality under P4P, taking advantage of the variation in timing of implementation across these eight states and using nursing homes in the 42 non-P4P states plus Washington, DC as contemporaneous controls. Quality improvement under P4P was inconsistent. While three clinical quality measures (the percent of residents being physically restrained, in moderate to severe pain, and developed pressure sores) improved with the implementation of P4P in states with P4P compared with states without P4P, other targeted quality measures either did not change or worsened. Of the two structural measures of quality that were tied to payment (total number of deficiencies and nurse staffing) deficiency rates worsened slightly under P4P while staffing levels did not change. Medicaid-based P4P in nursing homes did not result in consistent improvements in nursing home quality. Expectations for improvement in nursing home care under P4P should be tempered. © Health Research and Educational Trust.

Ensemble machine learning and forecasting can achieve 99% uptime for rural handpumps

PubMed Central

Thomas, Evan A.

2017-01-01

Broken water pumps continue to impede efforts to deliver clean and economically-viable water to the global poor. The literature has demonstrated that customers’ health benefits and willingness to pay for clean water are best realized when clean water infrastructure performs extremely well (>99% uptime). In this paper, we used sensor data from 42 Afridev-brand handpumps observed for 14 months in western Kenya to demonstrate how sensors and supervised ensemble machine learning could be used to increase total fleet uptime from a best-practices baseline of about 70% to >99%. We accomplish this increase in uptime by forecasting pump failures and identifying existing failures very quickly. Comparing the costs of operating the pump per functional year over a lifetime of 10 years, we estimate that implementing this algorithm would save 7% on the levelized cost of water relative to a sensor-less scheduled maintenance program. Combined with a rigorous system for dispatching maintenance personnel, implementing this algorithm in a real-world program could significantly improve health outcomes and customers’ willingness to pay for water services. PMID:29182673

Pay-for-performance in disease management: a systematic review of the literature.

PubMed

de Bruin, Simone R; Baan, Caroline A; Struijs, Jeroen N

2011-10-14

Pay-for-performance (P4P) is increasingly implemented in the healthcare system to encourage improvements in healthcare quality. P4P is a payment model that rewards healthcare providers for meeting pre-established targets for delivery of healthcare services by financial incentives. Based on their performance, healthcare providers receive either additional or reduced payment. Currently, little is known about P4P schemes intending to improve delivery of chronic care through disease management. The objectives of this paper are therefore to provide an overview of P4P schemes used to stimulate delivery of chronic care through disease management and to provide insight into their effects on healthcare quality and costs. A systematic PubMed search was performed for English language papers published between 2000 and 2010 describing P4P schemes related to the implementation of disease management. Wagner's chronic care model was used to make disease management operational. Eight P4P schemes were identified, introduced in the USA (n = 6), Germany (n = 1), and Australia (n = 1). Five P4P schemes were part of a larger scheme of interventions to improve quality of care, whereas three P4P schemes were solely implemented. Most financial incentives were rewards, selective, and granted on the basis of absolute performance. More variation was found in incented entities and the basis for providing incentives. Information about motivation, certainty, size, frequency, and duration of the financial incentives was generally limited. Five studies were identified that evaluated the effects of P4P on healthcare quality. Most studies showed positive effects of P4P on healthcare quality. No studies were found that evaluated the effects of P4P on healthcare costs. The number of P4P schemes to encourage disease management is limited. Hardly any information is available about the effects of such schemes on healthcare quality and costs. © 2011 de Bruin et al; licensee BioMed Central Ltd.

Pay-for-performance in disease management: a systematic review of the literature

PubMed Central

2011-01-01

Background Pay-for-performance (P4P) is increasingly implemented in the healthcare system to encourage improvements in healthcare quality. P4P is a payment model that rewards healthcare providers for meeting pre-established targets for delivery of healthcare services by financial incentives. Based on their performance, healthcare providers receive either additional or reduced payment. Currently, little is known about P4P schemes intending to improve delivery of chronic care through disease management. The objectives of this paper are therefore to provide an overview of P4P schemes used to stimulate delivery of chronic care through disease management and to provide insight into their effects on healthcare quality and costs. Methods A systematic PubMed search was performed for English language papers published between 2000 and 2010 describing P4P schemes related to the implementation of disease management. Wagner's chronic care model was used to make disease management operational. Results Eight P4P schemes were identified, introduced in the USA (n = 6), Germany (n = 1), and Australia (n = 1). Five P4P schemes were part of a larger scheme of interventions to improve quality of care, whereas three P4P schemes were solely implemented. Most financial incentives were rewards, selective, and granted on the basis of absolute performance. More variation was found in incented entities and the basis for providing incentives. Information about motivation, certainty, size, frequency, and duration of the financial incentives was generally limited. Five studies were identified that evaluated the effects of P4P on healthcare quality. Most studies showed positive effects of P4P on healthcare quality. No studies were found that evaluated the effects of P4P on healthcare costs. Conclusion The number of P4P schemes to encourage disease management is limited. Hardly any information is available about the effects of such schemes on healthcare quality and costs. PMID:21999234

Team Pay for Performance: Experimental Evidence from Round Rock's Project on Incentives in Teaching

ERIC Educational Resources Information Center

McCaffrey, Daniel F.; Pane, John F.; Springer, Matthew G.; Burns, Susan F.; Haas, Ann

2011-01-01

This paper presents the results of a rigorous experiment examining the impact of pay for performance on student achievement and instructional practice. This study, conducted by the National Center on Performance Incentives, examines a pay-for-performance program in Round Rock (Texas) which distributed performance awards to teachers based on a…

Effect on Baby-Friendly Hospital Steps When Hospitals Implement a Policy to Pay for Infant Formula.

PubMed

Tarrant, Marie; Lok, Kris Y W; Fong, Daniel Y T; Wu, Kendra M; Lee, Irene L Y; Sham, Alice; Lam, Christine; Bai, Dorothy Li; Wong, Ka Lun; Wong, Emmy M Y; Chan, Noel P T; Dodgson, Joan E

2016-05-01

The Baby-Friendly Hospital Initiative requires hospitals to pay market price for infant formula. No studies have specifically examined the effect of hospitals paying for infant formula on breastfeeding mothers' exposure to Baby-Friendly steps. To investigate the effect of hospitals implementing a policy of paying for infant formula on new mothers' exposure to Baby-Friendly steps and examine the effect of exposure to Baby-Friendly steps on breastfeeding rates. We used a repeated prospective cohort study design. We recruited 2 cohorts of breastfeeding mother-infant pairs (n = 2470) in the immediate postnatal period from 4 Hong Kong public hospitals and followed them by telephone up to 12 months postpartum. We assessed participants' exposure to 6 Baby-Friendly steps by extracting data from the medical record and by maternal self-report. After hospitals began paying for infant formula, new mothers were more likely to experience 4 out of 6 Baby-Friendly steps. Breastfeeding initiation within the first hour increased from 28.7% to 45%, and in-hospital exclusive breastfeeding rates increased from 17.9% to 41.4%. The proportion of mothers who experienced all 6 Baby-Friendly steps increased from 4.8% to 20.5%. The risk of weaning was progressively higher among participants experiencing fewer Baby-Friendly steps. Each additional step experienced by new mothers decreased the risk of breastfeeding cessation by 8% (hazard ratio = 0.92; 95% CI, 0.89-0.95). After implementing a policy of paying for infant formula, breastfeeding mothers were exposed to more Baby-Friendly steps, and exposure to more steps was significantly associated with a lower risk of breastfeeding cessation. © The Author(s) 2015.

An official American Thoracic Society policy statement: pay-for-performance in pulmonary, critical care, and sleep medicine.

PubMed

Kahn, Jeremy M; Scales, Damon C; Au, David H; Carson, Shannon S; Curtis, J Randall; Dudley, R Adams; Iwashyna, Theodore J; Krishnan, Jerry A; Maurer, Janet R; Mularski, Richard; Popovich, John; Rubenfeld, Gordon D; Sinuff, Tasnim; Heffner, John E

2010-04-01

Pay-for-performance is a model for health care financing that seeks to link reimbursement to quality. The American Thoracic Society and its members have a significant stake in the development of pay-for-performance programs. To develop an official ATS policy statement addressing the role of pay-for-performance in pulmonary, critical care and sleep medicine. The statement was developed by the ATS Health Policy Committee using an iterative consensus process including an expert workshop and review by ATS committees and assemblies. Pay-for-performance is increasingly utilized by health care purchasers including the United States government. Published studies generally show that programs result in small but measurable gains in quality, although the data are heterogeneous. Pay-for-performance may result in several negative consequences, including the potential to increase costs, worsen health outcomes, and widen health disparities, among others. Future research should be directed at developing reliable and valid performance measures, increasing the efficacy of pay-for-performance programs, minimizing negative unintended consequences, and examining issues of costs and cost-effectiveness. The ATS and its members can play a key role in the design and evaluation of these programs by advancing the science of performance measurement, regularly developing quality metrics alongside clinical practice guidelines, and working with payors to make performance improvement a routine part of clinical practice. Pay-for-performance programs will expand in the coming years. Pulmonary, critical care and sleep practitioners can use these programs as an opportunity to partner with purchasers to improve health care quality.

PAY-FOR-PERFORMANCE: A SURVEY OF SPECIALTY PROVIDERS IN UROGYNECOLOGY

PubMed Central

EREKSON, Elisabeth A.; SUNG, Vivian W.; CLARK, Melissa A.

2013-01-01

Introduction The objective of this study was to develop and implement a web-based survey to collect information on the reported knowledge, attitudes, and practice impact of pay for performance (P4P) among providers in the specialty of urogynecology. Study Design All members of the American Urogynecologic Society were invited to participate in a web-based survey. The questionnaire focused on reported knowledge, attitudes, and practice impact of P4P. Results Complete responses were obtained from 212 members for a survey response rate of 17.6%. A minority of participants (9.0%) reported having “a lot of knowledge” of the P4P reimbursement model. Fifty-five (25.9%) participants reported that the hospital or healthcare system where they worked had some involvement with P4P reimbursement. Conclusion A minority of participants reported having a lot of knowledge of P4P even though current involvement with some type of P4P reimbursement was reported by over 25% of participants. PMID:21366120

Medicare’s Payment Strategy For End-Stage Renal Disease Now Embraces Bundled Payment And Pay-For-Performance To Cut Costs

PubMed Central

Swaminathan, Shailender; Mor, Vincent; Mehrotra, Rajnish; Trivedi, Amal

2013-01-01

Since 1973 Medicare has provided health insurance coverage to all people who have been diagnosed with end-stage renal disease, or kidney failure. In this article we trace the history of payment policies in Medicare’s dialysis program from 1973 to 2011, while also providing some insight into the rationale for changes made over time. Initially, Medicare adopted a fee-for-service payment policy for dialysis care, using the same reimbursement standards employed in the broader Medicare program. However, driven by rapid spending growth in this population, the dialysis program has implemented innovative payment reforms, such as prospective bundled payments and pay-for-performance incentives. It is uncertain whether these strategies can stem the increase in the total cost of dialysis to Medicare, or whether they can do so without adversely affecting the quality of care. Future research on the intended and unintended consequences of payment reform will be critical. PMID:22949455

Influence of pay-for-performance programs on information technology use among child health providers: the devil is in the details.

PubMed

Menachemi, Nir; Struchen-Shellhorn, Wendy; Brooks, Robert G; Simpson, Lisa

2009-01-01

Pay-for-performance programs are used to promote improved health care quality, often through increased use of health information technology. However, little is known about whether pay-for-performance programs influence the adoption of health information technology, especially among child health providers. This study explored how various pay-for-performance compensation methods are related to health information technology use. Survey data from 1014 child health providers practicing in Florida were analyzed by using univariate and multivariate techniques. Questions asked about the adoption of electronic health records and personal digital assistants, as well as types of activities that affected child health provider compensation or income. The most common reported method to affect respondents' compensation was traditional productivity or billing (78%). Of the pay-for-performance-related methods of compensation, child health providers indicated that measures of clinical care (41%), patient surveys and experience (34%), the use of health information technology (29%), and quality bonuses or incentives (27%) were a major or minor factor in their compensation. In multivariate logistic regression analyses, only pay-for-performance programs that compensated directly for health information technology use were associated with an increased likelihood of electronic health record system adoption. Pay-for-performance programs linking measures of clinical quality to compensation were positively associated with personal digital assistant use among child health providers. Pay-for-performance programs that do not directly emphasize health information technology use do not influence the adoption of electronic health records among Florida physicians treating children. Understanding how different pay-for-performance compensation methods incentivize health information technology adoption is important for improving quality.

Collective Bargaining in Education and Pay for Performance. Research Brief

ERIC Educational Resources Information Center

National Center on Performance Incentives, 2008

2008-01-01

In "Collective Bargaining in Education and Pay for Performance"--a paper presented at the National Center on Performance Incentives research to policy conference in February--Jane Hannaway and Andrew J. Rotherham examine the interplay between the emerging policy focus on teacher pay for performance and the response of teacher unions.…

National Security Personnel System: An Optimization Strategy for Implementing Pay-for-Performance

DTIC Science & Technology

2006-03-15

leaders who can be more nimble and more adaptive in an environment of unprecedented cultural change. Unfortunately, for Exelon, these were qualities...has been thrust upon them. Therefore, to effect a successful cultural change, DoD leaders will have to communicate a compelling reason for...additional level of risk perceived by their employees.30 Communication. Perhaps, the most important thing leaders can do is to articulate clear, compelling

45 CFR 13.29 - Payment of award.

Code of Federal Regulations, 2010 CFR

2010-10-01

... States courts. The Department will pay the amount awarded to the applicant within 60 days, unless... Welfare DEPARTMENT OF HEALTH AND HUMAN SERVICES GENERAL ADMINISTRATION IMPLEMENTATION OF THE EQUAL ACCESS... and address of the appropriate Departmental finance office that will pay the award. An applicant...

5 CFR 534.501 - Coverage.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Coverage. 534.501 Section 534.501 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Senior-Level and Scientific and Professional Positions § 534.501 Coverage. (a) This subpart implements 5...

5 CFR 534.501 - Coverage.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Coverage. 534.501 Section 534.501 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Senior-Level and Scientific and Professional Positions § 534.501 Coverage. (a) This subpart implements 5...

5 CFR 534.501 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Coverage. 534.501 Section 534.501 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Senior-Level and Scientific and Professional Positions § 534.501 Coverage. (a) This subpart implements 5...

5 CFR 534.501 - Coverage.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Coverage. 534.501 Section 534.501 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Senior-Level and Scientific and Professional Positions § 534.501 Coverage. (a) This subpart implements 5...

5 CFR 534.501 - Coverage.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Coverage. 534.501 Section 534.501 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Senior-Level and Scientific and Professional Positions § 534.501 Coverage. (a) This subpart implements 5...

Teacher Pay-for-Performance in School Turnaround: How Bonuses and Differentiated Pay Scales Can Help Support School Turnaround. Meeting the Turnaround Challenge: Strategies, Resources & Tools to Transform a Framework into Practice

ERIC Educational Resources Information Center

Mass Insight Education (NJ1), 2009

2009-01-01

Given the importance of good teaching and leadership for school success, turnaround schools should think carefully about how to structure professional environments that reward and motivate excellence. A system of "Pay-for-Contribution" that includes tools such as hard-to-staff and skill shortage pay, performance pay, and/or retention…

Health economic value of an innovation: delimiting the scope and framework of future market entry agreements.

PubMed

Launois, Robert; Navarrete, Lucia Fiestas; Ethgen, Olivier; Le Moine, Jean-Gabriel; Gatsinga, René

2014-01-01

The objective of our paper is to offer a new, payer-friendly taxonomy of market entry agreements (MEAs) that aims to twin contracts with their methodological designs in an effort to clarify the distinction between contracts that are based on performance and those that are based on demonstrated effect. Our analysis proceeds in two stages: First, we delimit the scope and framework of pay for performance (P4P) and pay for demonstrated effect (P4E) agreements. Second, we distinguish the methodological designs supporting the implementation of each of these contracts. We elucidate why P4P contracts prevent the payer from funding the true effectiveness of an innovation by expanding on their limitations. These include: 1) the normative nature of comparisons, 2) the impossibility of true effect imputability for each individual, and 3) the use of intermediary outcome measures. We then explore three main criticisms that payers must take into account when reasoning in terms of performance rather than in terms of the product effectiveness. The potential effect that performance-based reimbursements may have on dissociating the components of the cost-effectiveness ratio constitutes an obstacle to a true health economic reasoning.

Performance Pay System Preferences of Students Preparing to Be Teachers

ERIC Educational Resources Information Center

Milanowski, Anthony

2007-01-01

This study explored the potential acceptability of performance pay to new teachers by investigating attitudes toward performance pay of students preparing to be teachers. Focus groups and a survey of students preparing to be teachers at a large U.S. university were conducted. Most students expressed a preference for some form of performance pay…

Early experience with pay-for-performance: from concept to practice.

PubMed

Rosenthal, Meredith B; Frank, Richard G; Li, Zhonghe; Epstein, Arnold M

2005-10-12

The adoption of pay-for-performance mechanisms for quality improvement is growing rapidly. Although there is intense interest in and optimism about pay-for-performance programs, there is little published research on pay-for-performance in health care. To evaluate the impact of a prototypical physician pay-for-performance program on quality of care. We evaluated a natural experiment with pay-for-performance using administrative reports of physician group quality from a large health plan for an intervention group (California physician groups) and a contemporaneous comparison group (Pacific Northwest physician groups). Quality improvement reports were included from October 2001 through April 2004 issued to approximately 300 large physician organizations. Three process measures of clinical quality: cervical cancer screening, mammography, and hemoglobin A1c testing. Improvements in clinical quality scores were as follows: for cervical cancer screening, 5.3% for California vs 1.7% for Pacific Northwest; for mammography, 1.9% vs 0.2%; and for hemoglobin A1c, 2.1% vs 2.1%. Compared with physician groups in the Pacific Northwest, the California network demonstrated greater quality improvement after the pay-for-performance intervention only in cervical cancer screening (a 3.6% difference in improvement [P = .02]). In total, the plan awarded 3.4 million dollars (27% of the amount set aside) in bonus payments between July 2003 and April 2004, the first year of the program. For all 3 measures, physician groups with baseline performance at or above the performance threshold for receipt of a bonus improved the least but garnered the largest share of the bonus payments. Paying clinicians to reach a common, fixed performance target may produce little gain in quality for the money spent and will largely reward those with higher performance at baseline.

5 CFR 9701.346 - Pay progression for new supervisors.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Pay progression for new supervisors. 9701.346 Section 9701.346 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES... SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Performance-Based Pay § 9701.346 Pay...

Presidential Compensation in Public Higher Education Institutions: Is There Pay for Performance?

ERIC Educational Resources Information Center

He, Lerong; Callahan, Charles, III

2017-01-01

This paper discusses the theoretical background of the pay-for-performance incentive as well as its implication for administrators in higher education institutions. Using pay data of a large state university system in the U.S., the paper finds that presidents in public research universities receive significantly higher pay than their counterparts…

Performance-Based Pay in the Federal Government. Research Brief

ERIC Educational Resources Information Center

National Center on Performance Incentives, 2008

2008-01-01

In "Performance-Based Pay in the Federal Government"--a paper presented at the February 2008 National Center on Performance Incentives research to policy conference--Steve Nelson discusses the evolution of employee pay systems in the federal government, from the inception of the General Schedule to continuing interest in creating more…

28 CFR 545.31 - Training.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Work and Performance Pay Program § 545.31 Training. The Warden shall ensure that staff receive training on their roles in, and on the operation of, the work and performance pay program. The Warden shall also ensure that the inmate population is informed of the work and performance pay program, and of the...

Teacher Opinions on Performance Pay: Evidence from India

ERIC Educational Resources Information Center

Muralidharan, Karthik; Sundararaman, Venkatesh

2011-01-01

The practical viability of performance-based pay programs for teachers depends critically on the extent of support the idea will receive from teachers. We present evidence on teacher opinions with regard to performance-based pay from teacher interviews conducted in the context of an experimental evaluation of a program that provided…

Performance Pay for Teachers: Determinants and Consequences

ERIC Educational Resources Information Center

Belfield, Clive R.; Heywood, John S.

2008-01-01

Theory and evidence on performance-related pay for teaching remain inconclusive. Teachers will respond to rewards, but an appropriate reward structure may not be devised because education is a collaborative endeavor. Here we test three hypotheses: performance-related pay among teachers is more likely to be observed when there are evident…

Effects of pay-for-performance system on tuberculosis default cases control and treatment in Taiwan.

PubMed

Tsai, Wen-Chen; Kung, Pei-Tseng; Khan, Mahmud; Campbell, Claudia; Yang, Wen-Ta; Lee, Tsuey-Fong; Li, Ya-Hsin

2010-09-01

In order to make tuberculosis (TB) treatment more effective and to lower the default rate of the disease, the Bureau of National Health Insurance (BNHI) in Taiwan implemented the "pay-for-performance on Tuberculosis" program (P4P on TB) in 2004. The purpose of this study is to investigate the effectiveness of the P4P system in terms of default rate. This is a retrospective study. National Health Insurance Research Datasets in Taiwan from 2002 to 2005 has been used for the study. The study compared the differences of TB default rate before and after the implementation of P4P program, between participating and non-participating hospitals, and between P4P hospitals with and without case managers. Furthermore, logistic regression analysis was conducted to explore the related factors influencing TB patients default treatment after TB detected. The treatment default rate after "P4P on TB" was 11.37% compared with the 15.56% before "P4P on TB" implementation. The treatment default rate in P4P hospitals was 10.67% compared to 12.7% in non-P4P hospitals. In addition, the default rate was 10.4% in hospitals with case managers compared with 12.68% in hospitals without case managers. The results of the study showed that "P4P on TB" program improved the treatment default rate for TB patients. In addition, case managers improved the treatment outcome in controlling patients' default rate. Copyright 2010 The British Infection Society. Published by Elsevier Ltd. All rights reserved.

An empirical survey of the benefits of implementing pay for safety scheme (PFSS) in the Hong Kong construction industry.

PubMed

Chan, Daniel W M; Chan, Albert P C; Choi, Tracy N Y

2010-10-01

The Government of the Hong Kong Special Administrative Region (SAR) has implemented different safety initiatives to improve the safety performance of the construction industry over the past decades. The Pay for Safety Scheme (PFSS), which is one of the effective safety measures launched by the government in 1996, has been widely adopted in the public works contracts. Both the accident rate and fatality rate of public sector projects have decreased noticeably over this period. This paper aims to review the current state of application of PFSS in Hong Kong, and attempts to identify and analyze the perceived benefits of PFSS in construction via an industry-wide empirical questionnaire survey. A total of 145 project participants who have gained abundant hands-on experience with the PFSS construction projects were requested to complete a survey questionnaire to indicate the relative importance of those benefits identified in relation to PFSS. The perceived benefits were measured and ranked from the perspectives of the client and contractor for crosscomparison. The survey findings suggested the most significant benefits derived from adopting PFSS were: (a) Increased safety training; (b) Enhanced safety awareness; (c) Encouragement of developing safety management system; and (d) Improved safety commitment. A wider application of PFSS should be advocated so as to achieve better safety performance within the construction industry. It is recommended that a similar scheme to the PFSS currently adopted in Hong Kong may be developed for implementation in other regions or countries for international comparisons. Copyright © 2010 Elsevier Ltd and National Safety Council. All rights reserved.

28 CFR 345.56 - Vacation pay.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 28 Judicial Administration 2 2010-07-01 2010-07-01 false Vacation pay. 345.56 Section 345.56... (FPI) INMATE WORK PROGRAMS Inmate Pay and Benefits § 345.56 Vacation pay. Inmate workers are granted FPI vacation pay by the SOI when their continued good work performance justifies such pay, based on...

Use of Provider-Level Dashboards and Pay-for-Performance in Venous Thromboembolism Prophylaxis*

PubMed Central

Michtalik, Henry J.; Carolan, Howard T.; Haut, Elliott R.; Lau, Brandyn D.; Streiff, Michael B.; Finkelstein, Joseph; Pronovost, Peter J.; Durkin, Nowella; Brotman, Daniel J.

2014-01-01

Background Despite safe and cost-effective venous thromboembolism (VTE) prevention measures, VTE prophylaxis rates are often suboptimal. Healthcare reform efforts emphasize transparency through programs to report performance, and payment incentives through programs to pay-for-performance. Objective To sequentially examine an individualized physician dashboard and pay-for-performance program to improve VTE prophylaxis rates amongst hospitalists. Design Retrospective analysis of 3144 inpatient admissions. After a baseline observation period, VTE prophylaxis compliance was compared during both interventions. Setting 1060-bed tertiary care medical center. Participants 38 part- and full-time academic hospitalists. Interventions A Web-based hospitalist dashboard provided VTE prophylaxis feedback. After 6 months of feedback only, a pay-for-performance program was incorporated, with graduated payouts for compliance rates of 80-100%. Measurements Prescription of American College of Chest Physicians guideline-compliant VTE prophylaxis and subsequent pay-for-performance payments. Results Monthly VTE prophylaxis compliance rates were 86% (95% CI: 85, 88), 90% (95% CI: 88, 93), and 94% (95% CI: 93, 96) during the baseline, dashboard, and combined dashboard/pay-for-performance periods, respectively. Compliance significantly improved with the use of the dashboard (p=0.01) and addition of the pay-for-performance program (p=0.01). The highest rate of improvement occurred with the dashboard (1.58%/month; p=0.01). Annual individual physician performance payments ranged from $53 to $1244 (mean $633; SD ±350). Conclusions Direct feedback using dashboards was associated with significantly improved compliance, with further improvement after incorporating an individual physician pay-for-performance program. Real-time dashboards and physician-level incentives may assist hospitals in achieving higher safety and quality benchmarks. PMID:25545690

Use of provider-level dashboards and pay-for-performance in venous thromboembolism prophylaxis.

PubMed

Michtalik, Henry J; Carolan, Howard T; Haut, Elliott R; Lau, Brandyn D; Streiff, Michael B; Finkelstein, Joseph; Pronovost, Peter J; Durkin, Nowella; Brotman, Daniel J

2015-03-01

Despite safe and cost-effective venous thromboembolism (VTE) prevention measures, VTE prophylaxis rates are often suboptimal. Healthcare reform efforts emphasize transparency through programs to report performance and payment incentives through pay-for-performance programs. To sequentially examine an individualized physician dashboard and pay-for-performance program to improve VTE prophylaxis rates among hospitalists. Retrospective analysis of 3144 inpatient admissions. After a baseline observation period, VTE prophylaxis compliance was compared during both interventions. A 1060-bed tertiary care medical center. Thirty-eight part-time and full-time academic hospitalists. A Web-based hospitalist dashboard provided VTE prophylaxis feedback. After 6 months of feedback only, a pay-for-performance program was incorporated, with graduated payouts for compliance rates of 80% to 100%. Prescription of American College of Chest Physicians' guideline-compliant VTE prophylaxis and subsequent pay-for-performance payments. Monthly VTE prophylaxis compliance rates were 86% (95% confidence interval [CI]: 85-88), 90% (95% CI: 88-93), and 94% (95% CI: 93-96) during the baseline, dashboard, and combined dashboard/pay-for-performance periods, respectively. Compliance significantly improved with the use of the dashboard (P = 0.01) and addition of the pay-for-performance program (P = 0.01). The highest rate of improvement occurred with the dashboard (1.58%/month; P = 0.01). Annual individual physician performance payments ranged from $53 to $1244 (mean $633; standard deviation ±$350). Direct feedback using dashboards was associated with significantly improved compliance, with further improvement after incorporating an individual physician pay-for-performance program. Real-time dashboards and physician-level incentives may assist hospitals in achieving higher safety and quality benchmarks. © 2014 Society of Hospital Medicine.

5 CFR 1639.27 - Procedures for salary offset.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Procedures for salary offset. 1639.27... Salary Offset § 1639.27 Procedures for salary offset. (a) The Board will coordinate salary deductions... pay and will implement the salary offset. (c) Deductions will begin within three official pay periods...

5 CFR 534.601 - Coverage.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Coverage. 534.601 Section 534.601 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Administrative Appeals Judge Positions § 534.601 Coverage. (a) This subpart implements 5 U.S.C. 5372b and applies...

5 CFR 534.601 - Coverage.

Code of Federal Regulations, 2012 CFR

2012-01-01

... 5 Administrative Personnel 1 2012-01-01 2012-01-01 false Coverage. 534.601 Section 534.601 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Administrative Appeals Judge Positions § 534.601 Coverage. (a) This subpart implements 5 U.S.C. 5372b and applies...

5 CFR 534.601 - Coverage.

Code of Federal Regulations, 2014 CFR

2014-01-01

... 5 Administrative Personnel 1 2014-01-01 2014-01-01 false Coverage. 534.601 Section 534.601 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Administrative Appeals Judge Positions § 534.601 Coverage. (a) This subpart implements 5 U.S.C. 5372b and applies...

5 CFR 534.601 - Coverage.

Code of Federal Regulations, 2013 CFR

2013-01-01

... 5 Administrative Personnel 1 2013-01-01 2013-01-01 false Coverage. 534.601 Section 534.601 Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay for Administrative Appeals Judge Positions § 534.601 Coverage. (a) This subpart implements 5 U.S.C. 5372b and applies...

Optimal Incentives for Public Sector Workers: The Case of Teacher-Designed Incentive Pay in Texas. Working Paper 2009-05

ERIC Educational Resources Information Center

Taylor, Lori L.; Springer, Matthew G.

2009-01-01

Pay for performance is a popular public education reform, and millions of dollars are currently being targeted for pay for performance programs. These reforms are popular because economic and management theories suggest that well-designed incentive pay programs could improve teacher effectiveness. There is little evidence about the characteristics…

Effects of and Preference for Pay for Performance: An Analogue Analysis

ERIC Educational Resources Information Center

Long, Robert D., III; Wilder, David A.; Betz, Alison; Dutta, Ami

2012-01-01

We examined the effects of 2 payment systems on the rate of check processing and time spent on task by participants in a simulated work setting. Three participants experienced individual pay-for-performance (PFP) without base pay and pay-for-time (PFT) conditions. In the last phase, we asked participants to choose which system they preferred. For…

5 CFR 9701.345 - Developmental pay adjustments.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Developmental pay adjustments. 9701.345 Section 9701.345 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT... HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Performance-Based Pay § 9701.345...

Chinese Teachers' Attitudes toward Performance Pay: The Cases of Three Schools

ERIC Educational Resources Information Center

Liu, Shujie; Zhao, Decheng; Xie, Wei

2016-01-01

Purpose: The purpose of this paper is to investigate Chinese teachers' attitudes toward performance pay. Specifically, this study examined the extent to which Chinese teachers supported performance-pay programs. The study also examined the effects of these programs on teachers, particularly on their levels of collaboration, work motivation, and…

Techniques of Power: Performance Pay Systems and the Network of School Power Relations

ERIC Educational Resources Information Center

Drexler Booth, Caleb

2014-01-01

As decades pass, new rounds of educational discussion surrounding teacher pay emerge calling for alternative compensation based on performance indicators. While much of the research on this latest iteration of performance pay, inspired by the presidential initiatives "No Child Left Behind" and "Race to the Top," focuses on…

Teacher Performance Pay Programs and Necessary Communication Actions

ERIC Educational Resources Information Center

Heneman, Herbert G., III; Worth, Robin; Arrigoni, Jessica; Kimball, Steven M.; Milanowski, Anthony

2013-01-01

Teacher performance pay programs have proliferated across the country over the past 20 years. To aid in understanding their many variations, the seven major components of these programs are described. Three examples of teacher performance pay programs are provided for illustration: Denver ProComp, TAP, and Houston ASPIRE. Evidence is mixed on the…

Modernizing the Federal Government: Paying for Performance

DTIC Science & Technology

2007-01-01

works (Barr, 2007d). Employees are rated on performance measures such as “fair and equitable treatment of taxpayers” and “customer satisfaction ... Performance Act of 2007, Senate bill 1046, Washington, D.C., 2007b. 38 Modernizing the Federal Government: Paying for Performance Vroom , Victor H...AND SUBTITLE Modernizing the federal government paying for performance 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR

The Effect of the MassHealth Hospital Pay-for-Performance Program on Quality

PubMed Central

Ryan, Andrew M; Blustein, Jan

2011-01-01

Objective To test the effect of Massachusetts Medicaid's (MassHealth) hospital-based pay-for-performance (P4P) program, implemented in 2008, on quality of care for pneumonia and surgical infection prevention (SIP). Data Hospital Compare process of care quality data from 2004 to 2009 for acute care hospitals in Massachusetts (N = 62) and other states (N = 3,676) and American Hospital Association data on hospital characteristics from 2005. Study Design Panel data models with hospital fixed effects and hospital-specific trends are estimated to test the effect of P4P on composite quality for pneumonia and SIP. This base model is extended to control for the completeness of measure reporting. Further sensitivity checks include estimation with propensity-score matched control hospitals, excluding hospitals in other P4P programs, varying the time period during which the program was assumed to have an effect, and testing the program effect across hospital characteristics. Principal Findings Estimates from our preferred specification, including hospital fixed effects, trends, and the control for measure completeness, indicate small and nonsignificant program effects for pneumonia (−0.67 percentage points, p>.10) and SIP (−0.12 percentage points, p>.10). Sensitivity checks indicate a similar pattern of findings across specifications. Conclusions Despite offering substantial financial incentives, the MassHealth P4P program did not improve quality in the first years of implementation. PMID:21210796

5 CFR 534.404 - Setting and adjusting pay for senior executives.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Setting and adjusting pay for senior... REGULATIONS PAY UNDER OTHER SYSTEMS Pay and Performance Awards Under the Senior Executive Service § 534.404 Setting and adjusting pay for senior executives. (a) Setting pay upon initial appointment to the SES. An...

Using provider performance incentives to increase HIV testing and counseling services in Rwanda.

PubMed

de Walque, Damien; Gertler, Paul J; Bautista-Arredondo, Sergio; Kwan, Ada; Vermeersch, Christel; de Dieu Bizimana, Jean; Binagwaho, Agnès; Condo, Jeanine

2015-03-01

Paying for performance provides financial rewards to medical care providers for improvements in performance measured by utilization and quality of care indicators. In 2006, Rwanda began a pay for performance scheme to improve health services delivery, including HIV/AIDS services. Using a prospective quasi-experimental design, this study examines the scheme's impact on individual and couples HIV testing. We find a positive impact of pay for performance on HIV testing among married individuals (10.2 percentage points increase). Paying for performance also increased testing by both partners by 14.7 percentage point among discordant couples in which only one of the partners is an AIDS patient. Copyright © 2014. Published by Elsevier B.V.

More on Pay-for-Performance: New Developments in the Field Provide Insights for Policymaking. The Progress of Education Reform. Volume 12, Number 5

ERIC Educational Resources Information Center

Thompson, Barbara; Baumann, Paul

2011-01-01

Whether referred to as "pay-for-performance" (PFP) or "merit pay," attempting to tie educators' compensation to their performance in the classroom and students' performance on high-stakes tests has been a key component of many educator compensation reform efforts in the last five years. This issue looks at PFP systems broadly…

In Tanzania, the many costs of pay-for-performance leave open to debate whether the strategy is cost-effective.

PubMed

Borghi, Josephine; Little, Richard; Binyaruka, Peter; Patouillard, Edith; Kuwawenaruwa, August

2015-03-01

Pay-for-performance programs in health care are widespread in low- and middle-income countries. However, there are no studies of these programs' costs or cost-effectiveness. We conducted a cost-effectiveness analysis of a pay-for-performance pilot program in Tanzania and modeled costs of its national expansion. We reviewed project accounts and reports, interviewed key stakeholders, and derived outcomes from a controlled before-and-after study. In 2012 US dollars, the financial cost of the pay-for-performance pilot was $1.2 million, and the economic cost was $2.3 million. The incremental cost per additional facility-based birth ranged from $540 to $907 in the pilot and from $94 to $261 for a national program. In a low-income setting, the costs of managing the program and generating and verifying performance data were substantial. Pay-for-performance programs can stimulate the generation and use of health information by health workers and managers for strategic planning purposes, but the time involved could divert attention from service delivery. Pay-for-performance programs may become more cost-effective when integrated into routine systems over time. Project HOPE—The People-to-People Health Foundation, Inc.

Willingness to Pay for Home-Based Rehabilitation Service Among Older Adults.

PubMed

Li, Xuemei; Wan, Xia; Pang, Yajuan; Zhou, Lanshu

2018-06-18

This study aims to investigate the willingness to pay (WTP) for a home-based rehabilitation service and explore the influencing factors of WTP among older adults in Shanghai, China. A cross-sectional design was used. A questionnaire survey based on the contingent valuation method was conducted by face-to-face survey over 3 months. Only 242 (44%) participants were willing to pay for a home-based rehabilitation service. The median amount they were willing to pay was RMB 8 (US$1.15) per visit. Older adults who had higher monthly income, had at least one partner who worked, and had medical insurance were willing to pay more for the service. Older adults showed low WTP for a home-based rehabilitation service. Economic status and health condition are the significant influencing factors of WTP. Studies on recipients' precise needs and ability to pay are required before home-based services are implemented.

Does Performance Related Pay for Teachers Improve Student Performance? Some Evidence from India.

ERIC Educational Resources Information Center

Kingdon, Geeta; Teal, Francis

This study examined whether teacher pay was responsive to measures of student performance, noting whether higher pay actually raised student learning outcomes. Data came from a survey of students and schools in India, where public and private school sectors have developed in parallel. The survey collected data on 902 students, 172 teachers, and…

Florida Public Middle School Principals' Perceptions of Teachers' Performance Pay and Its Relationship to Student Achievement

ERIC Educational Resources Information Center

Burchfield, Michael G.

2017-01-01

This study will examine principals' attitudes concerning the impact of the new performance pay plans on principals' relationships with their teachers and how these plans impact their schools. This study will explore principals' perceptions of performance pay, thus providing information to school policy stakeholders, policymakers, teachers, and…

Pay for Performance Proposals in Race to the Top Round II Applications. Briefing Memo

ERIC Educational Resources Information Center

Rose, Stephanie

2010-01-01

The Education Commission of the States reviewed all 36 Race to the Top (RttT) round II applications. Each of the 36 states that applied for round II funding referenced pay for performance under the heading of "Improving teacher and principal effectiveness based on performance." The majority of states outlined pay for performance…

Using an Equity/Performance Matrix to Address Salary Compression/Inversion and Performance Pay Issues

ERIC Educational Resources Information Center

Richardson, Peter; Thomas, Steven

2013-01-01

Pay compression and inversion are significant problems for many organizations and are often severe in schools of business in particular. At the same time, there is more insistence on showing accountability and paying employees based on performance. The authors explain and show a detailed example of how to use a Compensation Equity/ Performance…

Willingness-to-pay for an area-wide integrated Pest Managment Program to control the Asian Tiger Mosquito in New Jersey.

USDA-ARS?s Scientific Manuscript database

Using contingent valuation, the perceived value of an area-wide, integrated pest management program for the Asian tiger mosquito, Aedes albopictus, implemented in Monmouth and Mercer Counties, New Jersey, was estimated. The residents’ maximum willingness-to-pay (WTP) and payment modality was estimat...

Income Contingent Loans: Conceptual and Applied Framework for the Small College.

ERIC Educational Resources Information Center

Lamson, George; And Others

This document presents a conceptual model and applied framework for the small college to implement income contingent loans. Results of a Pay-As-You-Earn (PAYE) questionnaire indicate the utilization potential and attractiveness of the model. Further discussion concerns some prospects, the break-even tax rate, liquidity, the accumulation of debt…

Merit Pay and Job Enlargement as Reforms: Incentives, Implementation, and Teacher Response.

ERIC Educational Resources Information Center

Firestone, William A.

1991-01-01

Based on intensive case studies of two school districts, this study compared two teacher work reforms: merit pay and job enlargement. Interviews with 64 teachers and 53 administrators, supplemented by over 1,300 survey responses, indicate the efficacy of each approach and the potential advantages of job enlargement. (SLD)

Islands Unto Themselves: How Merit Pay Schemes May Undermine Positive Teacher Collaboration

ERIC Educational Resources Information Center

Brewer, T. Jameson; Myers, P. S.; Zhang, Michael

2015-01-01

Educational reforms have become the new policy mainstay in educational discourse and policy. Without doubt, "fixing" teachers and increasing student test scores have both been a large component of much of the reform rhetoric. Moreover, calls for implementing merit pay schemes have uniquely combined reformer's efforts to "fix"…

24 CFR 135.11 - Other laws governing training, employment, and contracting.

Code of Federal Regulations, 2010 CFR

2010-04-01

... AND URBAN DEVELOPMENT EMPLOYMENT AND BUSINESS OPPORTUNITY ECONOMIC OPPORTUNITIES FOR LOW- AND VERY LOW... requirement to pay prevailing wages determined under Davis-Bacon Act (40 U.S.C. 276a—276a-7) and implementing... with the requirement to pay prevailing wage rates, as determined or adopted by HUD, to laborers and...

Performance pay improves engagement, progress, and satisfaction in computer-based job skills training of low-income adults

PubMed Central

Koffarnus, Mikhail N.; DeFulio, Anthony; Sigurdsson, Sigurdur O.; Silverman, Kenneth

2018-01-01

Advancing the education of low-income adults could increase employment and income, but adult education programs have not successfully engaged low-income adults. Monetary reinforcement may be effective in promoting progress in adult education. This experiment evaluated the benefits of providing incentives for performance in a job-skills training program for low-income, unemployed adults. Participants worked on Typing and Keypad programs for 7 months. Participants randomly assigned to Group A (n=23) earned hourly and productivity pay on the Typing program (Productivity Pay), but earned only equalized hourly pay on the Keypad program (Hourly Pay). Group B (n=19) participants had the opposite contingencies. Participants worked more on, advanced further on, and preferred their productivity pay program. These results show that monetary incentives can increase performance in a job-skills training program, and indicate that payment in adult education programs should be delivered contingent on performance in the training program instead of simply on attendance. PMID:24114155

Performance pay improves engagement, progress, and satisfaction in computer-based job skills training of low-income adults.

PubMed

Koffarnus, Mikhail N; DeFulio, Anthony; Sigurdsson, Sigurdur O; Silverman, Kenneth

2013-01-01

Advancing the education of low-income adults could increase employment and income, but adult education programs have not successfully engaged low-income adults. Monetary reinforcement may be effective in promoting progress in adult education. This experiment evaluated the benefits of providing incentives for performance in a job-skills training program for low-income, unemployed adults. Participants worked on typing and keypad programs for 7 months. Participants randomly assigned to Group A (n = 23) earned hourly and productivity pay on the typing program (productivity pay), but earned only equalized hourly pay on the keypad program (hourly pay). Group B (n = 19) participants had the opposite contingencies. Participants worked more on, advanced further on, and preferred their productivity pay program. These results show that monetary incentives can increase performance in a job-skills training program, and indicate that payment in adult education programs should be delivered contingent on performance in the training program instead of simply on attendance. © Society for the Experimental Analysis of Behavior.

Convolution of large 3D images on GPU and its decomposition

NASA Astrophysics Data System (ADS)

Karas, Pavel; Svoboda, David

2011-12-01

In this article, we propose a method for computing convolution of large 3D images. The convolution is performed in a frequency domain using a convolution theorem. The algorithm is accelerated on a graphic card by means of the CUDA parallel computing model. Convolution is decomposed in a frequency domain using the decimation in frequency algorithm. We pay attention to keeping our approach efficient in terms of both time and memory consumption and also in terms of memory transfers between CPU and GPU which have a significant inuence on overall computational time. We also study the implementation on multiple GPUs and compare the results between the multi-GPU and multi-CPU implementations.

Exploring the Possibility and Potential for Pay for Performance in America's Public Schools

ERIC Educational Resources Information Center

Ellerson, Noelle M.

2009-01-01

In response to a growing dialogue at the local, state and national levels around the idea of restructuring teacher pay to include performance measures, the American Association of School Administrators surveyed a randomly selected sample of its members to gauge their feedback and interest in pay-for-performance programs. AASA launched this survey…

Performance Pay Preferences of College of Education Faculty and Administrators at One Historically Black University: A Case Study

ERIC Educational Resources Information Center

Jones, Corey Lee

2012-01-01

The purpose of this study was to determine the attitudes and perceptions College of Education faculty and administrators have about performance pay at a Historically Black University (HBCU). A secondary purpose of the study was to determine the performance pay plan and specific measures of faculty productivity preferred by College of Education…

Status of Teacher Performance Pay Programs across the United States. Information Capsule. Volume 1103

ERIC Educational Resources Information Center

Blazer, Christie

2011-01-01

An increasing number of states and school districts across the country are tying teacher pay to student performance. A recent RAND Education study found that nationwide spending on teacher performance pay increased from $99 million in 2006 to $439 million in 2010. However, many states and school districts face significant hurdles when they attempt…

Examining the Implementation of Technology-Based Blended Algebra I Curriculum at Scale

ERIC Educational Resources Information Center

Karam, Rita; Pane, John F.; Griffin, Beth Ann; Robyn, Abby; Phillips, Andrea; Daugherty, Lindsay

2017-01-01

Studies on blended education pay little attention to implementation, thus limiting the understanding of how such programs contribute to student math learning. This article examines the implementation of a widely used blended algebra curriculum and the relationship between implementation and student outcomes. The study was conducted in 74 middle…

Public reporting and pay-for-performance: safety-net hospital executives' concerns and policy suggestions.

PubMed

Goldman, L Elizabeth; Henderson, Stuart; Dohan, Daniel P; Talavera, Jason A; Dudley, R Adams

2007-01-01

Safety-net hospitals (SNHs) may gain little financial benefit from the rapidly spreading adoption of public reporting and pay-for-performance, but may feel compelled to participate (and bear the costs of data collection) to meet public expectations of transparency and accountability. To better understand the concerns that SNH administrators have regarding public reporting and pay-for-performance, we interviewed 37 executives at randomly selected California SNHs. The main concerns noted by SNH executives were that human and financial resource constraints made it difficult for SNHs to accurately measure their performance. Additionally, some executives felt that market-driven public reporting and pay-for-performance may focus on clinical areas and incentive structures that may not be high-priority clinical areas for SNHs. Executives at SNHs suggested several policy responses to these concerns-such as offering training programs for SNH data collectors-that could be relatively inexpensive and might improve the cost-benefit ratio of public reporting and pay-for-performance programs.

Patients' views of pay for performance in primary care: a qualitative study.

PubMed

Hannon, Kerin L; Lester, Helen E; Campbell, Stephen M

2012-05-01

Many countries use pay-for-performance schemes to reward family practices financially for achieving quality indicators. The views of patients on pay for performance remain largely unexplored. To gain the views of family practice patients on the United Kingdom pay-for-performance Quality and Outcomes Framework (QOF). Interviews with 52 patients were conducted in 15 family practices across England. All patients had at least one long-term condition that had been diagnosed before the introduction of the QOF in 2004. Semi-structured interviews analysed using open explorative thematic coding. Few patients had heard of the QOF or had noticed changes to the structure or process of their care. However, where they were noted, changes to consultations such as increased use of computers and health checks initiated by the GP or practice nurse were seen as good practice. The majority of patients were surprised to hear their practice received bonuses for doing 'simple things'. Some patients also raised concerns over potential unintended consequences of pay-for-performance frameworks, such as a reduced focus on non-incentivised areas. This study adds a unique patient perspective to the debate around the impact of pay-for-performance schemes and consequences on patient care. Patients' views, experiences, and concerns about pay for performance mostly chime with previously described opinions of primary care staff. Patient surprise and concern around incentivising basic processes of care shows how patient views are vital when monitoring and evaluating a scheme that is designed to improve patient care.

Radiation Therapy After Breast-Conserving Surgery: Does Hospital Surgical Volume Matter? A Population-Based Study in Taiwan

DOE Office of Scientific and Technical Information (OSTI.GOV)

Chien, Chun-Ru; Department of Radiation Oncology, China Medical University Hospital, and School of Medicine, China Medical University, Taichung, Taiwan; Pan, I-Wen

2012-01-01

Purpose: To examine the association between hospital surgical volume and the use of radiation therapy (RT) after breast-conserving surgery (BCS) in Taiwan. Methods and Materials: We used claims data from the National Health Insurance program in Taiwan (1997-2005) in this retrospective population-based study. We identified patients with breast cancer, receipt of BCS, use of radiation, and the factors that could potentially associated with the use of RT from enrollment records, and the ICD-9 and billing codes in claims. We conducted logistic regression to examine factors associated with RT use after BCS, and performed subgroup analyses to examine whether the associationmore » differs by medical center status or hospital volumes. Results: Among 5,094 patients with newly diagnosed invasive breast cancer who underwent BCS, the rate of RT was significantly lower in low-volume hospitals (74% vs. 82%, p < 0.01). Patients treated in low-volume hospitals were less likely to receive RT after BCS (odds ratio = 0.72, 95% confidence interval = 0.62-0.83). In addition, patients treated after the implementation of the voluntary pay-for-performance policy in 2001 were more likely to receive RT (odds ratio = 1.23; 95% confidence interval = 1.05-1.45). Subgroup analyses indicated that the high-volume effect was limited to hospitals accredited as non-medical centers, and that the effect of the pay-for-performance policy was most pronounced among low-volume hospitals. Conclusions: Using population-based data from Taiwan, our study concluded that hospital surgical volume and pay-for-performance policy are positively associated with RT use after BCS.« less

Developing a new national approach to surveillance for ventilator-associated events: executive summary.

PubMed

Magill, Shelley S; Klompas, Michael; Balk, Robert; Burns, Suzanne M; Deutschman, Clifford S; Diekema, Daniel; Fridkin, Scott; Greene, Linda; Guh, Alice; Gutterman, David; Hammer, Beth; Henderson, David; Hess, Dean R; Hill, Nicholas S; Horan, Teresa; Kollef, Marin; Levy, Mitchell; Septimus, Edward; VanAntwerpen, Carole; Wright, Don; Lipsett, Pamela

2013-11-01

In September 2011, the Centers for Disease Control and Prevention (CDC) convened a Ventilator-Associated Pneumonia (VAP) Surveillance Definition Working Group to organize a formal process for leaders and experts of key stakeholder organizations to discuss the challenges of VAP surveillance definitions and to propose new approaches to VAP surveillance in adult patients (Table 1). The charges to the Working Group were to (1) critically review a draft, streamlined VAP surveillance definition developed for use in adult patients; (2) suggest modifications to enhance the reliability and credibility of the surveillance definition within the critical care and infection prevention communities; and (3) propose a final adult surveillance definition algorithm to be implemented in the CDC's National Healthcare Safety Network (NHSN), taking into consideration the potential future use of the definition algorithm in public reporting, interfacility comparisons, and pay-for-reporting and pay-for-performance programs. Published by Mosby, Inc.

Merit pay: viable?

PubMed

Farmer, C R

1978-01-01

Can an organization really have a meaningful relationship between its merit pay program and motivation of its employees? C. Richard Farmer of Armstrong Cork says yes--if. If the approach to granting merit pay increases is coupled with a salary structure attuned to economic and competitive conditions, and if it is communicated effectively and openly to the employees, then it automatically translates labor market activity, performance, and the cost of living into a meaningful increase. Position descriptions, evaluations, and performance appraisals are some of the tools essential to a viable merit pay program. But besides these definite do's, the author outlines some of the don'ts of merit pay programs, such as centralized administration of the program--policies, programs, and procedures may be centralized, but their administration must be carried out by those close to the individual employees and work units. Above all, the merit pay program must be based on performance, not longevity.

Reforming Teacher Pay

ERIC Educational Resources Information Center

Burns, Susan Freeman; Gardner, Catherine D.

2010-01-01

A recent Google search for information regarding performance pay in education produced 6.1 million results. This number should come as no surprise given the current level of interest in incentives as a popular reform option in public education. Supporters believe pay-for-performance programs encourage less effective teachers to improve and will…

7 CFR 275.23 - Determination of State agency program performance.

Code of Federal Regulations, 2010 CFR

2010-01-01

... national performance measure for the fiscal year, the State agency shall pay or have its share of... the prescribed timeframe. (8) Interest charges. (i) To the extent that a State agency does not pay a... agency agrees to pay the claim through reduction in Federal financial participation for administrative...

5 CFR 534.406 - Conversion to the SES pay system.

Code of Federal Regulations, 2011 CFR

2011-01-01

... 5 Administrative Personnel 1 2011-01-01 2011-01-01 false Conversion to the SES pay system. 534.406... UNDER OTHER SYSTEMS Pay and Performance Awards Under the Senior Executive Service § 534.406 Conversion... senior executive's converted rate of basic pay. Conversion to a new SES rate of basic pay is not...

Compensation Reform in the Schools

ERIC Educational Resources Information Center

Laine, Sabrina; Potemski, Amy; Rowland, Cortney

2010-01-01

One of the most frequently discussed topics in education reform circles is teacher pay--how much money teachers make, for what work and who decides teachers' salaries. Over time, educator pay reform has included many different reward structures and goes by as many different names, such as merit pay, performance pay and differentiated pay. The…

76 FR 52537 - Pay for Sunday Work

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-23

... OFFICE OF PERSONNEL MANAGEMENT 5 CFR Parts 532 and 550 RIN 3206-AM08 Pay for Sunday Work AGENCY... the payment of Sunday premium pay for work performed on Sundays. The revised Sunday premium pay... Sunday premium pay, pursuant to 5 U.S.C. 5544(a). Intermittent employees continue to be excluded from...

5 CFR 9701.345 - Developmental pay adjustments.

Code of Federal Regulations, 2011 CFR

2011-01-01

... Section 9701.345 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Performance-Based Pay § 9701.345...

5 CFR 9701.345 - Developmental pay adjustments.

Code of Federal Regulations, 2012 CFR

2012-01-01

... Section 9701.345 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Performance-Based Pay § 9701.345...

5 CFR 9701.345 - Developmental pay adjustments.

Code of Federal Regulations, 2013 CFR

2013-01-01

... Section 9701.345 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Performance-Based Pay § 9701.345...

5 CFR 9701.345 - Developmental pay adjustments.

Code of Federal Regulations, 2014 CFR

2014-01-01

... Section 9701.345 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Performance-Based Pay § 9701.345...

Application of the analytic hierarchy process in the performance measurement of colorectal cancer care for the design of a pay-for-performance program in Taiwan.

PubMed

Chung, Kuo-Piao; Chen, Li-Ju; Chang, Yao-Jen; Chang, Yun-Jau; Lai, Mei-Shu

2013-02-01

To prioritize performance measures for colorectal cancer care to facilitate the implementation of a pay-for-performance (PFP) system. Questionnaires survey. Medical hospitals in Taiwan. Sixty-six medical doctors from 5 November 2009 to 10 December 2009. Analytic hierarchy process (AHP) technique. Main outcome measure(s) Performance measures (two pre-treatment, six treatment related and three monitoring related) were used. Forty-eight doctors responded and returned questionnaires (response rate 72.7%) with surgeons and physicians contributing equally. The most important measure was the proportion of colorectal patients who had pre-operative examinations that included chest X-ray and abdominal ultrasound, computed tomography or MRI (global priority: 0.144), followed by the proportion of stages I-III colorectal cancer patients who had undergone a wide surgical resection documented as 'negative margin' (global priority: 0.133) and the proportion of colorectal cancer patients who had undergone surgery with a pathology report that included information on tumor size and node differentiation (global priority: 0.116). Most participants considered that the best interval for the renewal indicators was 3-5 years (43.75%) followed by 5-10 years (27.08%). To design a PFP program, the AHP method is a useful technique to prioritize performance measures, especially in a highly specialized domain such as colorectal cancer care.

District Awards for Teacher Excellence: Research Brief

ERIC Educational Resources Information Center

National Center on Performance Incentives, 2010

2010-01-01

Since 2008 Texas's District Awards for Teacher Excellence (D.A.T.E.) program has provided grants to districts for the implementation of locally designed incentive pay plans. The 2010-11 school year is the third year of the D.A.T.E. incentive pay plans with approximately $197 million in annual state funding. This research brief summarizes the key…

The NYC Teacher Pay-For-Performance Program: Early Evidence from a Randomized Trial. Civic Report No. 56

ERIC Educational Resources Information Center

Springer, Matthew G.; Winters, Marcus A.

2009-01-01

Paying teachers varying amounts on the basis of how well their students perform is an idea that has been winning increasing support, both in the United States and abroad, and many school systems have adopted some version of it. Proponents claim that linking teacher pay to student performance is a powerful way to encourage talented and highly…

The NYC Teacher Pay-for-Performance Program: Early Evidence from a Randomized Trial. Civic Report No. 56

ERIC Educational Resources Information Center

Springer, Matthew G.; Winters, Marcus A.

2009-01-01

Paying teachers varying amounts on the basis of how well their students perform is an idea that has been winning increasing support, both in the United States and abroad, and many school systems have adopted some version of it. Proponents claim that linking teacher pay to student performance is a powerful way to encourage talented and highly…

Economic Evaluation of a Multifaceted Implementation Strategy for the Prevention of Hand Eczema Among Healthcare Workers in Comparison with a Control Group: The Hands4U Study.

PubMed

van der Meer, Esther W C; van Dongen, Johanna M; Boot, Cécile R L; van der Gulden, Joost W J; Bosmans, Judith E; Anema, Johannes R

2016-05-01

The aim of this study was to evaluate the cost-effectiveness of a multifaceted implementation strategy for the prevention of hand eczema in comparison with a control group among healthcare workers. A total of 48 departments (n=1,649) were randomly allocated to the implementation strategy or the control group. Data on hand eczema and costs were collected at baseline and every 3 months. Cost-effectiveness analyses were performed using linear multilevel analyses. The probability of the implementation strategy being cost-effective gradually increased with an increasing willingness-to-pay, to 0.84 at a ceiling ratio of €590,000 per person with hand eczema prevented (societal perspective). The implementation strategy appeared to be not cost-effective in comparison with the control group (societal perspective), nor was it cost-beneficial to the employer. However, this study had some methodological problems which should be taken into account when interpreting the results.

5 CFR 532.507 - Pay for holiday work.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Pay for holiday work. 532.507 Section 532... SYSTEMS Premium Pay and Differentials § 532.507 Pay for holiday work. (a) An employee who is entitled to holiday premium pay and who performs work on a holiday which is not overtime work shall be paid the...

The Pay-for-Performance Dilemma.

ERIC Educational Resources Information Center

Meyer, Herbert H.

1975-01-01

The basis for most problems with merit pay plans is that the great majority of employees believe their own job performance is above average. Even a well-administered merit pay plan cannot give positive feedback to this majority. The likely consequence is that the employee's self-esteem is threatened. Often one copes with such a threat by demeaning…

Review of "Cross-Country Evidence on Teacher Performance Pay"

ERIC Educational Resources Information Center

von Davier, Matthias

2011-01-01

The primary claim of this Harvard Program on Education Policy and Governance report and the abridged Education Next version is that nations "that pay teachers on their performance score higher on PISA tests." After statistically controlling for several variables, the author concludes that nations with some form of merit pay system have,…

Expecting Too Much of Performance Pay?

ERIC Educational Resources Information Center

Johnson, Susan Moore; Papay, John P.

2010-01-01

Pay for performance is not a new idea, and reformers should not ignore the dismal record of merit pay over the past century. Initially adopted with a flourish of expectations during several waves of popularity in the past, every plan eventually fell into disuse. These plans proved to be unexpectedly costly and cumbersome to run. They often…

Teachers' Perceptions of Individual Performance-Related Pay in Practice: A Picture of a Counterproductive Pay System

ERIC Educational Resources Information Center

Lundstrom, Ulf

2012-01-01

This article describes and discusses Swedish upper-secondary teachers' perceptions of the effects of individual performance-related pay (PRP) in the context of educational restructuring and governance. The empirical data were generated through semi-structured interviews of 23 teachers. Power's distinction between programmatic and technological…

Does Performance-Based Pay Improve Teaching? PISA in Focus. No. 16

ERIC Educational Resources Information Center

OECD Publishing (NJ1), 2012

2012-01-01

The Programme for International Student Assessment (PISA) has long established that high-performing education systems tend to pay their teachers more. They also often prioritise the quality of teaching over other choices, including class size. But in the current budgetary climate, paying everybody more may not be a viable alternative. So many…

Teaching to the Tails: Teacher Performance Pay and the Distribution of Student Achievement

ERIC Educational Resources Information Center

Loyalka, Prashant; Sylvia, Sean; Liu, Chengfang; Chu, James; Rozelle, Scott

2015-01-01

Growing evidence suggests that teachers in developing countries often have weak or misaligned incentives for improving student outcomes. In response, policymakers and researchers have proposed performance pay as a way to improve student outcomes by tying concrete measures like achievement scores to teacher pay. While evidence from randomized…

Patient opinions regarding 'pay for performance for patients'.

PubMed

Long, Judith A; Helweg-Larsen, Marie; Volpp, Kevin G

2008-10-01

Pay for performance (P4P) programs have shown only modest improvements in outcomes and do not target patient behaviors. Many large employers and payers are turning to pay for performance for patients (P4P4P) to reduce health costs and improve the health of their covered populations. How these programs may be perceived by patients is unknown. To assess patients' opinion of the acceptability of P4P4P. Cross-sectional self-administered survey. Patients in waiting rooms in two university-based primary care clinics. Participants were asked their opinions about paying people to quit smoking, lose weight, control their blood pressure, or control their diabetes. Respondents were split on whether P4P4P is desirable. Thirty-six to 42% thought it was a good/excellent idea to pay smokers to quit smoking, obese people to lose weight, people with hypertension to control their blood pressure, or people with diabetes to control their blood sugar, while 41-44% of the sample thought it was a bad/very bad idea. Smokers and patients who were obese endorsed P4P4P more favorably as a means to achieving tobacco cessation and weight loss than their non-smoking and non-obese counterparts. Acceptance of paying patients for performance by the general population is equivocal. Establishing the efficacy of paying patients for performance may help it gain wider acceptance.

Mobilization for HIV Voluntary Counseling and Testing Services in Vietnam: Clients' Risk Behaviors, Attitudes and Willingness to Pay.

PubMed

Nguyen, Long Hoang; Tran, Bach Xuan; Nguyen, Nhung Phuong; Phan, Huong Thu Thi; Bui, Trang Thu; Latkin, Carl A

2016-04-01

A multi-site survey was conducted on a sample of 365 clients to assess their willingness to pay for HIV voluntary counseling and testing (VCT) services in Ha Noi and Nam Dinh province, two epicenters of Vietnam. By using contingent valuation technique, the results showed that most of respondents (95.1 %) were willing to pay averagely 155 (95 % CI 132-177) thousands Vietnam Dong (~US $7.75, 2013) for a VCT service. Clients who were female, had middle income level, and current opioid users were willing to pay less; meanwhile clients who had university level of education were willing to pay more for a VCT service. The results highlighted the high rate of willingness to pay for the service at a high amount by VCT clients. These findings contribute to the implementation of co-payment scheme for VCT services toward the financial sustainability of HIV/AIDS programs in Vietnam.

Meeting the challenge in performance management: the diffusion and implementation of the balanced scorecard in Chinese hospitals.

PubMed

Gao, Tian; Gurd, Bruce

2015-03-01

The bonus system used in Chinese hospitals has been criticized for eroding doctors' professional ethics and aggravating patient expense. This research article focuses on one system to improve hospital performance, the balanced scorecard (BSC). We use three data sources to examine the diffusion and implementation of the BSC in China: a questionnaire survey in Shandong Province, a print-media indicators and content analysis of the published BSC papers and semi-structured interviews with managers of Chinese hospitals that use the BSC. The research evidence shows that bonus systems are important, partially because of the poor pay of hospital professionals, and the BSC is perceived as providing a fair system to award such bonuses. This helps explain the relative endurance of the BSC in Chinese hospitals. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2014; all rights reserved.

Pay It Forward: High School Video-based Instruction Can Disseminate CPR Knowledge in Priority Neighborhoods.

PubMed

Del Rios, Marina; Han, Josiah; Cano, Alejandra; Ramirez, Victor; Morales, Gabriel; Campbell, Teri L; Hoek, Terry Vanden

2018-03-01

The implementation of creative new strategies to increase layperson cardiopulmonary resuscitation (CPR) and defibrillation may improve resuscitation in priority populations. As more communities implement laws requiring CPR training in high schools, there is potential for a multiplier effect and reach into priority communities with low bystander-CPR rates. We investigated the feasibility, knowledge acquisition, and dissemination of a high school-centered, CPR video self-instruction program with a "pay-it-forward" component in a low-income, urban, predominantly Black neighborhood in Chicago, Illinois with historically low bystander-CPR rates. Ninth and tenth graders followed a video self-instruction kit in a classroom setting to learn CPR. As homework, students were required to use the training kit to "pay it forward" and teach CPR to their friends and family. We administered pre- and post-intervention knowledge surveys to measure knowledge acquisition among classroom and "pay-it-forward" participants. Seventy-one classroom participants trained 347 of their friends and family, for an average of 4.9 additional persons trained per kit. Classroom CPR knowledge survey scores increased from 58% to 93% (p < 0.0001). The pay-it-forward cohort saw an increase from 58% to 82% (p < 0.0001). A high school-centered, CPR educational intervention with a "pay-it-forward" component can disseminate CPR knowledge beyond the classroom. Because schools are centrally-organized settings to which all children and their families have access, school-based interventions allow for a broad reach that encompasses all segments of the population and have potential to decrease disparities in bystander CPR provision.

Report on Wellesley Conference on Equal Pay and Equal Opportunity Policy in the United States, Canada, and Western Europe.

ERIC Educational Resources Information Center

Ratner, Ronnie Steinberg

After a brief discussion of conference background and structure, these proceedings identify and summarize equal pay and employment policy issues discussed at a four-day working conference of sixty-five people from twelve advanced industrialized countries. Focus is on progress to date and alternative strategies for implementing policies. Strategies…

Assessment of Teachers' Reactions to a Knowledge- and Skills-Based Pay Structure at an International School

ERIC Educational Resources Information Center

Lowe, Joel Courtney

2013-01-01

This study explores teachers' reactions to a knowledge- and skills-based pay (KSBP) system implemented in a large international school. Such systems are designed to set teacher compensation based on demonstrated professional knowledge and skills as opposed to the traditional scale based on years of experience and degrees attained. This study fills…

Why do women pay more than they should? A mixed methods study of the implementation gap in a policy to subsidize the costs of deliveries in Burkina Faso.

PubMed

Ridde, Valéry; Kouanda, Seni; Yameogo, Maurice; Kadio, Kadidiatou; Bado, Aristide

2013-02-01

In 2007, Burkina Faso launched a public policy to subsidize 80% of the cost of normal deliveries. Although women are required to pay only the remaining 20%, i.e., 900F CFA (1.4 Euros), some qualitative evidence suggests they actually pay more. The aim of this study is to test and then (if confirmed) to understand the hypothesis that the amounts paid by women are more than the official fee, i.e., their 20% portion. A mixed method sequential explanatory design giving equal priority to both quantitative (n=883) and qualitative (n=50) methods was used in a rural health district of Ouargaye. Half (50%, median) of the women reported paying more than the official fee for a delivery. Health workers questioned the methodology of the study and the veracity of the women's reports. The three most plausible explanations for this payment disparity are: (i) the payments were for products used that were not part of the delivery kit covered by the official fee; (ii) the implementers had difficulty in understanding the policy; and (iii) there was improper conduct on the part of some health workers. Institutional design and organizational practices, as well as weak rule enforcement and organizational capacity, need to be considered more carefully to avoid an implementation gap in this public policy. Copyright © 2012 Elsevier Ltd. All rights reserved.

The Perceived Association of Merit Pay and Teacher Qualities in Two Middle Schools in a Southeastern State

ERIC Educational Resources Information Center

Balls, John Daniel

2013-01-01

This dissertation determined the perceived association of merit pay and teacher qualities in the sample schools. The research focused on the association of merit pay and levels of teacher qualities and if a relationship exists between teacher performance-based compensation and teacher qualities/performance. The indications and suggestions of this…

Value-Added Merit Pay.

ERIC Educational Resources Information Center

Twomey, Daniel F.

The purpose of merit pay is to reward employees for their accomplishments and motivate them to continue improving. Critics of merit pay say the increased extrinsic motivation that it prompts is more than offset by the decrease in intrinsic motivation. Supporters of performance-based pay claim several benefits of the practice. This study addressed…

75 FR 18133 - Pay for Sunday Work

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-09

...-AM08 Pay for Sunday Work AGENCY: Office of Personnel Management. ACTION: Proposed rule. SUMMARY: The U... provisions of 5 U.S.C. 5546(a), the statute governing the payment of Sunday premium pay for work performed on Sundays. The revised Sunday premium pay regulations would eliminate references to ``full-time'' employees...

5 CFR 610.407 - Premium pay for holiday work for employees on compressed work schedules.

Code of Federal Regulations, 2010 CFR

2010-01-01

... schedule who performs work on a holiday is entitled to basic pay, plus premium pay at a rate equal to basic pay, for the work that is not in excess of the employee's compressed work schedule for that day. For... 5 Administrative Personnel 1 2010-01-01 2010-01-01 false Premium pay for holiday work for...

Adapted all-numerical correlator for face recognition applications

NASA Astrophysics Data System (ADS)

Elbouz, M.; Bouzidi, F.; Alfalou, A.; Brosseau, C.; Leonard, I.; Benkelfat, B.-E.

2013-03-01

In this study, we suggest and validate an all-numerical implementation of a VanderLugt correlator which is optimized for face recognition applications. The main goal of this implementation is to take advantage of the benefits (detection, localization, and identification of a target object within a scene) of correlation methods and exploit the reconfigurability of numerical approaches. This technique requires a numerical implementation of the optical Fourier transform. We pay special attention to adapt the correlation filter to this numerical implementation. One main goal of this work is to reduce the size of the filter in order to decrease the memory space required for real time applications. To fulfil this requirement, we code the reference images with 8 bits and study the effect of this coding on the performances of several composite filters (phase-only filter, binary phase-only filter). The saturation effect has for effect to decrease the performances of the correlator for making a decision when filters contain up to nine references. Further, an optimization is proposed based for an optimized segmented composite filter. Based on this approach, we present tests with different faces demonstrating that the above mentioned saturation effect is significantly reduced while minimizing the size of the learning data base.

A Legal Perspective on Performance-Based Pay for Teachers. Working Paper 2008-10

ERIC Educational Resources Information Center

Ryan, James E.

2008-01-01

Merit pay is now in the midst of a renaissance. Hundreds of school districts are experimenting with some type of performance-based pay system. At least six states have statewide or pilot programs, and the federal government has spent close to $100 million on the Teacher Incentive Fund. Whether such programs will last, encourage the start of…

Effects of and preference for pay for performance: an analogue analysis.

PubMed

Long, Robert D; Wilder, David A; Betz, Alison; Dutta, Ami

2012-01-01

We examined the effects of 2 payment systems on the rate of check processing and time spent on task by participants in a simulated work setting. Three participants experienced individual pay-for-performance (PFP) without base pay and pay-for-time (PFT) conditions. In the last phase, we asked participants to choose which system they preferred. For all participants, the PFP condition produced higher rates of check processing and more time spent on task than did the PFT condition, but choice of payment system varied both within and across participants.

Impacts of Pay on Employee Behaviors and Attitudes: An Update

ERIC Educational Resources Information Center

Dyer, Lee; And Others

1978-01-01

Examines the potential impacts of pay on decisions to join organizations; behaviors such as performance and absenteeism levels; and pay satisfaction, dissatisfaction, and decisions to leave organizations. (Author/IRT)

Merit Pay in Arkansas: An Evaluation of the Cobra Pride Incentive Program in the Fountain Lake School District

ERIC Educational Resources Information Center

Jensen, Nathan C.

2012-01-01

Starting in the 2010-11, administrators at the Fountain Lake School District implemented the Cobra Pride Incentive Program (CPIP), a merit pay program designed to financially reward all school employees with year-end bonuses primarily for significant improvements in student achievement. At the conclusion of the 2010-11 school year, over $800,000…

Swift Trust in Hastily Formed Networks

DTIC Science & Technology

2002-01-01

in the Engineering School. 1983 Grand Prix Award, Sales Promotion Association of Australia A national award received for the best promotion of the...deposit of over $500. The average deposit was over $2,000. 1983 Best Small Budget Award, Sales Promotion Association of Australia A national award...Australian Sales Promotion Awards. Implemented the introduction of new financial services such as automatic bill paying and telephone bill paying. Planned

Pharmacists' perceptions of pay for performance versus fee-for-service remuneration for the management of hypertension through pharmacist prescribing.

PubMed

Rosenthal, Meagen M; Desai, Nimisha; Houle, Sherilyn K D

2017-10-01

As pharmacists expand their roles as patient care providers, remuneration must be offered for patient care activities apart from dispensing. Most jurisdictions paying for such services utilize the fee-for-service (FFS) model, while little is known about the role of pay for performance (P4P) within the pharmacy profession. This study aimed to elicit the experience of pharmacists practicing under both models within the Alberta Clinical Trial in Optimizing Hypertension (RxACTION) study in Alberta, Canada. Pharmacist participants in RxACTION caring for at least one patient under FFS and under P4P were interviewed about their experiences until data saturation was reached. Interviews were conducted in June-July 2015, with responses audio recorded, transcribed and coded to identify key themes. Eight pharmacists were interviewed, with three key themes identified: a perceived comfort with the existing FFS model particularly due to its ease related to business planning, the transformative effect of the study on their practices and a preference for future models to consider a blend of both service count- and performance-driven metrics. The degree of influence pharmacists feel they can have on outcomes achieved by patients, the perceptions of patients and other healthcare professionals on outcome-based payment, and concerns with the impact of variable remuneration on the pharmacy business model are concerns raised with P4P in pharmacy practice. This study reveals a hesitation to radically transform payment for pharmacists' patient care services towards a P4P model. Efforts to implement P4P should therefore be gradual and accompanied with a robust evaluation plan. © 2017 Royal Pharmaceutical Society.

Sustainability of quality improvement following removal of pay-for-performance incentives.

PubMed

Benzer, Justin K; Young, Gary J; Burgess, James F; Baker, Errol; Mohr, David C; Charns, Martin P; Kaboli, Peter J

2014-01-01

Although pay-for-performance (P4P) has become a central strategy for improving quality in US healthcare, questions persist about the effectiveness of these programs. A key question is whether quality improvement that occurs as a result of P4P programs is sustainable, particularly if incentives are removed. To investigate sustainability of performance levels following removal of performance-based incentives. Observational cohort study that capitalized on a P4P program within the Veterans Health Administration (VA) that included adoption and subsequent removal of performance-based incentives for selected inpatient quality measures. The study sample comprised 128 acute care VA hospitals where performance was assessed between 2004 and 2010. VA system managers set annual performance goals in consultation with clinical leaders, and report performance scores to medical centers on a quarterly basis. These scores inform performance-based incentives for facilities and their managers. Bonuses are distributed based on the attainment of these performance goals. Seven quality of care measures for acute coronary syndrome, heart failure, and pneumonia linked to performance-based incentives. Significant improvements in performance were observed for six of seven quality of care measures following adoption of performance-based incentives and were maintained up to the removal of the incentive; subsequently, the observed performance levels were sustained. This is a quasi-experimental study without a comparison group; causal conclusions are limited. The maintenance of performance levels after removal of a performance-based incentive has implications for the implementation of Medicare's value-based purchasing initiative and other P4P programs. Additional research is needed to better understand human and system-level factors that mediate sustainability of performance-based incentives.

Pay It Forward: High School Video-based Instruction Can Disseminate CPR Knowledge in Priority Neighborhoods

PubMed Central

Han, Josiah; Cano, Alejandra; Ramirez, Victor; Morales, Gabriel; Campbell, Teri L.; Hoek, Terry Vanden

2018-01-01

Introduction The implementation of creative new strategies to increase layperson cardiopulmonary resuscitation (CPR) and defibrillation may improve resuscitation in priority populations. As more communities implement laws requiring CPR training in high schools, there is potential for a multiplier effect and reach into priority communities with low bystander-CPR rates. Methods We investigated the feasibility, knowledge acquisition, and dissemination of a high school-centered, CPR video self-instruction program with a “pay-it-forward” component in a low-income, urban, predominantly Black neighborhood in Chicago, Illinois with historically low bystander-CPR rates. Ninth and tenth graders followed a video self-instruction kit in a classroom setting to learn CPR. As homework, students were required to use the training kit to “pay it forward” and teach CPR to their friends and family. We administered pre- and post-intervention knowledge surveys to measure knowledge acquisition among classroom and “pay-it-forward” participants. Results Seventy-one classroom participants trained 347 of their friends and family, for an average of 4.9 additional persons trained per kit. Classroom CPR knowledge survey scores increased from 58% to 93% (p < 0.0001). The pay-it-forward cohort saw an increase from 58% to 82% (p < 0.0001). Conclusion A high school-centered, CPR educational intervention with a “pay-it-forward” component can disseminate CPR knowledge beyond the classroom. Because schools are centrally-organized settings to which all children and their families have access, school-based interventions allow for a broad reach that encompasses all segments of the population and have potential to decrease disparities in bystander CPR provision. PMID:29560076

Self-Solicited Feedback: Effects of Hourly Pay and Individual Monetary Incentive Pay

ERIC Educational Resources Information Center

Slowiak, Julie M.; Dickinson, Alyce M.; Huitema, Bradley E.

2011-01-01

The frequency of feedback solicitation under hourly pay and individual monetary incentive pay conditions was examined. A between-subjects design was used with 30 college students in the two groups. Participants attended three experimental sessions and entered the cash value of simulated bank checks presented on a computer screen. Performance was…

76 FR 80268 - Pay for Senior-Level and Scientific or Professional Positions

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-23

... 3206-AL88 Pay for Senior-Level and Scientific or Professional Positions AGENCY: U.S. Office of... to amend rules for setting and adjusting pay of senior-level (SL) and scientific or professional (ST) employees. The Senior Professional Performance Act of 2008 changes pay for these employees by providing for...

Using Outperformance Pay to Motivate Academics: Insiders' Accounts of Promises and Problems

ERIC Educational Resources Information Center

Field, Laurie

2015-01-01

Many researchers have investigated the appropriateness of pay for outperformance, (also called "merit-based pay" and "performance-based pay") for academics, but a review of this body of work shows that the voice of academics themselves is largely absent. This article is a contribution to addressing this gap, summarising the…

28 CFR 545.26 - Performance pay provisions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... effective management of the overall performance pay program, the percentage of inmates assigned to each... categories as quality of work, quantity of work, initiative, ability to learn, dependability, response to...

28 CFR 545.26 - Performance pay provisions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... effective management of the overall performance pay program, the percentage of inmates assigned to each... categories as quality of work, quantity of work, initiative, ability to learn, dependability, response to...

Parents' Perceptions of the First-Year Implementation of a One-to-One Laptop Initiative in a Midwestern High School

ERIC Educational Resources Information Center

Jin, Yi; Schmidt-Crawford, Denise A.

2017-01-01

With the widespread use and implementation of technology into PK-20 education, one-to-one laptop programs are becoming popular approaches and have been implemented all over the world in PK-20 classrooms. With the enthusiastic implementation of this kind of program, educators and researchers have started to pay attention to evaluating their…

Willingness to pay for methadone maintenance treatment in Vietnamese epicentres of injection-drug-driven HIV infection.

PubMed

Tran, Bach Xuan

2013-07-01

Willingness to pay for methadone maintenance treatment (MMT) in three Vietnamese epicentres of injection-drug-driven human immunodeficiency virus (HIV) infection was assessed. A convenience sample of 1016 patients receiving HIV treatment in seven clinics was enrolled during 2012. Contingent valuation was used to assess willingness to pay. Interviewers reviewed adverse consequences of injection drug use and the benefits of MMT. Interviewers then described the government's plan to scale up MMT and the financial barriers to scale-up. Willingness to pay was assessed using double-bounded binary questions and a follow-up open-ended question. Point and interval data models were used to estimate maximum willingness to pay. A total of 548 non-drug-users and 468 injection drug users were enrolled; 988 were willing to pay for MMT. Monthly mean willingness to pay among non-drug-users, 347 drug users not receiving MMT and 121 drug users receiving MMT was 10.7 United States dollars [US$] (35.7% of treatment costs), US$ 21.1 (70.3%) and US$ 26.2 (87.3%), respectively (mean: US$ 15.9; 95% confidence interval, CI: 13.6-18.1). Fifty per cent of drug users were willing to pay 50% of MMT costs. Residence in households with low monthly per capita income and poor health status predicted willingness to pay less among drug users; educational level, employment status, health status and current antiretroviral therapy receipt predicted willingness to pay less among non-drug-users. Willingness to pay for MMT was very high, supporting implementation of a co-payment programme.

29 CFR 1620.17 - Jobs requiring equal responsibility in performance.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 4 2013-07-01 2013-07-01 false Jobs requiring equal responsibility in performance. 1620.17... THE EQUAL PAY ACT § 1620.17 Jobs requiring equal responsibility in performance. (a) In general. The equal pay standard applies to jobs the performance of which requires equal responsibility...

29 CFR 1620.17 - Jobs requiring equal responsibility in performance.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 4 2014-07-01 2014-07-01 false Jobs requiring equal responsibility in performance. 1620.17... THE EQUAL PAY ACT § 1620.17 Jobs requiring equal responsibility in performance. (a) In general. The equal pay standard applies to jobs the performance of which requires equal responsibility...

Patient Opinions Regarding ‘Pay for Performance for Patients’

PubMed Central

Helweg-Larsen, Marie; Volpp, Kevin G.

2008-01-01

Background Pay for performance (P4P) programs have shown only modest improvements in outcomes and do not target patient behaviors. Many large employers and payers are turning to pay for performance for patients (P4P4P) to reduce health costs and improve the health of their covered populations. How these programs may be perceived by patients is unknown. Objective To assess patients’ opinion of the acceptability of P4P4P. Design Cross-sectional self-administered survey. Participants Patients in waiting rooms in two university-based primary care clinics. Measurements Participants were asked their opinions about paying people to quit smoking, lose weight, control their blood pressure, or control their diabetes. Results Respondents were split on whether P4P4P is desirable. Thrity-six to 42% thought it was a good/excellent idea to pay smokers to quit smoking, obese people to lose weight, people with hypertension to control their blood pressure, or people with diabetes to control their blood sugar, while 41–44% of the sample thought it was a bad/very bad idea. Smokers and patients who were obese endorsed P4P4P more favorably as a means to achieving tobacco cessation and weight loss than their non-smoking and non-obese counterparts. Conclusions Acceptance of paying patients for performance by the general population is equivocal. Establishing the efficacy of paying patients for performance may help it gain wider acceptance. Electronic supplementary material The online version of this article (doi:10.1007/s11606-008-0739-1) contains supplementary material, which is available to authorized users. PMID:18663540

Analysis of the cost and efficiency relationship: experience in the Turkish pay for performance system.

PubMed

Gok, Mehmet Sahin; Altındağ, Erkut

2015-06-01

This paper analyzes the effects of the pay for performance (PFP) system on the efficiencies of public and private hospitals in Turkey. In order to evaluate these effects, we examine the relationship between hospital efficiency and health care costs in Turkey, and address the impact of the PFP system on the efficiencies of public and private hospitals. In an effort to analyze the efficiencies of public and private hospitals, this study uses data envelopment analysis. The Malmquist Productivity Index is also used to analyze the patterns of efficiency change for the study years from 2001 to 2008. This study shows that health care costs and hospital efficiency are negatively correlated for private hospitals, while they are positively correlated for public hospitals. In other words, increased health care costs might reduce efficiency in private hospitals in contrast to public hospitals. Our findings also indicate that average efficiencies of public hospitals tend to increase, particularly during the implementation period of PFP system. The efficiency trend of private hospitals, conversely, decreased in the latter periods of the PFP system. Suggestions for improvement are provided to the health care policy makers regarding the impact of health care reforms on public and private hospitals.

New thinking on how to link executive pay with performance.

PubMed

Rappaport, A

1999-01-01

As the stock market began its ascent in the mid-1990s, executive pay--always the subject of heated debate--mounted along with it. That's because among the largest U.S. companies, stock options now account for more than half of total CEO compensation and about 30% of senior operating managers' pay. One problem became particularly clear during the bull market's astonishing run: even below-average performers reap huge gains from stock options when the market is rising rapidly. The author proposes steps to close the gap between existing compensation practices and those needed to promote higher levels of achievement at all levels of the corporation. For top managers, he recommends replacing conventional stock options with options that are tied to a market or peer index. Below-average performers would not be rewarded under such plans; superior performers could, depending on the way plans were structured, receive even more. He notes that managers at the business unit level should not be judged on the company's stock price--over which they have little control--and advocates an approach that accurately measures the value added by each unit. Finally, he suggests how certain indicators of value can be used to measure the contribution of frontline managers and employees. The concept of pay for performance has gained wide acceptance, but the link between incentive pay and superior performance is still too weak. Reforms must be adopted at all levels of the organization. Shareholders will applaud changes in pay schemes that motivate companies to deliver more value.

The Impact of Hospital Pay-for-Performance on Hospital and Medicare Costs

PubMed Central

Kruse, Gregory B; Polsky, Daniel; Stuart, Elizabeth A; Werner, Rachel M

2012-01-01

Objective To evaluate the effects of Medicare's hospital pay-for-performance demonstration project on hospital revenues, costs, and margins and on Medicare costs. Data Sources/Study Setting All health care utilization for Medicare beneficiaries hospitalized for acute myocardial infarction (AMI; ICD-9-CM code 410.x1) in fiscal years 2002–2005 from Medicare claims, containing 420,211 admissions with AMI. Study Design We test for changes in hospital costs and revenues and Medicare payments among 260 hospitals participating in the Medicare hospital pay-for-performance demonstration project and a group of 780 propensity-score-matched comparison hospitals. Effects were estimated using a difference-in-difference model with hospital fixed effects, testing for changes in costs among pay-for-performance hospitals above and beyond changes in comparison hospitals. Principal Findings We found no significant effect of pay-for-performance on hospital financials (revenues, costs, and margins) or Medicare payments (index hospitalization and 1 year after admission) for AMI patients. Conclusions Pay-for-performance in the CMS hospital demonstration project had minimal impact on hospital financials and Medicare payments to providers. As P4P extends to all hospitals under the Affordable Care Act, these results provide some estimates of the impact of P4P and emphasize our need for a better understanding of the financial implications of P4P on providers and payers if we want to create sustainable and effective programs to improve health care value. PMID:23088391

The impact of hospital pay-for-performance on hospital and Medicare costs.

PubMed

Kruse, Gregory B; Polsky, Daniel; Stuart, Elizabeth A; Werner, Rachel M

2012-12-01

To evaluate the effects of Medicare's hospital pay-for-performance demonstration project on hospital revenues, costs, and margins and on Medicare costs. All health care utilization for Medicare beneficiaries hospitalized for acute myocardial infarction (AMI; ICD-9-CM code 410.x1) in fiscal years 2002-2005 from Medicare claims, containing 420,211 admissions with AMI. We test for changes in hospital costs and revenues and Medicare payments among 260 hospitals participating in the Medicare hospital pay-for-performance demonstration project and a group of 780 propensity-score-matched comparison hospitals. Effects were estimated using a difference-in-difference model with hospital fixed effects, testing for changes in costs among pay-for-performance hospitals above and beyond changes in comparison hospitals. We found no significant effect of pay-for-performance on hospital financials (revenues, costs, and margins) or Medicare payments (index hospitalization and 1 year after admission) for AMI patients. Pay-for-performance in the CMS hospital demonstration project had minimal impact on hospital financials and Medicare payments to providers. As P4P extends to all hospitals under the Affordable Care Act, these results provide some estimates of the impact of P4P and emphasize our need for a better understanding of the financial implications of P4P on providers and payers if we want to create sustainable and effective programs to improve health care value. © Health Research and Educational Trust.

The influence of medical cost controls implemented by Taiwan's national health insurance program on doctor-patient relationships.

PubMed

Chiu, Jhih-Ling

2015-01-01

To prevent medical costs from rising, the National Health Insurance administration implemented the global budget system for financial reform, effective 1 July 2004. Since the implementation of this system, patients have been required to pay for some medicines to limit costs to the system. More recently, as they have faced constant increases in health insurance fees and also faced an increase in the number of medical expenses they must pay during an economic recession and a rise in unemployment, would the economic burden on the people of Taiwan not be increased? Even though National Health Insurance is a form of social insurance, does it guarantee social equality? The value of the healthcare industry is irreplaceable, so the most critical concern is whether worsening doctor-patient relationships will worsen healthcare quality. In short, while the global budget system saves on National Health Insurance costs, whether its implementation has affected healthcare quality is also worth exploring. This commentary also hopes to serve as a reference for the implementation of national health insurance in the United States. Copyright © 2014 John Wiley & Sons, Ltd.

Implementation strategies for collaborative primary care-mental health models.

PubMed

Franx, Gerdien; Dixon, Lisa; Wensing, Michel; Pincus, Harold

2013-09-01

Extensive research exists that collaborative primary care-mental health models can improve care and outcomes for patients. These programs are currently being implemented throughout the United States and beyond. The purpose of this study is to review the literature and to generate an overview of strategies currently used to implement such models in daily practice. Six overlapping strategies to implement collaborative primary care-mental health models were described in 18 selected studies. We identified interactive educational strategies, quality improvement change processes, technological support tools, stakeholder engagement in the design and execution of implementation plans, organizational changes in terms of expanding the task of nurses and financial strategies such as additional collaboration fees and pay for performance incentives. Considering the overwhelming evidence about the effectiveness of primary care-mental health models, there is a lack of good studies focusing on their implementation strategies. In practice, these strategies are multifaceted and locally defined, as a result of intensive and required stakeholder engagement. Although many barriers still exist, the implementation of collaborative models could have a chance to succeed in the United States, where new service delivery and payment models, such as the Patient-Centered Medical Home, the Health Home and the Accountable Care Organization, are being promoted.

5 CFR 9701.343 - Within-band reductions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9701.343 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM (DEPARTMENT OF HOMELAND SECURITY-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Performance-Based Pay § 9701.343 Within-band...

29 CFR 1620.18 - Jobs performed under similar working conditions.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 4 2012-07-01 2012-07-01 false Jobs performed under similar working conditions. 1620.18... THE EQUAL PAY ACT § 1620.18 Jobs performed under similar working conditions. (a) In general. In order for the equal pay standard to apply, the jobs are required to be performed under similar working...

29 CFR 1620.18 - Jobs performed under similar working conditions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 4 2014-07-01 2014-07-01 false Jobs performed under similar working conditions. 1620.18... THE EQUAL PAY ACT § 1620.18 Jobs performed under similar working conditions. (a) In general. In order for the equal pay standard to apply, the jobs are required to be performed under similar working...

29 CFR 1620.18 - Jobs performed under similar working conditions.

Code of Federal Regulations, 2011 CFR

2011-07-01

... 29 Labor 4 2011-07-01 2011-07-01 false Jobs performed under similar working conditions. 1620.18... THE EQUAL PAY ACT § 1620.18 Jobs performed under similar working conditions. (a) In general. In order for the equal pay standard to apply, the jobs are required to be performed under similar working...

29 CFR 1620.18 - Jobs performed under similar working conditions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 4 2013-07-01 2013-07-01 false Jobs performed under similar working conditions. 1620.18... THE EQUAL PAY ACT § 1620.18 Jobs performed under similar working conditions. (a) In general. In order for the equal pay standard to apply, the jobs are required to be performed under similar working...

29 CFR 1620.18 - Jobs performed under similar working conditions.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 4 2010-07-01 2010-07-01 false Jobs performed under similar working conditions. 1620.18... THE EQUAL PAY ACT § 1620.18 Jobs performed under similar working conditions. (a) In general. In order for the equal pay standard to apply, the jobs are required to be performed under similar working...

Responsibility-centered management: a 10-year nursing assessment.

PubMed

McBride, A B; Neiman, S; Johnson, J

2000-01-01

In 1988-89, Indiana University became the first public university to implement responsibility-centered management (RCM) comprehensively. This article describes and assesses the implementation of RCM on the core campus of Indiana University School of Nursing in Indianapolis. It describes how RCM encouraged an information-rich environment, particularly with the advent of economic modeling; decision making linked to strategic goals/objectives; and a performance-based reward structure (e.g., merit pay increases and incentive plans). It ends with a discussion about the worth of RCM and the changes that frame-work produced, particularly in reconceptualizing the roles of the business officer and dean. The most profound consequence of RCM may be the effect it has in encouraging rethinking of what it means to be a school of nursing at this point in time.

Rewards and Supports

ERIC Educational Resources Information Center

Hershberg, Theodore; Robertson-Kraft, Claire

2010-01-01

Pay-for-performance systems in public schools have long been burdened with controversy. Critics of performance pay systems contend that because teachers' impact cannot be measured without error, it is impossible to create fair and accurate systems for evaluating and rewarding performance. By this standard, however, current practice fails on both…

Implementation of Maturity for Concrete Strength Measurement and Pay : Tech Summary

DOT National Transportation Integrated Search

2017-10-01

Using the maturity to determine concrete strength has been done for more than four decades. The concept was originally conceived in the late 1940s and early 1950s. More and more state and municipal DOTs are implementing its use every year, with some ...

Guiding Principles and Checklist for Population-Based Quality Metrics

PubMed Central

Brunelli, Steven M.; Maddux, Franklin W.; Parker, Thomas F.; Johnson, Douglas; Nissenson, Allen R.; Collins, Allan; Lacson, Eduardo

2014-01-01

The Centers for Medicare and Medicaid Services oversees the ESRD Quality Incentive Program to ensure that the highest quality of health care is provided by outpatient dialysis facilities that treat patients with ESRD. To that end, Centers for Medicare and Medicaid Services uses clinical performance measures to evaluate quality of care under a pay-for-performance or value-based purchasing model. Now more than ever, the ESRD therapeutic area serves as the vanguard of health care delivery. By translating medical evidence into clinical performance measures, the ESRD Prospective Payment System became the first disease-specific sector using the pay-for-performance model. A major challenge for the creation and implementation of clinical performance measures is the adjustments that are necessary to transition from taking care of individual patients to managing the care of patient populations. The National Quality Forum and others have developed effective and appropriate population-based clinical performance measures quality metrics that can be aggregated at the physician, hospital, dialysis facility, nursing home, or surgery center level. Clinical performance measures considered for endorsement by the National Quality Forum are evaluated using five key criteria: evidence, performance gap, and priority (impact); reliability; validity; feasibility; and usability and use. We have developed a checklist of special considerations for clinical performance measure development according to these National Quality Forum criteria. Although the checklist is focused on ESRD, it could also have broad application to chronic disease states, where health care delivery organizations seek to enhance quality, safety, and efficiency of their services. Clinical performance measures are likely to become the norm for tracking performance for health care insurers. Thus, it is critical that the methodologies used to develop such metrics serve the payer and the provider and most importantly, reflect what represents the best care to improve patient outcomes. PMID:24558050

Willingness to pay for methadone maintenance treatment in Vietnamese epicentres of injection-drug-driven HIV infection

PubMed Central

2013-01-01

Abstract Objective Willingness to pay for methadone maintenance treatment (MMT) in three Vietnamese epicentres of injection-drug-driven human immunodeficiency virus (HIV) infection was assessed. Methods A convenience sample of 1016 patients receiving HIV treatment in seven clinics was enrolled during 2012. Contingent valuation was used to assess willingness to pay. Interviewers reviewed adverse consequences of injection drug use and the benefits of MMT. Interviewers then described the government’s plan to scale up MMT and the financial barriers to scale-up. Willingness to pay was assessed using double-bounded binary questions and a follow-up open-ended question. Point and interval data models were used to estimate maximum willingness to pay. Findings A total of 548 non-drug-users and 468 injection drug users were enrolled; 988 were willing to pay for MMT. Monthly mean willingness to pay among non-drug-users, 347 drug users not receiving MMT and 121 drug users receiving MMT was 10.7 United States dollars [US$] (35.7% of treatment costs), US$ 21.1 (70.3%) and US$ 26.2 (87.3%), respectively (mean: US$ 15.9; 95% confidence interval, CI: 13.6–18.1). Fifty per cent of drug users were willing to pay 50% of MMT costs. Residence in households with low monthly per capita income and poor health status predicted willingness to pay less among drug users; educational level, employment status, health status and current antiretroviral therapy receipt predicted willingness to pay less among non-drug-users. Conclusion Willingness to pay for MMT was very high, supporting implementation of a co-payment programme. PMID:23825874

Patients’ willingness to pay for cognitive pharmacist services in community pharmacies

PubMed Central

Lakić, Dragana; Stević, Ivana; Odalović, Marina; Vezmar-Kovačević, Sandra; Tadić, Ivana

2017-01-01

Aim To determine the general population willingness to pay for cognitive pharmacist service in community pharmacy, describe the behavior of participants regarding health care issues, and evaluate correlation between participants’ sociodemographic characteristics or attitudes and their willingness to pay. Methods A questionnaire-based survey was conducted among general population visiting community pharmacies. The participants were asked about receiving cognitive pharmacist services to identify and resolve potential medication therapy problems after the initiation of a new medicine to optimize health outcomes of the patients. A univariate and multivariate analysis were used to analyze associations between different variables and willingness to pay for pharmacy service. Results Of 444 respondents, 167 (38%) reported that they were willing to pay for a medication management service provided in the community pharmacy. Univariate analysis showed significant association between the willingness to pay for pharmacist-provided service and respondents’ socio-demographic factors, health-related characteristics, and behavior, dilemmas, or need for certain pharmacist-provided service. The logistic regression model was statistically significant (χ2 = 4.599, P < 0.001). Conclusions The respondents expressed their willingness to pay for cognitive pharmacist services, which has not been fully recognized within the health care system. In future, pharmacists should focus on practical implementation of the service and models of funding. PMID:29094815

Patients' willingness to pay for cognitive pharmacist services in community pharmacies.

PubMed

Lakić, Dragana; Stević, Ivana; Odalović, Marina; Vezmar-Kovačević, Sandra; Tadić, Ivana

2017-10-31

To determine the general population willingness to pay for cognitive pharmacist service in community pharmacy, describe the behavior of participants regarding health care issues, and evaluate correlation between participants' sociodemographic characteristics or attitudes and their willingness to pay. A questionnaire-based survey was conducted among general population visiting community pharmacies. The participants were asked about receiving cognitive pharmacist services to identify and resolve potential medication therapy problems after the initiation of a new medicine to optimize health outcomes of the patients. A univariate and multivariate analysis were used to analyze associations between different variables and willingness to pay for pharmacy service. Of 444 respondents, 167 (38%) reported that they were willing to pay for a medication management service provided in the community pharmacy. Univariate analysis showed significant association between the willingness to pay for pharmacist-provided service and respondents' socio-demographic factors, health-related characteristics, and behavior, dilemmas, or need for certain pharmacist-provided service. The logistic regression model was statistically significant (χ2=4.599, P<0.001). The respondents expressed their willingness to pay for cognitive pharmacist services, which has not been fully recognized within the health care system. In future, pharmacists should focus on practical implementation of the service and models of funding.

[Pay more attention to the standardized oncologic assessment of gastric cancer prior to starting therapy].

PubMed

Ji, Jiafu; Shan, Fei

2015-02-01

With the development of specialized gastric cancer oncology, multidisciplinary treatment(MDT) model has been widely accepted and implemented. Reasonable combination of comprehensive therapy and individualized treatment can really benefit patients, but its premise is comprehensive and detailed assessment of the tumor. We must pay more attention to the standardized oncologic assessment of gastric cancer prior to starting therapy, including staging, resectability assessment, and the pathological and molecular features.

Managing imperfect competition by pay for performance and reference pricing.

PubMed

Mak, Henry Y

2018-01-01

I study a managed health service market where differentiated providers compete for consumers by choosing multiple service qualities, and where copayments that consumers pay and payments that providers receive for services are set by a payer. The optimal regulation scheme is two-sided. On the demand side, it justifies and clarifies value-based reference pricing. On the supply side, it prescribes pay for performance when consumers misperceive service benefits or providers have intrinsic quality incentives. The optimal bonuses are expressed in terms of demand elasticities, service technology, and provider characteristics. However, pay for performance may not outperform prospective payment when consumers are rational and providers are profit maximizing, or when one of the service qualities is not contractible. Copyright © 2017 Elsevier B.V. All rights reserved.

How Much Are Floridians Willing to Pay for Protecting Sea Turtles from Sea Level Rise?

NASA Astrophysics Data System (ADS)

Hamed, Ahmed; Madani, Kaveh; Von Holle, Betsy; Wright, James; Milon, J. Walter; Bossick, Matthew

2016-01-01

Sea level rise (SLR) is posing a great inundation risk to coastal areas. Some coastal nesting species, including sea turtle species, have experienced diminished habitat from SLR. Contingent valuation method (CVM) was used in an effort to assess the economic loss impacts of SLR on sea turtle nesting habitats for Florida coasts; and to elicit values of willingness to pay (WTP) of Central Florida residents to implement certain mitigation strategies, which would protect Florida's east coast sea turtle nesting areas. Using the open-ended and dichotomous choice CVM, we sampled residents of two Florida communities: Cocoa Beach and Oviedo. We estimated the WTP of households from these two cities to protect sea turtle habitat to be between 42 and 57 per year for 5 years. Additionally, we attempted to assess the impact of the both the respondents' demographics and their perception toward various situations on their WTP value. Findings include a negative correlation between the age of a respondent and the probability of an individual willing to pay the hypothetical WTP amount. We found that WTP of an individual was not dependent on prior knowledge of the effects of SLR on sea turtle habitat. The greatest indicators of whether or not an individual was willing to pay to protect sea turtle habitat were the respondents' perception regarding the trustworthiness and efficiency of the party which will implement the conservation measures and their confidence in the conservation methods used. Respondents who perceive sea turtles having an effect on their life were also more likely to pay.

How Much Are Floridians Willing to Pay for Protecting Sea Turtles from Sea Level Rise?

PubMed

Hamed, Ahmed; Madani, Kaveh; Von Holle, Betsy; Wright, James; Milon, J Walter; Bossick, Matthew

2016-01-01

Sea level rise (SLR) is posing a great inundation risk to coastal areas. Some coastal nesting species, including sea turtle species, have experienced diminished habitat from SLR. Contingent valuation method (CVM) was used in an effort to assess the economic loss impacts of SLR on sea turtle nesting habitats for Florida coasts; and to elicit values of willingness to pay (WTP) of Central Florida residents to implement certain mitigation strategies, which would protect Florida's east coast sea turtle nesting areas. Using the open-ended and dichotomous choice CVM, we sampled residents of two Florida communities: Cocoa Beach and Oviedo. We estimated the WTP of households from these two cities to protect sea turtle habitat to be between $42 and $57 per year for 5 years. Additionally, we attempted to assess the impact of the both the respondents' demographics and their perception toward various situations on their WTP value. Findings include a negative correlation between the age of a respondent and the probability of an individual willing to pay the hypothetical WTP amount. We found that WTP of an individual was not dependent on prior knowledge of the effects of SLR on sea turtle habitat. The greatest indicators of whether or not an individual was willing to pay to protect sea turtle habitat were the respondents' perception regarding the trustworthiness and efficiency of the party which will implement the conservation measures and their confidence in the conservation methods used. Respondents who perceive sea turtles having an effect on their life were also more likely to pay.

29 CFR 1620.15 - Jobs requiring equal skill in performance.

Code of Federal Regulations, 2012 CFR

2012-07-01

... 29 Labor 4 2012-07-01 2012-07-01 false Jobs requiring equal skill in performance. 1620.15 Section... EQUAL PAY ACT § 1620.15 Jobs requiring equal skill in performance. (a) In general. The jobs to which the equal pay standard is applicable are jobs requiring equal skill in their performance. Where the amount...

29 CFR 1620.15 - Jobs requiring equal skill in performance.

Code of Federal Regulations, 2013 CFR

2013-07-01

... 29 Labor 4 2013-07-01 2013-07-01 false Jobs requiring equal skill in performance. 1620.15 Section... EQUAL PAY ACT § 1620.15 Jobs requiring equal skill in performance. (a) In general. The jobs to which the equal pay standard is applicable are jobs requiring equal skill in their performance. Where the amount...

29 CFR 1620.15 - Jobs requiring equal skill in performance.

Code of Federal Regulations, 2014 CFR

2014-07-01

... 29 Labor 4 2014-07-01 2014-07-01 false Jobs requiring equal skill in performance. 1620.15 Section... EQUAL PAY ACT § 1620.15 Jobs requiring equal skill in performance. (a) In general. The jobs to which the equal pay standard is applicable are jobs requiring equal skill in their performance. Where the amount...

29 CFR 1620.15 - Jobs requiring equal skill in performance.

Code of Federal Regulations, 2010 CFR

2010-07-01

... 29 Labor 4 2010-07-01 2010-07-01 false Jobs requiring equal skill in performance. 1620.15 Section... EQUAL PAY ACT § 1620.15 Jobs requiring equal skill in performance. (a) In general. The jobs to which the equal pay standard is applicable are jobs requiring equal skill in their performance. Where the amount...

The relationship between human resource investments and organizational performance: a firm-level examination of equilibrium theory.

PubMed

Subramony, Mahesh; Krause, Nicole; Norton, Jacqueline; Burns, Gary N

2008-07-01

It is commonly believed that human resource investments can yield positive performance-related outcomes for organizations. Utilizing the theory of organizational equilibrium (H. A. Simon, D. W. Smithburg, & V. A. Thompson, 1950; J. G. March & H. A. Simon, 1958), the authors proposed that organizational inducements in the form of competitive pay will lead to 2 firm-level performance outcomes--labor productivity and customer satisfaction--and that financially successful organizations would be more likely to provide these inducements to their employees. To test their hypotheses, the authors gathered employee-survey and objective performance data from a sample of 126 large publicly traded U.S. organizations over a period of 3 years. Results indicated that (a) firm-level financial performance (net income) predicted employees' shared perceptions of competitive pay, (b) shared pay perceptions predicted future labor productivity, and (c) the relationship between shared pay perceptions and customer satisfaction was fully mediated by employee morale.

28 CFR 71.25 - Fees.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Administration DEPARTMENT OF JUSTICE (CONTINUED) IMPLEMENTATION OF THE PROVISIONS OF THE PROGRAM FRAUD CIVIL REMEDIES ACT OF 1986 Implementation for Actions Initiated by the Department of Justice § 71.25 Fees. The party requesting a subpoena shall pay the cost of the fees and mileage of any witness subpoenaed in the...

Putting pregnancy in its place: conceiving pregnancy as carework in the workplace.

PubMed

Gatrell, Caroline

2011-03-01

This paper contributes to understandings of the relationship between pregnancy, health and place by exploring how health advice on pregnancy may be implemented, in practice, 'at work'. The paper first defines the following of health advice on pregnancy as a form of informal 'carework' which obliges pregnant women to implement caring practices comprising emotional and embodied labour. It then observes how health advice on pregnancy carework pays little regard to the impact of place. Drawing upon in-depth interviews with 15 professionally employed mothers/expectant mothers; the paper suggests that the performance of pregnancy carework may be incompatible with workplace settings. The tensions are highlighted between medical representations of pregnancy as a 'condition' and the treatment of pregnancy, within professional workplaces, as 'not an illness'. The question is raised as to whether insufficient reference to place within health advice reflects underlying gendered expectations that pregnancy carework ought to be performed within the home. Copyright © 2009 Elsevier Ltd. All rights reserved.

[Financial incentives for quality improvement].

PubMed

Belicza, Eva; Evetovits, Tamás

2010-05-01

Policy makers and payers of health care services devote increasing attention to improve quality of services by incentivising health care providers. These--so called--pay for performance (P4P) programmes have so far been introduced in few countries only and evidence on their effectiveness is still scarce. Therefore we do not know yet which instruments of these programmes are most effective and efficient in improving quality. The P4P systems implemented so far in primary care and in integrated delivery systems use indicators for measurement of performance and the basis for rewards. These indicators are mostly process indicators, but there are some outcome indicators as well. The desired quality improvement effects are most likely to be achieved with programmes that provide seizable financial rewards and cover the extra cost of quality improvement efforts as well. Administration of the programme has to be fully transparent and clear to all involved. It has to be based on scientific evidence and supported with sufficient dedicated funding. Conducting pilot studies is a precondition for large scale implementation.

Experiences of general practices with a participatory pay-for-performance program: a qualitative study in primary care.

PubMed

Kirschner, Kirsten; Braspenning, Jozé; Jacobs, J E Annelies; Grol, Richard

2013-01-01

The involvement of target users in the design choices of a pay-for-performance program may enhance its impact, but little is known about the views of participants in these programs. To explore general practices' experiences with pay-for-performance in primary care we conducted a qualitative study in general practices in the Netherlands. Thirty out of 65 general practices participating in a pay-for-performance program, stratified for bonus, were invited for a semistructured interview on feasibility, feedback and the bonus, spending of the bonus, unintended consequences, and future developments. Content analysis was used to process the resulting transcripts. We included 29 practices. The feasibility of the pay-for-performance program was questioned due to the substantial time investment. The feedback on clinical care, practice management and patient experience was mostly discussed in the team, and used for improvement plans, but was also qualified as annoying for one GP and for another GP it brought feelings of insecurity. Most practices considered the bonus a stimulus to improve quality of care, in addition to compensation for their effort and time invested. Distinctive performance features were not displayed, for instance, on a website. The bonus was mainly spent on new equipment or team building. Practices referred to gaming and focusing on those aspects that were incentivised ('tunnel vision') as unintended consequences. Future developments should be directed to absolute thresholds, new indicators to keep the process going, and an independent audit. Linking a part of the bonus to innovation was also suggested. The participants thought the pay-for-performance program was a labour-intensive positive breakthrough to stimulate quality improvement, but warned of unintended consequences of the program and the sustainability of the indicator set.

5 CFR 9701.344 - Special within-band increases.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Special within-band increases. 9701.344 Section 9701.344 Administrative Personnel DEPARTMENT OF HOMELAND SECURITY HUMAN RESOURCES MANAGEMENT... HUMAN RESOURCES MANAGEMENT SYSTEM Pay and Pay Administration Performance-Based Pay § 9701.344 Special...

Pay for Performance: Whose Performance?

ERIC Educational Resources Information Center

Tienken, Christopher H.

2011-01-01

Education reform proposals are not in short supply. Recent issues of the "Kappa Delta Pi Record" examined two of these: Common Core State Standards (Winter 2011) and Charter Schools (Spring 2011). Teacher pay for performance is another policy gaining traction in state legislatures and at the federal level. The Race to the Top (RTTT)…

Performance Pay Path to Improvement

ERIC Educational Resources Information Center

Gratz, Donald B.

2011-01-01

The primary goal of performance pay for the past decade has been higher test scores, and the most prominent strategy has been to increase teacher performance through financial incentives. If teachers are rewarded for success, according to this logic, they will try harder. If they try harder, more children will achieve higher test scores. The…

Credentials versus Performance: Review of the Teacher Performance Pay Research

ERIC Educational Resources Information Center

Podgursky, Michael; Springer, Matthew G.

2007-01-01

In this article we examine the economic case for merit or performance-based pay for K-12 teachers. We review several areas of germane research. The direct evaluation literature on these incentive plans is slender; highly diverse in terms of methodology, targeted populations, and programs evaluated; and primarily focused on short-run motivational…

Teacher Responses to Pay-for-Performance Policies: Survey Results from Four High-Poverty, Urban School Districts

ERIC Educational Resources Information Center

Wells, John

2011-01-01

Policymakers are increasingly adopting "pay-for-performance" policies in which teachers are compensated based on their performance as measured by classroom evaluations and/or student achievement test results. Prior research has produced largely inconclusive findings concerning support among teachers for these policies and their effects…

Improvements Could Be Made in Reconciling Other Defense Organizations Civilian Pay to the General Ledger

DTIC Science & Technology

2016-03-25

could not record a journal entry to this account. DFAS Indianapolis provided us with a System Change Proposal dated April 17, 2014, which proposed a...system change to DAI to permit journal entries to USSGL 2213 that was implemented in October 2015. However, DFAS Indianapolis should not have allowed...properly accrued civilian pay for the 12 ODOs that used the Defense Agencies Initiative or the Defense Business Management System general ledgers

Person-based differences in pay reactions: A compensation-activation theory and integrative conceptual review.

PubMed

Fulmer, Ingrid Smithey; Shaw, Jason D

2018-06-07

Compensation research has focused traditionally on how pay design characteristics (e.g., pay level, individual or group incentives) relate to average employee outcomes and, in toto, on how these outcomes affect organizational performance. Recently, scholars have begun to pay more attention to how individuals vary in the strength of their reactions to pay. Empirical research in several disciplines examines how the interplay of pay systems and person-based characteristics (psychological individual differences, demographics, and relative performance or position in a group) relate to important work-related outcomes. We develop a compensation-activation theory that frames compensation design characteristics as workplace "situations" providing cues that activate individuals' corresponding fundamental social motives made salient due to chronic or transient person-based characteristics. Where activation occurs, stronger-than-average responses to the compensation "situation" are expected. Using the theory as a lens, we synthesize and reinterpret existing research on person-based reactions to pay characteristics, including sorting, incentive/motivational effects, and effects on collective pay system reactions and unit/organizational outcomes. We conclude with a research agenda aimed at refining compensation-activation theory and advancing the study of compensation as it affects individual and organizational outcomes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The influence of performance-based payment on childhood immunisation coverage.

PubMed

Merilind, Eero; Salupere, Rauno; Västra, Katrin; Kalda, Ruth

2015-06-01

Pay-for-performance, also called the quality system (QS) in Estonia, was implemented in 2006 and one indicator for achievement is the childhood immunisation coverage rate. The WHO vaccination coverage in Europe for diphtheria, tetanus and pertussis, and measles in children aged around one year old should meet or exceed 90 per cent. The study was conducted using a database from the Estonian Health Insurance Fund. The study compared childhood immunisation coverage rates of all Estonian family physicians in two groups, joined and not joined to the quality system during the observation period 2006-2012. Immunisation coverage was calculated as the percentage of persons in the target age group who received a vaccine dose by a given age. The target level of immunisations in Estonia is set at 90 per cent and higher. Immunisation coverage rates of family doctors (FD) in Estonia showed significant differences between two groups of doctors: joined to the quality system and not joined. Doctors joined to the quality system met the 90 per cent vaccination criterion more frequently compared to doctors not joined to the quality system. Doctors not joined to the quality system were below the 90 per cent vaccination criterion in all vaccinations listed in the Estonian State Immunisation Schedule. Pay-for-performance as a financial incentive encourages higher levels of childhood immunisations. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

The link between past informal payments and willingness of the Hungarian population to pay formal fees for health care services: results from a contingent valuation study.

PubMed

Baji, Petra; Pavlova, Milena; Gulácsi, László; Farkas, Miklós; Groot, Wim

2014-11-01

We examine the willingness of health care consumers to pay formal fees for health care use and how this willingness to pay is associated with past informal payments. We use data from a survey carried out in Hungary in 2010 among a representative sample of 1,037 respondents. The contingent valuation method is used to elicit the willingness to pay official charges for health care services covered by the social health insurance if certain quality attributes (regarding the health care facility, access to the services and health care personnel) are guaranteed. A bivariate probit model is applied to examine the relationship between willingness to pay and past informal payments. We find that 66% of the respondents are willing to pay formal fees for specialist examinations and 56% are willing to pay for planned hospitalizations if these services are provided with certain quality and access attributes. The act of making past informal payments for health care services is positively associated with the willingness to pay formal charges. The probability that a respondent is willing to pay official charges for health care services is 22% points higher for specialist examinations and 45% points higher for hospitalization if the respondent paid informally during the last 12 months. The introduction of formal fees should be accompanied by adequate service provision to assure acceptance of the fees. Furthermore, our results suggest that the problem of informal patient payments may remain even after the implementation of user fees.

Improving Teaching Effectiveness: Merit Pay vs. Organizational Culture.

ERIC Educational Resources Information Center

Bushardt, Stephen C.; Fowler, Aubrey R.

1987-01-01

Identifies four conditions which cause merit pay systems to fail to increase teacher performance: lack of skills, the poor timing of rewards, an inability to measure performance; and competing reinforcers. Explains why organizational culture is a more effective mediator of rewards. (SD)

Improving the health care work environment: implications for research, practice, and policy.

PubMed

Harrison, Michael I; Henriksen, Kerm; Hughes, Ronda G

2007-11-01

Despite the gains to date, we need better understanding of practices for implementing and sustaining improvements in health care work environments and further study of organizational conditions affecting implementation of improvements. Limiting work hours, improving schedules, and providing sleep hygiene training will help combat clinician fatigue. Hospital crowding can be reduced through systemwide improvement of patient flow and capacity management, coupled with management support, measurement, and reporting on crowding. Long-term solutions to nurse staffing shortfalls include process redesign to enhance efficiency. Improvement of organizational climate, human resource management, and interoccupational relations will also contribute to staff retention. Evidence-based enhancements to patient rooms and other physical features in hospitals contribute directly to safety and quality and also affect staff performance. POLICY: Landrigan and his colleagues call for external restrictions on residents' work shifts. Clarke examines prospects for mandated nursing-staff ratios. Public reporting on staffing, crowding, and other risks may incent change. Reporting and pay for performance require standardized measures of targeted conditions. Organizations promoting care quality can help spread safe work practices; they can also support collaborative learning and other strategies that may enhance implementation of improvements in work environments.

Willingness to pay for flexible working conditions of people with type 2 diabetes: discrete choice experiments.

PubMed

Nexo, M A; Cleal, B; Hagelund, Lise; Willaing, I; Olesen, K

2017-12-15

The increasing number of people with chronic diseases challenges workforce capacity. Type 2 diabetes (T2D) can have work-related consequences, such as early retirement. Laws of most high-income countries require workplaces to provide accommodations to enable people with chronic disabilities to manage their condition at work. A barrier to successful implementation of such accommodations can be lack of co-workers' willingness to support people with T2D. This study aimed to examine the willingness to pay (WTP) of people with and without T2D for five workplace initiatives that help individuals with type 2 diabetes manage their diabetes at work. Three samples with employed Danish participants were drawn from existing online panels: a general population sample (n = 600), a T2D sample (n = 693), and a matched sample of people without diabetes (n = 539). Participants completed discrete choice experiments eliciting their WTP (reduction in monthly salary, €/month) for five hypothetical workplace initiatives: part-time job, customized work, extra breaks with pay, and time off for medical consultations with and without pay. WTP was estimated by conditional logits models. Bootstrapping was used to estimate confidence intervals for WTP. There was an overall WTP for all initiatives. Average WTP for all attributes was 34 €/month (95% confidence interval [CI]: 27-43] in the general population sample, 32 €/month (95% CI: 26-38) in the T2D sample, and 55 €/month (95% CI: 43-71) in the matched sample. WTP for additional breaks with pay was considerably lower than for the other initiatives in all samples. People with T2D had significantly lower WTP than people without diabetes for part-time work, customized work, and time off without pay, but not for extra breaks or time off with pay. For people with and without T2D, WTP was present for initiatives that could improve management of diabetes at the workplace. WTP was lowest among people with T2D. Implementation of these initiatives seems feasible and may help unnecessary exclusion of people with T2D from work.

Impact of 'stretch' targets for cardiovascular disease management within a local pay-for-performance programme.

PubMed

Pape, Utz J; Huckvale, Kit; Car, Josip; Majeed, Azeem; Millett, Christopher

2015-01-01

Pay-for-performance programs are often aimed to improve the management of chronic diseases. We evaluate the impact of a local pay for performance programme (QOF+), which rewarded financially more ambitious quality targets ('stretch targets') than those used nationally in the Quality and Outcomes Framework (QOF). We focus on targets for intermediate outcomes in patients with cardiovascular disease and diabetes. A difference-in-difference approach is used to compare practice level achievements before and after the introduction of the local pay for performance program. In addition, we analysed patient-level data on exception reporting and intermediate outcomes utilizing an interrupted time series analysis. The local pay for performance program led to significantly higher target achievements (hypertension: p-value <0.001, coronary heart disease: p-values <0.001, diabetes: p-values <0.061, stroke: p-values <0.003). However, the increase was driven by higher rates of exception reporting (hypertension: p-value <0.001, coronary heart disease: p-values <0.03, diabetes: p-values <0.05) in patients with all conditions except for stroke. Exception reporting allows practitioners to exclude patients from target calculations if certain criteria are met, e.g. informed dissent of the patient for treatment. There were no statistically significant improvements in mean blood pressure, cholesterol or HbA1c levels. Thus, achievement of higher payment thresholds in the local pay for performance scheme was mainly attributed to increased exception reporting by practices with no discernable improvements in overall clinical quality. Hence, active monitoring of exception reporting should be considered when setting more ambitious quality targets. More generally, the study suggests a trade-off between additional incentive for better care and monitoring costs.

A Comparison of Prediction Methods for Design of Pump as Turbine for Small Hydro Plant: Implemented Plant

NASA Astrophysics Data System (ADS)

Naeimi, Hossein; Nayebi Shahabi, Mina; Mohammadi, Sohrab

2017-08-01

In developing countries, small and micro hydropower plants are very effective source for electricity generation with energy pay-back time (EPBT) less than other conventional electricity generation systems. Using pump as turbine (PAT) is an attractive, significant and cost-effective alternative. Pump manufacturers do not normally provide the characteristic curves of their pumps working as turbines. Therefore, choosing an appropriate Pump to work as a turbine is essential in implementing the small-hydro plants. In this paper, in order to find the best fitting method to choose a PAT, the results of a small-hydro plant implemented on the by-pass of a Pressure Reducing Valve (PRV) in Urmia city in Iran are presented. Some of the prediction methods of Best Efficiency Point of PATs are derived. Then, the results of implemented project have been compared to the prediction methods results and the deviation of from measured data were considered and discussed and the best method that predicts the specifications of PAT more accurately determined. Finally, the energy pay-back time for the plant is calculated.

From performance to performativity: The legitimization of US security contracting and its consequences.

PubMed

Krahmann, Elke

2017-12-01

Discussions about the legitimacy of private security companies (PSCs) in multilateral military interventions abound. This article looks at how the United States has sought to legitimize the outsourcing of security services to PSCs through performance-based contracting and performance assessments. Both mechanisms aim to demonstrate the effective provision of publicly desirable outcomes. However, the immaterial and socially constructed nature of security presents major problems for performance assessments in terms of observable and measurable outcomes. Performance has therefore given way to performativity - that is, the repetitive enactment of particular forms of behaviour and capabilities that are simply equated with security as an outcome. The implications of this development for the ways in which security has been conceptualized, implemented and experienced within US interventions have been profound. Ironically, the concern with performance has not encouraged PSCs to pay increased attention to their impacts on security environments and civilian populations, but has fostered a preoccupation with activities and measurable capabilities that can be easily assessed by government auditors.

From performance to performativity: The legitimization of US security contracting and its consequences

PubMed Central

Krahmann, Elke

2017-01-01

Discussions about the legitimacy of private security companies (PSCs) in multilateral military interventions abound. This article looks at how the United States has sought to legitimize the outsourcing of security services to PSCs through performance-based contracting and performance assessments. Both mechanisms aim to demonstrate the effective provision of publicly desirable outcomes. However, the immaterial and socially constructed nature of security presents major problems for performance assessments in terms of observable and measurable outcomes. Performance has therefore given way to performativity – that is, the repetitive enactment of particular forms of behaviour and capabilities that are simply equated with security as an outcome. The implications of this development for the ways in which security has been conceptualized, implemented and experienced within US interventions have been profound. Ironically, the concern with performance has not encouraged PSCs to pay increased attention to their impacts on security environments and civilian populations, but has fostered a preoccupation with activities and measurable capabilities that can be easily assessed by government auditors. PMID:29276346

Teacher Pay for Performance: Experimental Evidence from the Project on Incentives in Teaching

ERIC Educational Resources Information Center

Springer, Matthew G.; Hamilton, Laura; McCaffrey, Daniel F.; Ballou, Dale; Le, Vi-Nhuan; Pepper, Matthew; Lockwood, J. R.; Stecher, Brian M.

2010-01-01

In an effort to explore the impact of performance incentives in education, the National Center on Performance Incentives (NCPI) partnered with the Metropolitan Nashville Public Schools (MNPS) to conduct the Project on Incentives in Teaching, or POINT. The study examines the effects on student outcomes of paying eligible teachers bonuses of up to…

Characteristics and Determinants of Teacher-Designed Pay for Performance Plans: Evidence from Texas' Governor's Educator Excellence Grant (GEEG) Program. Research Brief

ERIC Educational Resources Information Center

National Center on Performance Incentives, 2008

2008-01-01

In "Characteristics and Determinants of Teacher-Designed Pay for Performance Plans: Evidence from Texas' Governor's Educator Excellence Grant (GEEG) Program"--a paper presented at the February 2008 National Center on Performance Incentives research to policy conference--Lori Taylor, Matthew Springer, and Mark Ehlert describe the teacher…

Pay-for-performance policy and data-driven decision making within nursing homes: a qualitative study.

PubMed

Abrahamson, Kathleen; Miech, Edward; Davila, Heather Wood; Mueller, Christine; Cooke, Valerie; Arling, Greg

2015-05-01

Health systems globally and within the USA have introduced nursing home pay-for-performance (P4P) programmes in response to the need for improved nursing home quality. Central to the challenge of administering effective P4P is the availability of accurate, timely and clinically appropriate data for decision making. We aimed to explore ways in which data were collected, thought about and used as a result of participation in a P4P programme. Semistructured interviews were conducted with 232 nursing home employees from within 70 nursing homes that participated in P4P-sponsored quality improvement (QI) projects. Interview data were analysed to identify themes surrounding collecting, thinking about and using data for QI decision making. The term 'data' appeared 247 times in the interviews, and over 92% of these instances (228/247) were spontaneous references by nursing home staff. Overall, 34% of respondents (79/232) referred directly to 'data' in their interviews. Nursing home leadership more frequently discussed data use than direct care staff. Emergent themes included using data to identify a QI problem, gathering data in new ways at the local level, and measuring outcomes in response to P4P participation. Alterations in data use as a result of policy change were theoretically consistent with the revised version of the Promoting Action on Research Implementation in Health Services framework, which posits that successful implementation is a function of evidence, context and facilitation. Providing a reimbursement context that facilitates the collection and use of reliable local evidence may be an important consideration to others contemplating the adaptation of P4P policies. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Paying your marketers--properly.

PubMed

Pearson, Elizabeth Zink

2003-09-01

Home health agencies have more freedom to market their services since the implementation of the prospective payment system. In order to do that, a number of agencies have turned to marketing professionals for help. A common method of compensating marketers in the business world, however, is through payment for referrals--something expressly forbidden by federal statute. Home health agencies need to know what they can and can't do to pay marketers and must train their marketers on the federal anti-kickback regulations to assure their compliance.

Creating Ideal Facilities.

ERIC Educational Resources Information Center

Kennedy, Mike

2002-01-01

Reviews ways that schools can provide effective indoor learning environments by paying attention to the following areas: daylighting, acoustics, space allocation, technology implementation, ergonomics, maintenance, indoor air quality, safety, restrooms, and roofing. (GR)

32 CFR 716.3 - Special situations.

Code of Federal Regulations, 2010 CFR

2010-07-01

... of a Reserve component who performs active duty, active duty for training, or inactive-duty training..., including special pay and incentive pay if appropriate, while performing such duties. (b) Death occurring while traveling to and from active duty for training and inactive-duty training. Any member of a Reserve...

Medicaid nursing home pay for performance: where do we stand?

PubMed

Arling, Greg; Job, Carol; Cooke, Valerie

2009-10-01

Nursing home pay-for-performance (P4P) programs are intended to maximize the value obtained from public and private expenditures by measuring and rewarding better nursing home performance. We surveyed the 6 states with operational P4P systems in 2007. We describe key features of six Medicaid nursing home P4P systems and make recommendations for further development of nursing home P4P. We surveyed the six states with operational P4P systems in 2007. The range of performance measures employed by the states is quite broad: staffing level and satisfaction, findings from the regulatory system, clinical quality indicators, resident quality of life or satisfaction with care, family satisfaction, access to care for special populations, and efficiency. The main data sources for the measures are the Minimum Data Set (MDS), nursing home inspections, special surveys of nursing home residents, consumers or employees, and facility cost reports or other administrative systems. The most common financial incentive for better performance is a percentage bonus or an add-on to a facility's per diem rate. The bonus is generally proportional to a facility performance score, which consists of simple or weighted sums of scores on individual measures. States undertaking nursing home P4P programs should involve key stakeholders at all stages of P4P system design and implementation. Performance measures should be comprehensive, valid and reliable, risk adjusted where appropriate, and communicated clearly to providers and consumers. The P4P system should encourage provider investment in better care yet recognize state fiscal restraints. Consumer report cards, quality improvement initiatives, and the regulatory process should complement and reinforce P4P. Finally, the P4P system should be transparent and continuously evaluated.

[Public reporting of the Californian "pay for performance" conducted by the Integrated Healthcare Association (IHA)].

PubMed

Emmert, M; Schöffski, O

2007-01-01

In Germany, there is little transparency when it comes to quality of care of national health care providers. The population has hardly any opportunity to identify well-performing health-care providers. Therefore, the emerging quality improvement initiative "Pay for Performance (P4P)" developed in California, USA is examined with regard to an implementation into the German health care sector. This program wants to achieve higher levels of health care by setting both goal-oriented financial and non-financial incentives. Therefore, performance-based payment is combined with Public Reporting of the measured quality of care. As people can be influenced by the information provided, Public Reporting is supposed to have a positive effect on the quality of treatment. Published data to the American population will be highlighted as well as indications and examinations included in the P4P program. Also, it will be shown how the performance of health care providers is determined. Since published performance results can be considered not only for a specific indication but also as a whole, patients have the opportunity to choose a well-performing health-care provider, according to their specific requirements. Thus, Public Reporting might be regarded as an effective method in order to improve the quality of care provided by health-care providers. Public Reporting in P4P is already conducted in a differentiated but also in a broad context. In the development of this key success element, many stakeholders have been involved, including health-care providers. So, the presented way of Public Reporting can be regarded as a business case to learn from with regard to more transparency in the German health-care sector.

Employee Reactions to Merit Pay: Cognitive Approach and Social Approach

ERIC Educational Resources Information Center

Wang, Yingchun

2010-01-01

The dissertation aims to tackle one of the most pressing questions facing the merit pay system researchers and practitioners: Why do merit pay raises have such a small effect on employees' satisfaction, commitment and job performance? My approach to the study of this question is to develop explanatory frameworks from two perspectives: cognitive…

Partnering for Compensation Reform: Collaborations between Union and District Leadership in Four School Systems

ERIC Educational Resources Information Center

Sommerfeld, Meg

2011-01-01

A growing number of American school systems are experimenting with innovative and varied methods of tying educators' salaries more closely to their work through differential pay. Differential pay means paying teachers differently based on their performance, their responsibilities, and/or their teaching assignments. For instance, it can mean…

Medicaid Nursing Home Pay for Performance: Where Do We Stand?

ERIC Educational Resources Information Center

Arling, Greg; Job, Carol; Cooke, Valerie

2009-01-01

Purpose: Nursing home pay-for-performance (P4P) programs are intended to maximize the value obtained from public and private expenditures by measuring and rewarding better nursing home performance. We surveyed the 6 states with operational P4P systems in 2007. We describe key features of six Medicaid nursing home P4P systems and make…

Motivational Factors of Pay-for-Performance Plans in Educational Institutions: A Study of Select Private, Faith-Based Schools

ERIC Educational Resources Information Center

Wrobbel, Paul H.

2009-01-01

In the United States there is considerable focus on the need for continuous improvement in the quality of schools, including student achievement and teacher performance. Performance-based pay has been repeatedly suggested as a way to improve teaching in school systems. Therefore, a more thorough understanding of the differences in the perceptions…

The Politics of Teacher Reform in Florida: Analyzing Causal Narratives Surrounding State Adoption of Performance-Based Evaluations, Performance Pay, and Tenure Elimination

ERIC Educational Resources Information Center

Harrison, Christopher; Cohen-Vogel, Lora

2012-01-01

Following a multiyear debate, Florida lawmakers passed the "Student Success Act" in March 2011, introducing some of the most sweeping educational reforms in the state's history--the introduction of teacher evaluation systems based on value-added modeling, mandatory "performance pay" for teachers, and the elimination of…

The Problem with Performance Pay

ERIC Educational Resources Information Center

Gratz, Donald B.

2009-01-01

Although today's performance pay plans take many forms, the most commonly proposed version--in which teachers are rewarded on the basis of their students' standardized test scores--flows from flawed logic and several troublesome assumptions: that teachers lack motivation and supposedly need financial awards to give students what they need; that…

Teacher Evaluation, Performance-Related Pay, and Constructivist Instruction

ERIC Educational Resources Information Center

Liang, Guodong; Akiba, Motoko

2015-01-01

Using statewide longitudinal teacher survey data collected in 2009 and 2010, this study examined the characteristics of teacher evaluation used to determine performance-related pay (PRP), and the association between PRP and improvement in the practice of constructivist instruction. The study found that 10.9% of middle school mathematics teachers…

When and Why Do University Managers Use Publication Incentive Payments?

ERIC Educational Resources Information Center

Opstrup, Niels

2017-01-01

Pay-for-performance schemes have become a widespread management strategy in the public sector. However, not much is known about the rationales that trigger the adoption of performance-related pay provisions. This article examines managerial and organisational features of university departments in Denmark that use publication incentive payments.…

75 FR 64397 - Value Pricing Pilot Program Participation, Fiscal Years 2010 and 2011

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-19

... existing highway. Absent one or both of these conditions being met, an agreement will not be considered... program can be used to support pre- implementation study activities as well as to pay for pricing-specific implementation costs of value pricing projects. Pursuant to section 1012(b)(2) of ISTEA, FHWA may not fund pre...

33 CFR 241.1 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-07-01

... CONTROL COST-SHARING REQUIREMENTS UNDER THE ABILITY TO PAY PROVISION § 241.1 Purpose. This rule gives general instructions on the implementation of section 103(m) of the Water Resources Development Act of...

The value of value-based insurance design: savings from eliminating drug co-payments.

PubMed

Maeng, Daniel D; Pitcavage, James M; Snyder, Susan R; Davis, Duane E

2016-02-01

To estimate the cost impact of a $0 co-pay prescription drug program implemented by a large healthcare employer as a part of its employee wellness program. A $0 co-pay program that included approximately 200 antihypertensive, antidiabetic, and antilipid medications was offered to Geisinger Health System (GHS) employees covered by Geisinger Health Plan (GHP) in 2007. Claims data from GHP for the years 2005 to 2011 were obtained. The sample was restricted to continuously enrolled members with Geisinger primary care providers throughout the study period. The intervention group, defined as 2251 GHS employees receiving any of the drugs eligible for $0 co-pay, was propensity score matched based on 2 years of pre-intervention claims data to a comparison group, which was defined as 3857 non-GHS employees receiving the same eligible drugs at the same time. Generalized linear models were used to estimate differences in terms of per-member-per-month (PMPM) claims amounts related to prescription drugs and medical care. Total healthcare spending (medical plus prescription drug spending) among the GHS employees was lower by $144 PMPM (13%; 95% CI, $38-$250) during the months when they were taking any of the eligible drugs. Considering the drug acquisition cost and the forgone co-pay, the estimated return on investment over a 5-year period was 1.8. This finding suggests that VBID implementation within the context of a wider employee wellness program targeting the appropriate population can potentially lead to positive cost savings.

Strategic Pay Reform: A Student Outcomes-Based Evaluation of Denver's ProComp Teacher Pay Initiative

ERIC Educational Resources Information Center

Goldhaber, Dan; Walch, Joe

2012-01-01

Denver Public Schools utilizes one of the nation's highest profile alternative teacher compensation systems, and a key element of Denver's Professional Compensation System for Teachers (ProComp) is pay for performance. This study analyzes the student achievement implications of ProComp utilizing matched student- and teacher-level data from 2003 to…

Teacher Incentive Pay Programs: Characteristics and Association with Instructional Practices

ERIC Educational Resources Information Center

Liang, Guodong

2011-01-01

This dissertation research examined the characteristics of teacher incentive pay programs in the state of Missouri and across the nation in the United States. The purposes of this study were (a) to examine the characteristics of districts that offered performance-related pay (PRP) programs and teachers who received PRP awards in 2007 using the…

New Pay: Compensation as a Strategic Tool. Workforce Brief #5.

ERIC Educational Resources Information Center

Mitchell, Stephen

Although what the work companies do and how they do it have shifted significantly, companies' reward and salary structures have remained largely the same; however, a properly designed compensation and pay system can be a strategic tool to enhance a firm's competitiveness. New approaches tie pay more closely to performance, rather than to tenure…

Shortchanged: The Hidden Costs of Lockstep Teacher Pay

ERIC Educational Resources Information Center

TNTP, 2014

2014-01-01

Nobody goes into teaching to get rich, but that's no excuse not to pay teachers as professionals. Compensation is one of the most important factors in determining who enters the teaching profession and how long they stay--yet 90 percent of all U.S. school districts pay teachers without any regard for their actual performance with students,…

Teachers' Perceptions of Merit Pay

ERIC Educational Resources Information Center

Jackson, Vanessa; Langheinrich, Cornelia; Loth, Dan

2012-01-01

The purpose of the study is to show the various perceptions teachers have on merit pay. This research was designed to examine the perceptions and attitudes of teachers towards the idea of performance based pay. This topic has been an ongoing battle within school systems since the 1800s. The participants in this study were teachers from the state…

Designing Incentives for Public School Teachers: Evidence from a Texas Incentive Pay Program

ERIC Educational Resources Information Center

Springer, Matthew G.; Taylor, Lori L.

2016-01-01

Pay-for-performance is a popular public education reform, but there is little evidence about the characteristics of a well-designed incentive pay plan for teachers. Some of the literature suggests that effective incentive plans must offer relatively large awards to induce behavioral changes. On the other hand, the experimental economics literature…

Insertion Sorter in P Systems

NASA Astrophysics Data System (ADS)

Pour Yousefian Barfeh, Davood; Ebron, Jonalyn G.; Pabico, Jaderick P.

2018-02-01

In this study researchers pay attention to the essence of Insertion Sort and propose a sorter in Membrane Computing. This research shows how a theoretical computing device same as Membrane Computing can perform the basic concepts same as sorting. In this regard, researches introduce conditional reproduction rule such that each membrane can reproduce another membrane having same structure with the original membrane. The researchers use the functionality of comparator P system as a basis in which two multisets are compared and then stored in two adjacent membranes. And finally, the researchers present the process of sorting as a collection of transactions implemented in four levels while each level has different steps.

Bell-Curve Genetic Algorithm for Mixed Continuous and Discrete Optimization Problems

NASA Technical Reports Server (NTRS)

Kincaid, Rex K.; Griffith, Michelle; Sykes, Ruth; Sobieszczanski-Sobieski, Jaroslaw

2002-01-01

In this manuscript we have examined an extension of BCB that encompasses a mix of continuous and quasi-discrete, as well as truly-discrete applications. FVe began by testing two refinements to the discrete version of BCB. The testing of midpoint versus fitness (Tables 1 and 2) proved inconclusive. The testing of discrete normal tails versus standard mutation showed was conclusive and demonstrated that the discrete normal tails are better. Next, we implemented these refinements in a combined continuous and discrete BCB and compared the performance of two discrete distance on the hub problem. Here we found when "order does matter" it pays to take it into account.

Designing and Piloting a Program to Provide Water Filters and Improved Cookstoves in Rwanda

PubMed Central

Barstow, Christina K.; Ngabo, Fidele; Rosa, Ghislaine; Majorin, Fiona; Boisson, Sophie; Clasen, Thomas; Thomas, Evan A.

2014-01-01

Background In environmental health interventions addressing water and indoor air quality, multiple determinants contribute to adoption. These may include technology selection, technology distribution and education methods, community engagement with behavior change, and duration and magnitude of implementer engagement. In Rwanda, while the country has the fastest annual reduction in child mortality in the world, the population is still exposed to a disease burden associated with environmental health challenges. Rwanda relies both on direct donor funding and coordination of programs managed by international non-profits and health sector businesses working on these challenges. Methods and Findings This paper describes the design, implementation and outcomes of a pilot program in 1,943 households across 15 villages in the western province of Rwanda to distribute and monitor the use of household water filters and improved cookstoves. Three key program design criteria include a.) an investment in behavior change messaging and monitoring through community health workers, b.) free distributions to encourage community-wide engagement, and c.) a private-public partnership incentivized by a business model designed to encourage “pay for performance”. Over a 5-month period of rigorous monitoring, reported uptake was maintained at greater than 90% for both technologies, although exclusive use of the stove was reported in only 28.5% of households and reported water volume was 1.27 liters per person per day. On-going qualitative monitoring suggest maintenance of comparable adoption rates through at least 16 months after the intervention. Conclusion High uptake and sustained adoption of a water filter and improved cookstove was measured over a five-month period with indications of continued comparable adoption 16 months after the intervention. The design attributes applied by the implementers may be sufficient in a longer term. In particular, sustained and comprehensive engagement by the program implementer is enabled by a pay-for-performance business model that rewards sustained behavior change. PMID:24676210

Unintended consequences: organizational practices and their impact on workplace safety and productivity.

PubMed

Kaminski, M

2001-04-01

Managers often implement new organizational practices to improve firm performance while neglecting possible side effects. This study examines the relationship between 6 organizational practices and both productivity and injury rates in 86 small manufacturing firms. The use of performance-based pay was associated with higher injury rates and lower productivity (on 1 of 2 measures). The opposite pattern held for training: Training hours were negatively related to the injury rate and positively related to 1 measure of productivity. Surprisingly, higher hours worked per week was associated with a lower injury rate and also with lower productivity. The use of teams was associated with a lower injury rate but was unrelated to productivity. The potential interaction between hazard control measures and organizational practices in predicting injury rates is also discussed.

An exploratory analysis for Lean and Six Sigma implementation in hospitals: Together is better?

PubMed

Lee, Jung Young; McFadden, Kathleen L; Gowen, Charles R

Despite the increasing interest for Lean and Six Sigma implementations in hospitals, there has been little empirical evidence that goes beyond descriptive case studies to address the current status and the effectiveness of the implementations. The aim of this study was to explore existing patterns of Lean and Six Sigma implementation in U.S. hospitals and compare the performance of the different patterns. We collected data from 215 U.S. hospitals via a survey that includes measurement items developed from related literature. Using the cross-sectional data, we conducted a cluster analysis, followed by t tests, chi-square tests, and regression analyses for cluster verification. The cluster analysis identifies two clusters, a Moderate Six Sigma group and a Lean Six Sigma group. Results show that the Lean Six Sigma group outperforms the Moderate Six Sigma group across many performance dimensions: responsiveness capability, patient safety, and possibly cost saving. In addition, the Lean Six Sigma group tends to be composed of larger, private teaching hospitals located in more urban areas, and they employ more resources for quality improvement. Our research contributes to the quality management literature by supporting the possible complementary relationship between Lean and Six Sigma in hospitals. Our study encourages practitioners and managers to pay more attention to Lean implementation. Although Lean seems to be conducted in a limited fashion in many hospitals, it should be expanded and combined with Six Sigma for better results.

25 CFR 170.931 - Can tribes use IRR Program funds to pay tribal transportation department operating costs?

Code of Federal Regulations, 2010 CFR

2010-04-01

... OF THE INTERIOR LAND AND WATER INDIAN RESERVATION ROADS PROGRAM Miscellaneous Provisions Tribal... performance of approved IRR Program activities (see appendix A, subpart B). Tribes can also use BIA road maintenance funds to pay the cost of planning, administration, and performance of maintenance activities under...

Exploring the Political Underbelly of Organizational Learning: Learning during Pay and Performance Management Change

ERIC Educational Resources Information Center

Field, Laurie

2011-01-01

Purpose: In an effort to better understand the political dimensions of organizational learning, this paper aims to examine learning processes in an organizational context--namely renegotiation of pay and performance management arrangements--where the interests of organizational members are threatened. Design/methodology/approach: Data were derived…

Diplomatic Mission: President Obama's Path to Performance Pay

ERIC Educational Resources Information Center

Smarick, Andy

2011-01-01

In his first major education speech as a presidential candidate, Senator Barack Obama affirmed his support of teachers unions. Less than two years later, in his first major education address as president, delivered to the Hispanic Chamber of Commerce in March 2009, Obama explicitly backed paying teachers for performance, a reform the unions…

26 CFR 1.83-3 - Meaning and use of certain terms.

Code of Federal Regulations, 2014 CFR

2014-04-01

... the stock and pays the interest on the note. However, he makes no payments toward the face amount of... the face amount of the note, the likelihood of E paying the full purchase price is in substantial... thereof) in recognition of the performance of, or the refraining from performance of, services is...

Educators' Perceptions on Performance Pay: The Economic Factors

ERIC Educational Resources Information Center

BenDavid-Hadar, Iris

2012-01-01

Performance-pay as an educational policy is currently discussed both in research and in public debate. The principal agent theory application to an education system views teachers as more altruistic than opportunistic, and therefore affected by intrinsic rather than extrinsic motivations. An extensive amount of research has been published on the…

The Best Laid Plans: Pay for Performance Incentive Programs for School Leaders

ERIC Educational Resources Information Center

Goff, Peter; Goldring, Ellen; Canney, Melissa

2016-01-01

In an era of heightened accountability and limited fiscal resources, school districts have sought novel ways to increase the effectiveness of their principals in an effort to increase student proficiency. To address these needs, some districts have turned to pay-for-performance programs, aligning leadership goals with financial incentives to…

Teacher Professionalism and Team Performance Pay: A Mixed Methods Study

ERIC Educational Resources Information Center

Wells, Pamela; Combs, Julie P.; Bustamante, Rebecca M.

2012-01-01

The purpose of this mixed methods research study was to explore teachers' perceptions of their professional behaviors when they worked in schools that awarded team performance pay. Teachers' archival responses from two questionnaires were analyzed using mixed methods data analysis techniques (Year 1, n = 368; Year 2, n = 649). Most teachers had…

Paying for Performance to Improve the Delivery and Uptake of Family Planning in Low and Middle Income Countries: A Systematic Review.

PubMed

Blacklock, Claire; MacPepple, Ekelechi; Kunutsor, Setor; Witter, Sophie

2016-12-01

Paying for performance is a strategy to meet the unmet need for family planning in low and middle income countries; however, rigorous evidence on effectiveness is lacking. Scientific databases and grey literature were searched from 1994 to May 2016. Thirteen studies were included. Payments were linked to units of targeted services, usually modified by quality indicators. Ancillary components and payment indicators differed between studies. Results were mixed for family planning outcome measures. Paying for performance was associated with improved modern family planning use in one study, and increased user and coverage rates in two more. Paying for performance with conditional cash transfers increased family planning use in another. One study found increased use in the upper wealth group only. However, eight studies reported no impact on modern family planning use or prevalence. Secondary outcomes of equity, financial risk protection, satisfaction, quality, and service organization were mixed. Available evidence is inconclusive and limited by the scarcity of studies and by variation in intervention, study design, and outcome measures. Further studies are warranted. © 2016 The Population Council, Inc.

Examing the prospective of implementing passive house standards in providing sustainable schools

NASA Astrophysics Data System (ADS)

Suhaili, Wan Farhani; Shahrill, Masitah

2018-04-01

This study examines the potential of implementing the passive house standards to reduce energy consumption on school buildings in Brunei. Furthermore, it investigates whether sustainable school buildings make business sense to the government. To do this, conventional and Passive House primary school buildings are compared in terms of their performances using the Passive House Planning Package as well as the Ecotect environmental analysis tool. The findings indicated that by replacing lower U-values building fabrics brought a significantly reduction in the cooling demand of 54%. Whereas, Ecotect models have demonstrated that the heating and cooling loads have tremendously reduced to 75% by reorienting the location of the building to south elevation and by replacing the building fabrics with a lower U-values. These findings were then evaluated with a cost benefit analysis that proved to save cost energy annually from air-conditioning usage from a typical primary school with eight years of pay back period.

Impact of pay for performance on quality of chronic disease management by social class group in England.

PubMed

Crawley, Danielle; Ng, Anthea; Mainous, Arch G; Majeed, Azeem; Millett, Christopher

2009-03-01

To examine associations between social class and achievement of selected national audit targets for coronary heart disease (CHD), diabetes and hypertension in England before and after the introduction of a major pay for performance programme in 2004. Secondary analysis of 2003 and 2006 national survey data for respondents with CHD and diabetes and hypertension. England. Achievement of national audit targets for blood pressure, blood glucose and cholesterol control. There were no significant differences in achievement of blood pressure targets in individuals from manual and non-manual occupational groups with diabetes (2003: 65.9% v 60.3%, 2006: 67.6% v 69.7%) or hypertension (2003: 66.2% v 66.2%, 2006: 72.8% v 71.9%) before or after the introduction of pay for performance. Achievement of the cholesterol target was also similar in individuals from manual and non-manual groups with diabetes (2003: 52.5% v 46.6%, 2006: 68.7% v 70.5%) or CHD (2003: 54.3% v 53.3%, 2006: 68.6% v 71.3%). Differences in achievement of the blood pressure target in CHD [75.8% v 84.5%; AOR 0.44 (0.21-0.90)] were evident between manual and non-manual occupational groups after the introduction of pay for performance. The quality of chronic disease management in England was broadly equitable between socioeconomic groups before this major pay for performance programme and remained so after its introduction.

Managing poorly performing clinicians: health care providers' willingness to pay for independent help.

PubMed

Watson, Verity; Sussex, Jon; Ryan, Mandy; Tetteh, Ebenezer

2012-03-01

To determine the willingness to pay (WTP) of senior managers in the UK National Health Service (NHS) for services to help manage performance concerns with doctors, dentists and pharmacists. A discrete choice experiment (DCE) was used to elicit senior managers' preferences for a support service to help manage clinical performance concerns. The DCE was based on: a literature review; interviews with support service providers and clinical professional bodies; and discussion groups with managers. From the DCE responses, we estimate marginal WTP for aspects of support services. 451 NHS managers completed the DCE questionnaire. NHS managers are willing to pay for: advice, 'facilitation', and behavioural, health, clinical and organisational assessments. Telephone advice with written confirmation was valued most highly. NHS managers were willing to pay £161.56 (CI: £160.81-£162.32) per year per whole time equivalent doctor, dentist or pharmacist, for support to help manage clinical performance concerns. Marginal WTP varied across respondent subgroups but was always positive. Health care managers valued help in managing the clinicians' performance, and were willing to pay for it from their organisations' limited funds. Their WTP exceeds the current cost of a UK body providing similar support. Establishing a central body to provide such services across a health care system, with the associated economies of scale including cumulative experience, is an option that policy makers should consider seriously. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Neuromorphic VLSI Models of Selective Attention: From Single Chip Vision Sensors to Multi-chip Systems

PubMed Central

Indiveri, Giacomo

2008-01-01

Biological organisms perform complex selective attention operations continuously and effortlessly. These operations allow them to quickly determine the motor actions to take in response to combinations of external stimuli and internal states, and to pay attention to subsets of sensory inputs suppressing non salient ones. Selective attention strategies are extremely effective in both natural and artificial systems which have to cope with large amounts of input data and have limited computational resources. One of the main computational primitives used to perform these selection operations is the Winner-Take-All (WTA) network. These types of networks are formed by arrays of coupled computational nodes that selectively amplify the strongest input signals, and suppress the weaker ones. Neuromorphic circuits are an optimal medium for constructing WTA networks and for implementing efficient hardware models of selective attention systems. In this paper we present an overview of selective attention systems based on neuromorphic WTA circuits ranging from single-chip vision sensors for selecting and tracking the position of salient features, to multi-chip systems implement saliency-map based models of selective attention. PMID:27873818

Neuromorphic VLSI Models of Selective Attention: From Single Chip Vision Sensors to Multi-chip Systems.

PubMed

Indiveri, Giacomo

2008-09-03

Biological organisms perform complex selective attention operations continuously and effortlessly. These operations allow them to quickly determine the motor actions to take in response to combinations of external stimuli and internal states, and to pay attention to subsets of sensory inputs suppressing non salient ones. Selective attention strategies are extremely effective in both natural and artificial systems which have to cope with large amounts of input data and have limited computational resources. One of the main computational primitives used to perform these selection operations is the Winner-Take-All (WTA) network. These types of networks are formed by arrays of coupled computational nodes that selectively amplify the strongest input signals, and suppress the weaker ones. Neuromorphic circuits are an optimal medium for constructing WTA networks and for implementing efficient hardware models of selective attention systems. In this paper we present an overview of selective attention systems based on neuromorphic WTA circuits ranging from single-chip vision sensors for selecting and tracking the position of salient features, to multi-chip systems implement saliency-map based models of selective attention.

The Challenge of Innovation: The Case of the Minneapolis Professional Pay Plan? EPI Briefing Paper #267

ERIC Educational Resources Information Center

Harris, Debbi

2010-01-01

What is the "best" way to pay teachers? Should teachers be paid based only on their experience and education, or does this merely reward mediocrity? Would it be better to base teachers' pay on their performance in the classroom or their students' learning, or would this undermine cooperation among colleagues and encourage an unhealthy…

Supporting High School Teachers' College and Career Readiness Efforts: Bridging California's Vision with Local Implementation Needs. Policy Brief

ERIC Educational Resources Information Center

Lewis, Jodi; Nodine, Thad; Venezia, Andrea

2016-01-01

This brief shares the perspectives and concerns of high school teachers in two districts regarding implementing the Common Core State Standards, specifically as the Common Core pertains to preparing more students for college and well-paying careers. The brief also makes state policy recommendations for ways to support teachers in their efforts to…

Guiding principles and checklist for population-based quality metrics.

PubMed

Krishnan, Mahesh; Brunelli, Steven M; Maddux, Franklin W; Parker, Thomas F; Johnson, Douglas; Nissenson, Allen R; Collins, Allan; Lacson, Eduardo

2014-06-06

The Centers for Medicare and Medicaid Services oversees the ESRD Quality Incentive Program to ensure that the highest quality of health care is provided by outpatient dialysis facilities that treat patients with ESRD. To that end, Centers for Medicare and Medicaid Services uses clinical performance measures to evaluate quality of care under a pay-for-performance or value-based purchasing model. Now more than ever, the ESRD therapeutic area serves as the vanguard of health care delivery. By translating medical evidence into clinical performance measures, the ESRD Prospective Payment System became the first disease-specific sector using the pay-for-performance model. A major challenge for the creation and implementation of clinical performance measures is the adjustments that are necessary to transition from taking care of individual patients to managing the care of patient populations. The National Quality Forum and others have developed effective and appropriate population-based clinical performance measures quality metrics that can be aggregated at the physician, hospital, dialysis facility, nursing home, or surgery center level. Clinical performance measures considered for endorsement by the National Quality Forum are evaluated using five key criteria: evidence, performance gap, and priority (impact); reliability; validity; feasibility; and usability and use. We have developed a checklist of special considerations for clinical performance measure development according to these National Quality Forum criteria. Although the checklist is focused on ESRD, it could also have broad application to chronic disease states, where health care delivery organizations seek to enhance quality, safety, and efficiency of their services. Clinical performance measures are likely to become the norm for tracking performance for health care insurers. Thus, it is critical that the methodologies used to develop such metrics serve the payer and the provider and most importantly, reflect what represents the best care to improve patient outcomes. Copyright © 2014 by the American Society of Nephrology.

An under-met and over-met expectations model of employee reactions to merit raises.

PubMed

Schaubroeck, John; Shaw, Jason D; Duffy, Michelle K; Mitra, Atul

2008-03-01

The authors developed a model of how raise expectations influence the relationship between merit pay raises and employee reactions and tested it using a sample of hospital employees. Pay-for-performance (PFP) perceptions were consistently related to personal reactions (e.g., pay raise happiness, pay-level satisfaction, and turnover intentions). Merit pay raises were strongly related to reactions only among employees with high raise expectations and high PFP perceptions. The interactive effects of under-met/over-met expectations and PFP perceptions were mediated by the extent to which participants saw the raise as generous and they were happy with the raises they received. The authors discuss the implications of these findings for expectation-fulfillment theories, merit pay research, and the administration of incentives. Copyright 2008 APA

Quality management of human resources. Providers should begin by focusing on education, performance management, and reward systems.

PubMed

Blair, C S; Fordyce, M; Barney, S M

1993-10-01

For a quality management transformation to occur, a healthcare organization must focus on education and development, performance management, and recognition and reward systems during the first years of implementation. Education and development are perhaps the most important human resource management functions when implementing quality management principles and processes because behavioral changes will be required at all organizational levels. Specific programs that support an organization's quality management effort will vary but should include the conceptual, cultural, and technical aspects of quality management. The essence of quality management is to always satisfy the customer and to continuously improve the services and products the organization offers. The approach to performance management should therefore rely on customer feedback and satisfaction. An organization committed to quality management should base its performance management approach on customer orientation, process improvement, employee involvement, decision making with data, and continuous improvement. Managers and trustees are being challenged to provide innovative recognition and reward systems that reinforce the values and behaviors consistent with quality management. Such systems must also be aligned with the behaviors and outcomes that support the philosophy, mission, and values of the Catholic healthcare ministry. The following components should be considered for a recognition and reward system: base pay, incentives, benefits, and nonmonetary rewards.

Factors affecting participating farmers' willingness-to-pay for the Tree Farming Fund: a study in a participatory forest in Bangladesh.

PubMed

Salam, Md Abdus; Noguchi, Toshikuni; Alim, Md Abdul

2006-07-01

This paper examined the factors that might influence participating farmers' willingness-to-pay for the Tree Farming Fund (TFF) established for sustainable development of participatory forest management (PFM). Information on willingness-to-pay, socioeconomic characteristics, and attitudes of participating farmers toward TFF were obtained from interviews with 581 participating farmers. Logistic regression analysis was used to determine the dominant factors that might influence participating farmers' willingness-to-pay for the TFF. The results showed that participating farmers' willingness-to-pay was significantly affected by (i) family income; (ii) education level; (iii) confidence that his aspired benefits will be received; (iv) agreement with the statement that 'PFM is sustainable under the present state of management'; (v) agreement with the statement that 'PFM is a good strategy for forest conservation'; and (vi) knowledge of PFM strategies. Thus, participating farmers with a higher level of education, higher income and positive attitudes toward TFF tended to express more willingness-to-pay. Establishment of TFF could be an effective strategy in implementing sustainable PFM in Bangladesh. For this strategy to succeed, however, active partnership between the participating farmers and Forest Department is required. Participating farmers' attitudes toward TFF should therefore be taken into consideration as should the results of this study, which are important indicators of participating farmers' positive attitudes toward TFF.

Teacher Attitudes toward Pay for Performance: Evidence from Hillsborough County, Florida. Working Paper 2008-08

ERIC Educational Resources Information Center

Jacob, Brian; Springer, Matthew G.

2008-01-01

Pay for Performance (PFP) is once again gaining popularity within education. This study examines teacher attitudes toward PFP policies, and how these views vary by teacher experience, subject area specialization, grade level(s) taught, educational background, risk and time preferences, and feelings of efficacy. Data were collected through a…

Pay-for-Performance Teacher Compensation: An Inside View of Denver's ProComp Plan

ERIC Educational Resources Information Center

Gonring, Phil; Teske, Paul; Jupp, Brad

2007-01-01

Denver's groundbreaking campaign to introduce performance-based pay for teachers captured national and international attention and has paved the way for similar efforts elsewhere. In this book, Phil Gonring, Paul Teske, and Brad Jupp--among the key players in this successful come-from-behind campaign--offer the inside story of the ProComp…

Changing the Education Workforce? The Relationships between Teacher Quality, Motivation, and Performance Pay

ERIC Educational Resources Information Center

Bowen, Daniel H.; Mills, Jonathan N.

2017-01-01

Background/Context: With a growing body of evidence to support the assertion that teacher quality is vital to producing better student outcomes, policymakers continue to seek solutions to attract and retain the best educators. Performance-based pay is a reform that has become popular in K-12 education over the last decade. This strategy…

Race to the Paycheck: Merit Pay and Theories of Teacher Motivation

ERIC Educational Resources Information Center

Horne, Jason; Foley, Virginia P.; Flora, Bethany H.

2014-01-01

Recent reforms in teacher evaluation tie these evaluations to student performance as measured by test scores and merit pay has been offered as a way to reward high test scores and improve teacher performance. Thus, the federal Race to the Top program has led several states toward teacher evaluation instruments that incorporate outcome data in the…

Is There a Correlation between US University Presidential Pay and Performance?

ERIC Educational Resources Information Center

Risler, Laura; Harrison, Laura M.

2014-01-01

This paper scrutinises the escalating salaries of US college and university presidents (vice-chancellors, or rectors, as they might be known in other parts of the world). Some research suggests that presidential pay is largely correlated with factors that have little or nothing to do with performance and may, therefore, overstate the benefit that…

Team Performance Pay and Motivation Theory: A Mixed Methods Study

ERIC Educational Resources Information Center

Wells, Pamela; Combs, Julie P.; Bustamante, Rebecca M.

2013-01-01

This study was conducted to explore teachers' perceptions of a team performance pay program in a large suburban school district through the lens of motivation theories. Mixed data analysis was used to analyze teacher responses from two archival questionnaires (Year 1, n = 368; Year 2, n = 649). Responses from teachers who participated in the team…

Not-for-profit hospital CEO performance and pay: some evidence from Connecticut.

PubMed

Kramer, Jeffrey; Santerre, Rexford E

2010-01-01

This paper uses observations from a panel data set of 35 chief executive officers (CEOs) from 29 not-for-profit hospitals in Connecticut over the period 1998 to 2006 to investigate the relationship between CEO performance and pay. Both economic and charity performance measures are specified in the empirical model. The multiple regression results reveal that not-for-profit hospital CEOs, at least in Connecticut, are driven at the margin to increase the occupancy rate of privately insured patients at the expense of uncompensated care and public-pay patients. This type of behavior on the part of not-for-profit hospital CEOs calls into question the desirability of allowing these hospitals a tax exemption on earned income, property, and purchases.

77 FR 38042 - TRICARE; Implementation of TRICARE Transitional Outpatient Payments

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-26

... amounts using a method similar to Medicare. TRICARE will pay an amount equal to 85 percent of the... TRICARE TOPs provision. The Patient Protection and Affordable Care Act (PPACA) extended the hold harmless...

User fee exemptions and excessive household spending for normal delivery in Burkina Faso: the need for careful implementation.

PubMed

Ben Ameur, Amal; Ridde, Valéry; Bado, Aristide R; Ingabire, Marie-Gloriose; Queuille, Ludovic

2012-11-21

In 2006, the Parliament of Burkina Faso passed a policy to reduce the direct costs of obstetric services and neonatal care in the country's health centres, aiming to lower the country's high national maternal mortality and morbidity rates. Implementation was via a "partial exemption" covering 80% of the costs. In 2008 the German NGO HELP launched a pilot project in two health districts to eliminate the remaining 20% of user fees. Regardless of any exemptions, women giving birth in Burkina Faso's health centres face additional expenses that often represent an additional barrier to accessing health services. We compared the total cost of giving birth in health centres offering partial exemption versus those with full exemption to assess the impact on additional out-of-pocket fees. A case-control study was performed to compare medical expenses. Case subjects were women who gave birth in 12 health centres located in the Dori and Sebba districts, where HELP provided full fee exemption for obstetric services and neonatal care. Controls were from six health centres in the neighbouring Djibo district where a partial fee exemption was in place. A random sample of approximately 50 women per health centre was selected for a total of 870 women. There was an implementation gap regarding the full exemption for obstetric services and neonatal care. Only 1.1% of the sample from Sebba but 17.5% of the group from Dori had excessive spending on birth related costs, indicating that women who delivered in Sebba were much less exposed to excessive medical expenses than women from Dori. Additional out-of-pocket fees in the full exemption health districts took into account household ability to pay, with poorer women generally paying less. We found that the elimination of fees for facility-based births benefits especially the poorest households. The existence of excessive spending related to direct costs of giving birth is of concern, making it urgent for the government to remove all direct fees for obstetric and neonatal care. However, the policy of completely abolishing user fees is insufficient; the implementation process must have a thorough monitoring system to reduce implementation gaps.

Implementing clinical protocols in oncology: quality gaps and the learning curve phenomenon.

PubMed

Kedikoglou, Simos; Syrigos, Konstantinos; Skalkidis, Yannis; Ploiarchopoulou, Fani; Dessypris, Nick; Petridou, Eleni

2005-08-01

The quality improvement effort in clinical practice has focused mostly on 'performance quality', i.e. on the development of comprehensive, evidence-based guidelines. This study aimed to assess the 'conformance quality', i.e. the extent to which guidelines once developed are correctly and consistently applied. It also aimed to assess the existence of quality gaps in the treatment of certain patient segments as defined by age or gender and to investigate methods to improve overall conformance quality. A retrospective audit of clinical practice in a well-defined oncology setting was undertaken and the results compared to those obtained from prospectively applying an internally developed clinical protocol in the same setting and using specific tools to increase conformance quality. All indicators showed improvement after the implementation of the protocol that in many cases reached statistical significance, while in the entire cohort advanced age was associated (although not significantly) with sub-optimal delivery of care. A 'learning curve' phenomenon in the implementation of quality initiatives was detected, with all indicators improving substantially in the second part of the prospective study. Clinicians should pay separate attention to the implementation of chosen protocols and employ specific tools to increase conformance quality in patient care.

The Strategic Design of Reward Systems.

DTIC Science & Technology

1982-10-01

AuTO1 , 8 CO NTRACT Ok .NANT NUMO lll , Edward E. Lawler III N-00014-81-K-0048 9 PERFORMING ORGANIZATION NAME AND ADORErS 10. PROGRAM ELEMENT...SUPPLEMENTARY NOTES .iL L:~ 19 KEY WORDS (Continue on reveres side It necessary and Identify by block number) A Pay, performance appraisal, motivation...retention, culture development:, and skill development are considered. The relationship between these object iwv and such design options as performance pay

Pay-for-Performance Incentives: Holy Grail or Sippy Cup?

PubMed

Caveney, Brian J

2016-01-01

The health care system is slowly evolving from fee-for-service care to other forms of payment. Pay-for-performance contracts based on quality, patient satisfaction, and utilization are an important development along the continuum. The metrics are not perfect and do not always nudge clinicians to improve their performance, but many outcomes are likely to improve. ©2016 by the North Carolina Institute of Medicine and The Duke Endowment. All rights reserved.

Pay for performance in the inpatient sector: A review of 34 P4P programs in 14 OECD countries.

PubMed

Milstein, Ricarda; Schreyoegg, Jonas

2016-10-01

Across the member countries of the Organisation for Economic Co-operation and Development (OECD), pay-for-performance (P4P) programs have been implemented in the inpatient sector to improve the quality of care provided by hospitals. This paper provides an overview of 34 existing P4P programs in the inpatient sector in 14 OECD countries based on a structured literature search in five databases to identify relevant sources in Danish, English, French, German, Hebrew, Italian, Japanese, Korean, Norwegian, Spanish, Swedish and Turkish. It assembles information on the design and effects of these P4P systems and discusses whether evaluations of such programs allow preliminary conclusions to be drawn about the effects of P4P. The programs are very heterogeneous in their aim, the selection of indicators and the design of financial rewards. The impact of P4P is unclear and it may be that the moderately positive effects seen for some programs can be attributed to side effects, such as public reporting and increased awareness of data recording. Policy makers must decide whether the potential benefits of introducing a P4P program outweigh the potential risks within their particular national or regional context, and should be aware that P4P programs have yet not lived up to expectations. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Willingness to join and pay for the newly proposed social health insurance among teachers in Wolaita Sodo Town, South Ethiopia.

PubMed

Agago, Tesfamichael Alaro; Woldie, Mirkuzie; Ololo, Shimeles

2014-07-01

Cost-sharing between beneficiaries and governments is critical to achieve universal health care coverage. To address this, Ethiopia is currently introducing Social Health Insurance. However, there has been limited evidence on willingness to join the newly proposed insurance scheme in the country. The purpose of this study is to assess willingness to join and pay for the scheme among teachers in Wolaita Sodo Town government educational institutions, South Ethiopia. A cross-sectional study was conducted from February 5 to March 10, 2012 on 335 teachers. Stratified simple random sampling technique was used and data were collected using structured interviewer administered questionnaire. Binary and multiple logistic regressions were used to estimate the crude and adjusted odds ratios for willingness to pay. Three hundred twenty-eight teachers participated in the study with response rate of 98%. About 55% of the teachers had never heard of any type of health insurance scheme. However, 74.4% of them were willing to pay for the suggested insurance scheme. About 47% of those who were willing to pay agreed to contribute greater than or equal to 4% of their monthly salaries. Willingness to pay was more likely among those who had heard about health insurance, had previous history of inability to pay for medical bills and achieved higher educational status. The majority of the teachers were willing to join social health insurance; however, adequate awareness creation and discussion should be made with all employees at various levels for the successful implementation of the scheme.

User Fees in General Practice: Willingness to Pay and Potential Substitution Patterns-Results from a Danish GP Patient Survey.

PubMed

Kronborg, Christian; Pedersen, Line Bjørnskov; Fournaise, Anders; Kronborg, Christel Nøhr

2017-10-01

Increases in public expenditures to general practitioner (GP) services and specialist care have spurred debate over whether to implement user fees for healthcare services such as GP consultations in Denmark. The objective of this study was to examine Danish patients' attitudes towards user fees and their willingness to pay (WTP) for a consultation, and to investigate how user charges may impact patients' behaviour. A questionnaire survey was conducted in a GP clinic. A total of 343 individual persons answered the questionnaire. One hundred and seventy (50%) persons were not willing to pay for a consultation. Among patients reporting positive WTP values, the mean WTP was 137 (standard deviation 140) Danish kroner (DKK). Patients who were 65 years old or older were more likely to be willing to pay for a GP consultation than patients under the age of 65 years. Furthermore, patients with a personal annual income of more than 200,000 DKK were more likely to be willing to pay for a consultation than other income groups. With respect to patients with a positive WTP value, their own assessment of the seriousness of the consultation and their self-assessed health influenced the amount they would be willing to pay. Finally, we observed a stated willingness to substitute GP consultations with alternatives that are free of charge. About half of the patients with an appointment for a GP consultation are willing to pay for the consultation. User charges may potentially influence the patients' behaviour. ClinicalTrials.gov NCT01784731.

Tackling the Transition to UC: To Implement Unified Communications on Campus, It Often Pays to Take a Phased Approach

ERIC Educational Resources Information Center

Ramaswami, Rama

2011-01-01

In this article, the author talks about the challenges faced by two schools that lie, coincidentally, just 110 miles apart in the vast spaces of North Dakota. Both schools, members of the North Dakota University System, decided to forge ahead with a unified communications (UC) implementation. And while their final solutions differ, how the two…

75 FR 29584 - Notice of Lodging of Consent Decree Under the Clean Air Act

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-26

... and violations of the Pennsylvania State Implementation Plan at a steel manufacturing facility in...) Cease operation of the Natrona steel manufacturing facility not later than November 30, 2010; (2) pay a...

Teachers' Unions and Compensation: The Impact of Collective Bargaining on Salary Schedules and Performance Pay Schemes

ERIC Educational Resources Information Center

West, Kristine Lamm; Mykerezi, Elton

2011-01-01

This study examines the impact that collective bargaining has on multiple dimensions of teacher compensation, including average and starting salaries, early and late returns to experience, returns to graduate degrees, and the incidence of different pay for performance schemes. Using data from the School and Staffing Survey (SASS) and a more recent…

Dangerous Mind Games: Are We Ready to Overhaul the Teaching Profession? Education Outlook. No. 4

ERIC Educational Resources Information Center

Dale, Jack D.

2011-01-01

In today's school reform discussions, the teaching profession is often mistakenly viewed as a singular activity. Evaluating teachers for their performance in the classroom assumes that the focus should be on each individual teacher. Merit pay and performance pay both assume that student achievement is the result of only the individual teacher. But…

Implementing a Mobile Health System to Integrate the Treatment of Addiction Into Primary Care: A Hybrid Implementation-Effectiveness Study.

PubMed

Quanbeck, Andrew; Gustafson, David H; Marsch, Lisa A; Chih, Ming-Yuan; Kornfield, Rachel; McTavish, Fiona; Johnson, Roberta; Brown, Randall T; Mares, Marie-Louise; Shah, Dhavan V

2018-01-30

Despite the near ubiquity of mobile phones, little research has been conducted on the implementation of mobile health (mHealth) apps to treat patients in primary care. Although primary care clinicians routinely treat chronic conditions such as asthma and diabetes, they rarely treat addiction, a common chronic condition. Instead, addiction is most often treated in the US health care system, if it is treated at all, in a separate behavioral health system. mHealth could help integrate addiction treatment in primary care. The objective of this paper was to report the effects of implementing an mHealth system for addiction in primary care on both patients and clinicians. In this implementation research trial, an evidence-based mHealth system named Seva was introduced sequentially over 36 months to a maximum of 100 patients with substance use disorders (SUDs) in each of three federally qualified health centers (FQHCs; primary care clinics that serve patients regardless of their ability to pay). This paper reports on patient and clinician outcomes organized according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. The outcomes according to the RE-AIM framework are as follows: Reach-Seva reached 8.31% (268/3226) of appropriate patients. Reach was limited by our ability to pay for phones and data plans for a maximum of 100 patients per clinic. Effectiveness-Patients who were given Seva had significant improvements in their risky drinking days (44% reduction, (0.7-1.25)/1.25, P=.04), illicit drug-use days (34% reduction, (2.14-3.22)/3.22, P=.01), quality of life, human immunodeficiency virus screening rates, and number of hospitalizations. Through Seva, patients also provided peer support to one another in ways that are novel in primary care settings. Adoption-Patients sustained high levels of Seva use-between 53% and 60% of the patients at the 3 sites accessed Seva during the last week of the 12-month implementation period. Among clinicians, use of the technology was less robust than use by patients, with only a handful of clinicians using Seva in each clinic and behavioral health providers making most referrals to Seva in 2 of the 3 clinics. Implementation-At 2 sites, implementation plans were realized successfully; they were delayed in the third. Maintenance-Use of Seva dropped when grant funding stopped paying for the mobile phones and data plans. Two of the 3 clinics wanted to maintain the use of Seva, but they struggled to find funding to support this. Implementing an mHealth system can improve care among primary care patients with SUDs, and patients using the system can support one another in their recovery. Among clinicians, however, implementation requires figuring out how information from the mHealth system will be used and making mHealth data available in the electronic health (eHealth) record. In addition, paying for an mHealth system remains a challenge. ©Andrew Quanbeck, David H Gustafson, Lisa A Marsch, Ming-Yuan Chih, Rachel Kornfield, Fiona McTavish, Roberta Johnson, Randall T Brown, Marie-Louise Mares, Dhavan V Shah. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 30.01.2018.

Quadrennial Review of Military Compensation (5th). Executive Summary.

DTIC Science & Technology

1984-01-01

COMBINATION Any proposed legislation to modify the current retire- ment system by reducing retired pay must stress the absolute requirement that a form of...Hazardous Duty Incentive Pays: — Parachute Duty — Flight Deck Duty -- Demolition Duty — Toxic Fuels and — Experimental Stress Duty Propellants — Non...3) Experimental Stress Duty Pay - an incentive for performance of hazardous duty while participating in acceleration/ deceleration testing, thermal

Employee Compensation.

ERIC Educational Resources Information Center

Osif, Bonnie A.; Harwood, Richard L.

1995-01-01

Presents an overview of selected literature about employee compensation. Highlights include the foundations of reward and recognition systems, incentive plans, problems with merit pay, a historical perspective on performance pay, evaluation criteria and processes, self-rating, job motivation and satisfaction, employee attitudes, collective…

What is the empirical basis for paying for quality in health care?

PubMed

Rosenthal, Meredith B; Frank, Richard G

2006-04-01

Despite more than a decade of bench-marking and public reporting of quality problems in the health care sector, changes in medical practice have been slow to materialize. To accelerate quality improvement, many private and public payers have begun to offer financial incentives to physicians and hospitals based on their performance on clinical and service quality measures. The authors review the empirical literature on paying for quality in health care and comparable interventions in other sectors. They find little evidence to support the effectiveness of paying for quality. The absence of findings for an effect may be attributable to the small size of the bonuses studied and the fact that payers often accounted for only a fraction of the targeted provider's panel. Even in non-health settings, however, where the institutional features are more favorable to a positive impact, the literature contains mixed results on the effectiveness of analogous pay-for-performance schemes.

Examining the Role of Patient Experience Surveys in Measuring Health Care Quality

PubMed Central

Elliott, Marc N.; Zaslavsky, Alan M.; Hays, Ron D.; Lehrman, William G.; Rybowski, Lise; Edgman-Levitan, Susan; Cleary, Paul D.

2015-01-01

Patient care experience surveys evaluate the degree to which care is patient-centered. This article reviews the literature on the association between patient experiences and other measures of health care quality. Research indicates that better patient care experiences are associated with higher levels of adherence to recommended prevention and treatment processes, better clinical outcomes, better patient safety within hospitals, and less health care utilization. Patient experience measures that are collected using psychometrically sound instruments, employing recommended sample sizes and adjustment procedures, and implemented according to standard protocols are intrinsically meaningful and are appropriate complements for clinical process and outcome measures in public reporting and pay-for-performance programs. PMID:25027409

Domain decomposition methods in computational fluid dynamics

NASA Technical Reports Server (NTRS)

Gropp, William D.; Keyes, David E.

1991-01-01

The divide-and-conquer paradigm of iterative domain decomposition, or substructuring, has become a practical tool in computational fluid dynamic applications because of its flexibility in accommodating adaptive refinement through locally uniform (or quasi-uniform) grids, its ability to exploit multiple discretizations of the operator equations, and the modular pathway it provides towards parallelism. These features are illustrated on the classic model problem of flow over a backstep using Newton's method as the nonlinear iteration. Multiple discretizations (second-order in the operator and first-order in the preconditioner) and locally uniform mesh refinement pay dividends separately, and they can be combined synergistically. Sample performance results are included from an Intel iPSC/860 hypercube implementation.

Attitudes and expectations of producers to the use of a microcomputer-based management information system to monitor dairy herd performance

PubMed Central

Lissemore, Kerry D.; Leslie, Ken E.; Martin, S. Wayne; Menzies, Paula I.; Meek, Alan H.

1992-01-01

The attitudes and expectations of producers toward the use of a microcomputer-based herd management information system were assessed. The study was conducted over a two-year period, beginning in January 1986, and was operated as a bureau service. The implementation and use of the program are described elsewhere. Pre- and posttrial questionnaires were administered to assess producer attitudes. We found that the monthly analysis reports were used in the management of the dairy farms and were found to be a useful management tool. The majority of producers indicated a willingness to pay, on average, $6.86/cow/year for such a service. PMID:17423946

Funding conservation through use and potentials for price discrimination among scuba divers at Sipadan, Malaysia.

PubMed

Emang, Diana; Lundhede, Thomas Hedemark; Thorsen, Bo Jellesmark

2016-11-01

The protected coral reefs off the coast of Malaysia receive numerous tourists, while also being as fishing grounds. These joint environmental pressures raise the need for additional costly conservation measures. It is natural to consider the potential for expanding the 'user pays' principle, already implemented in the form of various user fees. This study explores the potential for price discrimination among scuba divers at Sipadan in Malaysia. The study applies a choice experiment to estimate scuba divers willingness to pay higher user fees for avoiding decreases of or getting improvements in environmental and recreational aspects of the diving experience. We investigate how sensitivity to fee size and hence willingness to pay vary with suitable selected characteristics of divers. We find potentials for a third degree price discrimination strategy exploiting higher willingness to pay among foreign divers (45%), male divers (16%) and people who has visited Sipadan several times (25%). Thus, revised pricing structures could significantly increase funds for the preservation of Sipadan. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Women's willingness to pay for cancer screening].

PubMed

Kwak, Min-Son; Sung, Na-Young; Yang, Jeong Hee; Park, Eun-Cheol; Choi, KuiSon

2006-07-01

The goal of this study is to measure women's willingness to pay for cancer screening and to identify those factors associated with this willingness to pay A population-based telephone survey was performed on 1,562 women (aged 30 years or over) for 2 weeks (9-23th, July, 2004). Data about sociodemographic characteristics, health behaviors, the intention of the cancer screenings and willingness to pay for cancer screening were collected. 1,400 respondents were included in the analysis. The women's willingness to pay for cancer screening and the factors associated with this willingness to pay were evaluated. The results show that 76% of all respondents have a willingness to pay for cancer screening. Among those who are willing to pay, the average and median amount of money for which the respondents are willing to pay are 126,636 (s.d.: 58,414) and 120,000 won, respectively. As the status of education & the income are higher, the average amount that women are willing to pay becomes much more. The amount of money women are willing to pay is the highest during the 'contemplation' stage. Being willing to pay or not is associated with a change of behavior (transtheoretical model), the income, the concern about the cancer risk, the family cancer history, the marital status, the general health exam, age and the place of residence. Income is associated with a greater willingness to pay. Old age was associated with a lower willingness to pay. According to the two-part model, income and TTM are the most important variables associated with the willingness to pay for cancer screening. The cancer screening participation rate is low compared with the willingness to pay for cancer screening. It is thought that we have to consider the participants' behavior that's associated with cancer screening and their willingness to pay in order to organize and manage cancer screening program.

Potential difficulties in applying the Pay for Safety Scheme (PFSS) in construction projects.

PubMed

Choi, Tracy N Y; Chan, Daniel W M; Chan, Albert P C

2012-09-01

Since 1996, the Government of the Hong Kong Special Administrative Region (HKSAR) has introduced the Pay for Safety Scheme (PFSS) to the public works construction contracts to uplift their safety performance. However, the adoption of PFSS has also encountered some difficulties that merit considerable attention. This paper purports to provide a concise review of the prevailing application of PFSS in Hong Kong in general, and to explore the potential difficulties associated with PFSS in particular. By means of an empirical questionnaire survey geared towards industrial practitioners with extensive direct hands-on PFSS experience, their opinions were solicited, analyzed and compared between the client group and contractor group of respondents. The three most significant difficulties in implementing PFSS were found to be: (1) "Plenty of paperwork required for certifying payment to contractor"; (2) "Complicated contract documents and lengthy assessment process"; and (3) "Over-tight project schedule requiring rush jobs". The output of this research study is particularly essential in assisting the contracting parties to mitigate the avoidable hindrances when embarking on PFSS. It has also generated valuable insights into developing effective recommendations for alleviating the barriers to PFSS success for future construction projects. Copyright © 2011 Elsevier Ltd. All rights reserved.

Assessment of collection schemes for packaging and other recyclable waste in European Union-28 Member States and capital cities.

PubMed

Seyring, Nicole; Dollhofer, Marie; Weißenbacher, Jakob; Bakas, Ioannis; McKinnon, David

2016-09-01

The Waste Framework Directive obliged European Union Member States to set up separate collection systems to promote high quality recycling for at least paper, metal, plastic and glass by 2015. As implementation of the requirement varies across European Union Member States, the European Commission contracted BiPRO GmbH/Copenhagen Resource Institute to assess the separate collection schemes in the 28 European Union Member States, focusing on capital cities and on metal, plastic, glass (with packaging as the main source), paper/cardboard and bio-waste. The study includes an assessment of the legal framework for, and the practical implementation of, collection systems in the European Union-28 Member States and an in depth-analysis of systems applied in all capital cities. It covers collection systems that collect one or more of the five waste streams separately from residual waste/mixed municipal waste at source (including strict separation, co-mingled systems, door-to-door, bring-point collection and civic amenity sites). A scoreboard including 13 indicators is elaborated in order to measure the performance of the systems with the capture rates as key indicators to identify best performers. Best performance are by the cities of Ljubljana, Helsinki and Tallinn, leading to the key conclusion that door-to-door collection, at least for paper and bio-waste, and the implementation of pay-as-you-throw schemes results in high capture and thus high recycling rates of packaging and other municipal waste. © The Author(s) 2016.

Experiences with the implementation of Individual Placement and Support for people with severe mental illness: a qualitative study among stakeholders.

PubMed

Vukadin, Miljana; Schaafsma, Frederieke G; Westerman, Marjan J; Michon, Harry W C; Anema, Johannes R

2018-05-24

Individual Placement and Support (IPS) is an evidence-based approach to help people with severe mental illness achieve competitive employment. This article provides insight into an organizational and a financial implementation strategy for IPS in the Netherlands by exploring the perceived facilitators and barriers among participating stakeholders. The goal of this multifaceted strategy was to improve IPS implementation by improving the collaboration between all organizations involved, and realising secured IPS funding with a 'pay for performance' element. A qualitative, explorative study among practitioners (n = 8) and decision makers (n = 7) in mental health care and vocational rehabilitation was performed using semi-structured interviews to collect rich information about the possible facilitators and barriers with regard to the organizational and financial implementation strategy for IPS. Important perceived facilitators were the key principles of the IPS model, regular meetings of stakeholders in mental health care and vocational rehabilitation, stakeholders' experienced ownership of IPS and collaboration, the mandate and influence of the decision makers involved and secured IPS funding. Important perceived barriers included the experienced rigidity of the IPS model fidelity scale and lack of independent fidelity reviewers, the temporary and fragmented character of the secured funding, lack of communication between decision makers and practitioners and negative attitudes and beliefs among mental health clinicians. Changes in legislation were experienced as a facilitator as well as a barrier. The results of this study suggest that the collaboration and IPS funding were experienced as improved by applying an organizational and a financial implementation strategy. However, considerable effort is still necessary to overcome the remaining barriers identified and to make the implementation of IPS a success in practice.

Leading in Times of Change: Principals' Perspectives of Their Role in a New Pay-for-Performance System

ERIC Educational Resources Information Center

Ortiz-Torres, Amanda

2012-01-01

The purpose of this qualitative study was to explore principals' perspectives on how they make sense of their leadership roles in a new pay-for-performance system. The study describes the perceptions of six principals, two each from elementary, middle, and high school levels, regarding leadership in a recently changed system. Principals were…

Making Work Pay: How To Design and Implement Financial Work Supports To Improve Family and Child Well-Being and Reduce Poverty. How-To Guide: Technical Assistance for States and Localities.

ERIC Educational Resources Information Center

Greenberger, Debbie; Anselmi, Robert

This guide explains how to design and implement financial work supports in order to improve family and child well-being. The information provided draws heavily from the study of these three programs that increased employment and earnings while improving employment stability, boosting income, and reducing poverty: Minnesota Family Investment…

Evaluating the fair market value of pay for performance.

PubMed

Johnson, Jen; Higgins, Alexandra

2014-04-01

When assessing a pay-for-performance arrangement, the following factors should be considered: Existence and/or size of minimum savings threshold before savings are allocated. Savings allocation percentage available to physicians. Benchmarks used to measure quality against past performance and/or medical evidence. Ways in which quality outcomes are measured and paid for. Per member per month payments for patient management. Physician investment (participation fee, time, or capital). Existence of downside risk to physicians. Employed compensation structure (if applicable).

Impact of pay for performance on access at first dialysis in Queensland.

PubMed

Haarsager, Jennie; Krishnasamy, Rathika; Gray, Nicholas A

2018-05-01

Commencement of haemodialysis with an arteriovenous fistula (AVF) or arteriovenous graft (AVG) is associated with improved survival compared with commencement with a central venous catheter. In 2011-2012, Queensland Health made incentive payments to renal units for early referred patients who commenced peritoneal dialysis (PD), or haemodialysis with an AVF/AVG. The aim of this study was to determine if pay for performance improved clinical care. All patients who commenced dialysis in Australia between 2009 and 2014 and were registered with the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) were included. A multivariable regression model was used to compare rates of commencing dialysis with a PD catheter or permanent AVF/AVG during the pay-for-performance period (2011-2012) with periods prior (2009-2010) and after (2013-2014). A total of 10 858 early referred patients commenced dialysis during the study period, including 2058 in Queensland. In Queensland, PD as first modality increased with time (P < 0.001) but there was no change in AVF/AVG rate at first haemodialysis (P = 0.5). In a multivariate model using the pay-for-performance period as reference, the odds ratio for commencement with PD or haemodialysis with an AVF/AVG in Queensland was 1.02 (95% CI 0.81-1.29) in 2009-2010 and 1.28 (95% CI 1.01-1.61) in 2013-2014. There was no change for the rest of Australia (0.97 95% CI 0.87-1.09 in 2009-2010 and 1.00 95% CI 0.90-1.11 in 2013-14). Pay for performance did not improve rates of commencement of dialysis with PD or an AVF/AVG during the payment period. A lag effect on clinical care may explain the improvement in later years. © 2017 Asian Pacific Society of Nephrology.

Compliance with prompt payment legislation: the initial experiences of New Jersey radiologists.

PubMed

Swayne, Lawrence C; Fask, Alan; Crewson, Philip E; Stelletell, Helen D; Fanburg, John D; Williams, Gary

2002-07-01

Prompt payment has emerged as a dominant issue in managed care reform, with 47 states passing laws or regulations requiring prompt remuneration for medical services. The New Jersey Prompt-Pay Act, effective on December 28, 1999, requires payment within 30 days of electronic submission and within 40 days for nonelectronic submission. This study was undertaken to assess compliance with the New Jersey Prompt-Pay Act for radiology claims submitted 1 and 5 months after implementation (7-11 months after passage of the statute). A retrospective prompt payment analysis was undertaken of all claims submitted in February and June 2000 to six major payers by a common third-party billing company on behalf of 11 radiology practices of various sizes, settings, and locations in New Jersey. A total of 33,537 claims were assigned to one of six time periods on the basis of timeliness of payment: less than or equal to 30 days, 31-40 days, 41-50 days, 51-60 days, 61-90 days, and greater than 90 days or a separate unpaid category after 170 days had elapsed. A detailed analysis of 3156 claims from one practice was performed to estimate a clean claims submission rate. The overall percentage of claims paid within 40 days was 70%. After 170 days, the overall percentage of paid claims was 93%. The annualized interest lost on delayed payments was $23,939 for the practice analyzed. Prompt payment for radiology services remains an elusive goal in New Jersey, despite passage and implementation of prompt payment legislation.

Relationship between performance barriers and pharmacist competency towards the implementation of an expanded public health pharmacy role.

PubMed

Mathialagan, Amuthaganesh; Nagalinggam, Preesha; Mathialagan, Saravanabavan; Kirby, Brian P

2015-10-01

The objective of this study was to examine the relationship between performance barriers and competency, and implementation of an expanded public health role for community pharmacists. A validated questionnaire was utilised for this study whereby three variables of the study (performance barriers, competency and public health role) were measured using a 5-point Likert scale. Three hundred questionnaires were distributed to target respondents of registered community pharmacies in five states (Johor, Negeri Sembilan, Selangor, Perak and Penang) in Malaysia. The data were analysed utilising the principles of structural equation modelling. There were 191 completed and usable responses received, which represented a 66.7% response rate. This study showed perceived competency had a direct relationship with delivering a general public health role. A perceived lack of competency was shown to be a barrier to fulfilling a public health role. However, other factors, such as design of premises, IT infrastructure and pay, were not viewed as barriers to carrying out a public health role. Perceived competency is an obstacle for community pharmacists to undertake a public health role in Malaysia. Adequate training programmes in pharmaceutical public health have to be put in place to address this concern and this should therefore be a priority. © 2015 Royal Pharmaceutical Society.

A closer look at self-pay segmentation.

PubMed

Franklin, David; Ingramn, Coy; Levin, Steve

2010-09-01

Successful scoring approaches for self-pay accounts have three common characteristics: Thoughtful selection of a scoring model and segmentation approach. Deployment of workflows (either segmented or account prioritization) consistent with a hospital's capabilities and the likelihood of collection. Ongoing performance monitoring.

Prescriber preferences for behavioural economics interventions to improve treatment of acute respiratory infections: a discrete choice experiment

PubMed Central

Gong, Cynthia L; Hay, Joel W; Meeker, Daniella; Doctor, Jason N

2016-01-01

Objective To elicit prescribers' preferences for behavioural economics interventions designed to reduce inappropriate antibiotic prescribing, and compare these to actual behaviour. Design Discrete choice experiment (DCE). Setting 47 primary care centres in Boston and Los Angeles. Participants 234 primary care providers, with an average 20 years of practice. Main outcomes and measures Results of a behavioural economic intervention trial were compared to prescribers' stated preferences for the same interventions relative to monetary and time rewards for improved prescribing outcomes. In the randomised controlled trial (RCT) component, the 3 computerised prescription order entry-triggered interventions studied included: Suggested Alternatives (SA), an alert that populated non-antibiotic treatment options if an inappropriate antibiotic was prescribed; Accountable Justifications (JA), which prompted the prescriber to enter a justification for an inappropriately prescribed antibiotic that would then be documented in the patient's chart; and Peer Comparison (PC), an email periodically sent to each prescriber comparing his/her antibiotic prescribing rate with those who had the lowest rates of inappropriate antibiotic prescribing. A DCE study component was administered to determine whether prescribers felt SA, JA, PC, pay-for-performance or additional clinic time would most effectively reduce their inappropriate antibiotic prescribing. Willingness-to-pay (WTP) was calculated for each intervention. Results In the RCT, PC and JA were found to be the most effective interventions to reduce inappropriate antibiotic prescribing, whereas SA was not significantly different from controls. In the DCE however, regardless of treatment intervention received during the RCT, prescribers overwhelmingly preferred SA, followed by PC, then JA. WTP estimates indicated that each intervention would be significantly cheaper to implement than pay-for-performance incentives of $200/month. Conclusions Prescribing behaviour and stated preferences are not concordant, suggesting that relying on stated preferences alone to inform intervention design may eliminate effective interventions. Trial registration number NCT01454947; Results. PMID:27660322

[Quitting smoking and willingness to pay for cessation in Panama].

PubMed

Herrera-Ballesteros, Víctor H; Zúñiga, Julio; Moreno, Ilais; Gómez, Beatriz; Roa-Rodríguez, Reina

2017-01-01

To characterize the desire for cessation and willingness to pay for abandonment therapy. The data source is the Global Adult Tobacco Survey (GATS). Cessation and willingness to pay were characterized by sociodemographic (SD) and socioeconomic (SE) variables. Logistic regressions were performed to estimate associations. A greater desire for cessation was observed in variables: women, education, non-governmental and inactive employees, rural areas, occasional smokers and middle income, and greater willingness to pay, in: education, over 60 years old, non-governmental, self-employed, urban area, occasional smokers and low median income. There is a high relation between the desire for abandonment, and willingness to pay with SD and SE variables. Cessation therapies can be applied in work centers, and require a change of focus in the intervention.

Impact of satisfactions with psychological reward and pay on Chinese nurses' work attitudes.

PubMed

Chen, Feifei; Yang, Min; Gao, Wei; Liu, Ye; De Gieter, Sara

2015-11-01

To examine the impact of satisfaction with psychological rewards (received from the head nurse and from physicians) and with pay on Chinese nurses' work attitudes. We conducted a cross-sectional survey in China. A total of 413 nurses completed our survey. We examined the effect of satisfactions with psychological rewards and pay on work attitudes by performing a series of hierarchical regression analyses. We found that both satisfaction with pay and satisfaction with psychological rewards from the head nurse significantly predicted work attitudes, whereas satisfaction with psychological rewards from physicians did not. Our results illustrate that when nurses feel satisfied with their pay and the psychological rewards received from the head nurse they exhibit more positive work attitudes. Copyright © 2015 Elsevier Inc. All rights reserved.

76 FR 29633 - Freedom of Information Act Implementation

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-23

...; or (5) The submitter's designation, under paragraph (b) of this section, appears on its face to be... failed to pay a fee to FHFA or FHFA-OIG in a timely fashion, i.e., within 30 calendar days of the date of...

Rewarding healthy behaviors--pay patients for performance.

PubMed

Wu, Joanne

2012-01-01

Despite a considerable investment of resources into pay for performance, preliminary studies have found that it may not be significantly more effective in improving health outcome measures when compared with voluntary quality improvement programs. Because patient behaviors ultimately affect health outcomes, I would propose a novel pay-for-performance program that rewards patients directly for achieving evidence-based health goals. These rewards would be in the form of discounts towards co-payments for doctor's visits, procedures, and medications, thereby potentially reducing cost and compliance issues. A pilot study recruiting patients with diabetes or hypertension, diseases with clear and objective outcome measures, would be useful to examine true costs, savings, and health outcomes of such a reward program. Offering incentives to patients for reaching health goals has the potential to foster a stronger partnership between doctors and patients and improve health outcomes.

Implementation of Instrument Based on Eight Health Related Quality of Life Domains for Measuring of Willingness to Pay for Psoriasis Treatment.

PubMed

Dobrev, Hristo P; Atanasov, Nikolay G; Dimitrova, Donka D

2017-09-01

Psoriasis vulgaris (PsV) is a chronic skin condition that has a major impact on health-related quality of life (HRQOL). To determine the individual burden of PsV on HRQOL using willingness to pay (WTP) instrument. Fifty-one consecutive PsV patients were asked to evaluate their overall health and psoriasis affected health by visual analogue scale (VAS), and interviewed on 8 domains (physical, emotional, sleep, work, social, self-care, intimacy, and concentration) of HRQOL and WTP for a hypothetical cure in each domain. Two additional questions proposing 6 alternatives for therapy were also asked. The analysis is performed with descriptive and frequency statistics, Mann-Whitney and Kruskal-Wallis tests. The domains ranked highly were: physical comfort (90%), social comfort (77%), emotional health (75%) and work (53%). The following tendencies concerning WTP for top four impacted domains were found: the median WTP were the highest in the top impacted domains; the younger patients were willing to pay more than the older ones; the highest median WTP amounts appear in the lowest income group; the highest median WTP is associated with smaller psoriasis affected health VAS scores. The largest proportion and number of patients (37.3%, n=19) stated preferences for the systemic therapy. The second preferred choice was the thalassotherapy (29.4%, n=15). The utility and reliability of the instrument based on the assessment of WTP stated preferences for 8 domains of HRQOL for evaluation the individual burden of psoriasis were strongly supported.

'Just another incentive scheme': a qualitative interview study of a local pay-for-performance scheme for primary care.

PubMed

Hackett, Julia; Glidewell, Liz; West, Robert; Carder, Paul; Doran, Tim; Foy, Robbie

2014-10-25

A range of policy initiatives have addressed inequalities in healthcare and health outcomes. Local pay-for-performance schemes for primary care have been advocated as means of enhancing clinical ownership of the quality agenda and better targeting local need compared with national schemes such as the UK Quality and Outcomes Framework (QOF). We investigated whether professionals' experience of a local scheme in one English National Health Service (NHS) former primary care trust (PCT) differed from that of the national QOF in relation to the goal of reducing inequalities. We conducted retrospective semi-structured interviews with primary care professionals implementing the scheme and those involved in its development. We purposively sampled practices with varying levels of population socio-economic deprivation and achievement. Interviews explored perceptions of the scheme and indicators, likely mechanisms of influence on practice, perceived benefits and harms, and how future schemes could be improved. We used a framework approach to analysis. Thirty-eight professionals from 16 general practices and six professionals involved in developing local indicators participated. Our findings cover four themes: ownership, credibility of the indicators, influences on behaviour, and exacerbated tensions. We found little evidence that the scheme engendered any distinctive sense of ownership or experiences different from the national scheme. Although the indicators and their evidence base were seldom actively questioned, doubts were expressed about their focus on health promotion given that eventual benefits relied upon patient action and availability of local resources. Whilst practices serving more affluent populations reported status and patient benefit as motivators for participating in the scheme, those serving more deprived populations highlighted financial reward. The scheme exacerbated tensions between patient and professional consultation agendas, general practitioners benefitting directly from incentives and nurses who did much of the work, and practices serving more and less affluent populations which faced different challenges in achieving targets. The contentious nature of pay-for-performance was not necessarily reduced by local adaptation. Those developing future schemes should consider differential rewards and supportive resources for practices serving more deprived populations, and employing a wider range of levers to promote professional understanding and ownership of indicators.

From Data to Bonuses: A Case Study of the Issues Related to Awarding Teachers Pay on the Basis of Their Students' Progress. Working Paper 2008-14

ERIC Educational Resources Information Center

McCaffrey, Daniel F.; Han, Bing; Lockwood, J. R.

2008-01-01

A key component to the new wave of performance-based pay initiatives is the use of student achievement data to evaluate teacher performance. As greater amounts of student achievement data are being collected, researchers have been developing and applying innovative statistical and econometric models to longitudinal data to develop measures of an…

Imminent Danger Pay: Actions Needed Regarding Pay Designations in the U.S. Central Command Area of Responsibility

DTIC Science & Technology

2014-01-30

results of previous audits conducted on the data systems 1The source of this review is the Senate...locations within the CENTCOM area of responsibility. We conducted this performance audit from December 2012 to January 2014 in accordance with...generally accepted government auditing standards. Those standards require that we plan and perform the audit to obtain sufficient, appropriate evidence to

Performance Management of High Performance Computing for Medical Image Processing in Amazon Web Services.

PubMed

Bao, Shunxing; Damon, Stephen M; Landman, Bennett A; Gokhale, Aniruddha

2016-02-27

Adopting high performance cloud computing for medical image processing is a popular trend given the pressing needs of large studies. Amazon Web Services (AWS) provide reliable, on-demand, and inexpensive cloud computing services. Our research objective is to implement an affordable, scalable and easy-to-use AWS framework for the Java Image Science Toolkit (JIST). JIST is a plugin for Medical-Image Processing, Analysis, and Visualization (MIPAV) that provides a graphical pipeline implementation allowing users to quickly test and develop pipelines. JIST is DRMAA-compliant allowing it to run on portable batch system grids. However, as new processing methods are implemented and developed, memory may often be a bottleneck for not only lab computers, but also possibly some local grids. Integrating JIST with the AWS cloud alleviates these possible restrictions and does not require users to have deep knowledge of programming in Java. Workflow definition/management and cloud configurations are two key challenges in this research. Using a simple unified control panel, users have the ability to set the numbers of nodes and select from a variety of pre-configured AWS EC2 nodes with different numbers of processors and memory storage. Intuitively, we configured Amazon S3 storage to be mounted by pay-for-use Amazon EC2 instances. Hence, S3 storage is recognized as a shared cloud resource. The Amazon EC2 instances provide pre-installs of all necessary packages to run JIST. This work presents an implementation that facilitates the integration of JIST with AWS. We describe the theoretical cost/benefit formulae to decide between local serial execution versus cloud computing and apply this analysis to an empirical diffusion tensor imaging pipeline.

Performance management of high performance computing for medical image processing in Amazon Web Services

NASA Astrophysics Data System (ADS)

Bao, Shunxing; Damon, Stephen M.; Landman, Bennett A.; Gokhale, Aniruddha

2016-03-01

Adopting high performance cloud computing for medical image processing is a popular trend given the pressing needs of large studies. Amazon Web Services (AWS) provide reliable, on-demand, and inexpensive cloud computing services. Our research objective is to implement an affordable, scalable and easy-to-use AWS framework for the Java Image Science Toolkit (JIST). JIST is a plugin for Medical- Image Processing, Analysis, and Visualization (MIPAV) that provides a graphical pipeline implementation allowing users to quickly test and develop pipelines. JIST is DRMAA-compliant allowing it to run on portable batch system grids. However, as new processing methods are implemented and developed, memory may often be a bottleneck for not only lab computers, but also possibly some local grids. Integrating JIST with the AWS cloud alleviates these possible restrictions and does not require users to have deep knowledge of programming in Java. Workflow definition/management and cloud configurations are two key challenges in this research. Using a simple unified control panel, users have the ability to set the numbers of nodes and select from a variety of pre-configured AWS EC2 nodes with different numbers of processors and memory storage. Intuitively, we configured Amazon S3 storage to be mounted by pay-for- use Amazon EC2 instances. Hence, S3 storage is recognized as a shared cloud resource. The Amazon EC2 instances provide pre-installs of all necessary packages to run JIST. This work presents an implementation that facilitates the integration of JIST with AWS. We describe the theoretical cost/benefit formulae to decide between local serial execution versus cloud computing and apply this analysis to an empirical diffusion tensor imaging pipeline.

Performance Management of High Performance Computing for Medical Image Processing in Amazon Web Services

PubMed Central

Bao, Shunxing; Damon, Stephen M.; Landman, Bennett A.; Gokhale, Aniruddha

2016-01-01

Adopting high performance cloud computing for medical image processing is a popular trend given the pressing needs of large studies. Amazon Web Services (AWS) provide reliable, on-demand, and inexpensive cloud computing services. Our research objective is to implement an affordable, scalable and easy-to-use AWS framework for the Java Image Science Toolkit (JIST). JIST is a plugin for Medical-Image Processing, Analysis, and Visualization (MIPAV) that provides a graphical pipeline implementation allowing users to quickly test and develop pipelines. JIST is DRMAA-compliant allowing it to run on portable batch system grids. However, as new processing methods are implemented and developed, memory may often be a bottleneck for not only lab computers, but also possibly some local grids. Integrating JIST with the AWS cloud alleviates these possible restrictions and does not require users to have deep knowledge of programming in Java. Workflow definition/management and cloud configurations are two key challenges in this research. Using a simple unified control panel, users have the ability to set the numbers of nodes and select from a variety of pre-configured AWS EC2 nodes with different numbers of processors and memory storage. Intuitively, we configured Amazon S3 storage to be mounted by pay-for-use Amazon EC2 instances. Hence, S3 storage is recognized as a shared cloud resource. The Amazon EC2 instances provide pre-installs of all necessary packages to run JIST. This work presents an implementation that facilitates the integration of JIST with AWS. We describe the theoretical cost/benefit formulae to decide between local serial execution versus cloud computing and apply this analysis to an empirical diffusion tensor imaging pipeline. PMID:27127335

Measuring Success in Health Care Value-Based Purchasing Programs

PubMed Central

Damberg, Cheryl L.; Sorbero, Melony E.; Lovejoy, Susan L.; Martsolf, Grant R.; Raaen, Laura; Mandel, Daniel

2014-01-01

Abstract Value-based purchasing (VBP) refers to a broad set of performance-based payment strategies that link financial incentives to health care providers' performance on a set of defined measures in an effort to achieve better value. The U.S. Department of Health and Human Services is advancing the implementation of VBP across an array of health care settings in the Medicare program in response to requirements in the 2010 Patient Protection and Affordable Care Act, and policymakers are grappling with many decisions about how best to design and implement VBP programs so that they are successful in achieving stated goals. This article summarizes the current state of knowledge about VBP based on a review of the published literature, a review of publicly available documentation from VBP programs, and discussions with an expert panel composed of VBP program sponsors, health care providers and health systems, and academic researchers with VBP evaluation expertise. Three types of VBP models were the focus of the review: (1) pay-for-performance programs, (2) accountable care organizations, and (3) bundled payment programs. The authors report on VBP program goals and what constitutes success; the evidence on the impact of these programs; factors that characterize high– and low–performing providers in VBP programs; the measures, incentive structures, and benchmarks used by VBP programs; evidence on spillover effects and unintended consequences; and gaps in the knowledge base. PMID:28083347

5 CFR 9901.342 - Performance payouts.

Code of Federal Regulations, 2010 CFR

2010-01-01

... 9901.342 Administrative Personnel DEPARTMENT OF DEFENSE HUMAN RESOURCES MANAGEMENT AND LABOR RELATIONS SYSTEMS (DEPARTMENT OF DEFENSE-OFFICE OF PERSONNEL MANAGEMENT) DEPARTMENT OF DEFENSE NATIONAL SECURITY... appropriate, management may establish one or more subsets of a pay pool population (i.e., sub pay pools) for...

Tailoring an educational program on the AHRQ Patient Safety Indicators to meet stakeholder needs: lessons learned in the VA.

PubMed

Shin, Marlena H; Rivard, Peter E; Shwartz, Michael; Borzecki, Ann; Yaksic, Enzo; Stolzmann, Kelly; Zubkoff, Lisa; Rosen, Amy K

2018-02-14

Given that patient safety measures are increasingly used for public reporting and pay-for performance, it is important for stakeholders to understand how to use these measures for improvement. The Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSIs) are one particularly visible set of measures that are now used primarily for public reporting and pay-for-performance among both private sector and Veterans Health Administration (VA) hospitals. This trend generates a strong need for stakeholders to understand how to interpret and use the PSIs for quality improvement (QI). The goal of this study was to develop an educational program and tailor it to stakeholders' needs. In this paper, we share what we learned from this program development process. Our study population included key VA stakeholders involved in reviewing performance reports and prioritizing and initiating quality/safety initiatives. A pre-program formative evaluation through telephone interviews and web-based surveys assessed stakeholders' educational needs/interests. Findings from the formative evaluation led to development and implementation of a cyberseminar-based program, which we tailored to stakeholders' needs/interests. A post-program survey evaluated program participants' perceptions about the PSI educational program. Interview data confirmed that the concepts we had developed for the interviews could be used for the survey. Survey results informed us on what program delivery mode and content topics were of high interest. Six cyberseminars were developed-three of which focused on two content areas that were noted of greatest interest: learning how to use PSIs for monitoring trends and understanding how to interpret PSIs. We also used snapshots of VA PSI reports so that participants could directly apply learnings. Although initial interest in the program was high, actual attendance was low. However, post-program survey results indicated that perceptions about the program were positive. Conducting a formative evaluation was a highly important process in program development. The useful information that we collected through the interviews and surveys allowed us to tailor the program to stakeholders' needs and interests. Our experiences, particularly with the formative evaluation process, yielded valuable lessons that can guide others when developing and implementing similar educational programs.

Paying physician group practices for quality: A statewide quasi-experiment.

PubMed

Conrad, Douglas A; Grembowski, David; Perry, Lisa; Maynard, Charles; Rodriguez, Hector; Martin, Diane

2013-12-01

This article presents the results of a unique quasi-experiment of the effects of a large-scale pay-for-performance (P4P) program implemented by a leading health insurer in Washington state during 2001-2007. The authors received external funding to provide an objective impact evaluation of the program. The program was unique in several respects: (1) It was designed dynamically, with two discrete intervention periods-one in which payment incentives were based on relative performance (the "contest" period) and a second in which payment incentives were based on absolute performance compared to achievable benchmarks. (2) The program was designed in collaboration with large multispecialty group practices, with an explicit run-in period to test the quality metrics. Public reporting of the quality scorecard for all participating medical groups was introduced 1 year before the quality incentive payment program's inception, and continued throughout 2002-2007. (3) The program was implemented in stages with distinct medical groups. A control group of comparable group practices also was assembled, and difference-in-differences methodology was applied to estimate program effects. Case mix measures were included in all multivariate analyses. The regression design permitted a contrast of intervention effects between the "contest" approach in the sub-period of 2003-2004 and the absolute standard, "achievable benchmarks of care" approach in sub-period 2005-2007. Most of the statistically significant quality incentive program coefficients were small and negative (opposite to program intent). A consistent pattern of differential intervention impact in the sub-periods did not emerge. Cumulatively, the probit regression estimates indicate that neither the quality scorecard nor the quality incentive payment program had a significant positive effect on general clinical quality. Based on key informant interviews with medical leaders, practicing physicians, and administrators of the participating groups, the authors conclude that several factors likely combined to dampen program effects: (1) modest size of the incentive; (2) use of rewards only, rather than a balance of rewards and penalties; (3) targeting incentive payments to the group, thus potentially weakening incentive effects at the individual level. Copyright © 2013 Elsevier Inc. All rights reserved.

Work-related violence and inconsistent condom use with non-paying partners among female sex workers in Adama City, Ethiopia.

PubMed

Mooney, Alyssa; Kidanu, Aklilu; Bradley, Heather M; Kumoji, Evelyn Kuor; Kennedy, Caitlin E; Kerrigan, Deanna

2013-08-23

Although reported condom use between female sex workers and their clients is high in Ethiopia, condom use with regular, non-paying partners remains low, posing a substantial risk of HIV infection to sex workers, their partners and the general population. Previous studies have identified the synergistic effects of substance abuse, violence and HIV risk, but few have examined these inter-relationships among female sex workers and their regular, non-paying partners. This study explored the associations between work-related violence, alcohol abuse and inconsistent condom use among establishment-based female sex workers and their regular, non-paying partners in Adama City, Ethiopia. A cross-sectional survey was conducted with 350 establishment-based female sex workers, aged 15-35, at 63 bars, hotels and nightclubs. Multivariate logistic regression analysis was conducted to test the association between work-related violence and condom use with regular, non-paying partners, controlling for age, overall income, education and sex workers' total number of sexual partners in the past week. Alcohol abuse was explored as an effect modifier. Respondents reported a high prevalence of work-related violence (59%) and alcohol abuse (51%). Work-related violence was statistically significantly associated with unprotected sex with regular, non-paying partners among those who abused alcohol (OR: 6.34, 95% CI: 2.43-16.56) and among those who did not (OR: 2.98, 95% CI: 1.36-6.54). Alcohol abuse was not associated with inconsistent condom use within these partnerships, though it may strengthen the effect of work-related violence on unprotected sex. Findings suggest violence against establishment-based female sex workers is associated with HIV risk within regular, non-paying partnerships. Qualitative work is needed to better understand the links between a violent work environment and condom use with regular, non-paying partners and how interventions can be implemented in this context to prevent violence against sex workers and reduce HIV transmission.

Awareness and attitude of the public toward personalized medicine in Korea

PubMed Central

Lee, Iyn-Hyang; Kang, Hye-Young; Suh, Hae Sun; Lee, Sukhyang; Oh, Eun Sil

2018-01-01

Objectives As personalized medicine (PM) is expected to greatly improve health outcomes, efforts have recently been made for its clinical implementation in Korea. We aimed to evaluate public awareness and attitude regarding PM. Methods We performed a self-administered questionnaire survey to 703 adults, who participated in the survey on a voluntary basis. The primary outcome measures included public knowledge, attitude, and acceptance of PM. We conducted multinomial multivariate logistic analysis for outcome variables with three response categories and performed multivariate logistic regression analyses for dichotomous outcome variables. Results Only 28% of participants had knowledge that genetic factors can contribute to inter-individual variations in drug response and the definition of PM (199 out of 702). Higher family income was correlated with greater knowledge concerning PM (OR = 3.76, p = 0.034). A majority of respondents preferred integrated pharmacogenomic testing over drug-specific testing and agreed to inclusion of pharmacogenomic testing in the national health examination (64% and 77%, respectively), but only 51% were willing to pay for it. Discussion Our results identify the urgent need for public education as well as the potential health disparities in access to PM. This study helps to frame policies for implementing PM in clinical practice. PMID:29451916

Performance-based financial incentives for diabetes care: an effective strategy?

PubMed

Latham, Lesley P; Marshall, Emily Gard

2015-02-01

The use of financial incentives provided to primary care physicians who achieve target management or clinical outcomes has been advocated to support the fulfillment of care recommendations for patients with diabetes. This article explores the characteristics of incentive models implemented in the context of universal healthcare systems in the United Kingdom, Australia, Taiwan and Canada; the extent to which these interventions have been successful in improving diabetes outcomes; and the key challenges and concerns around implementing incentive models. Research in the effect of incentives in the United Kingdom demonstrates some improvements in process outcomes and achievement of cholesterol, blood pressure and glycated hemoglobin (A1C) targets. Evidence of the efficacy of programs implemented outside of the United Kingdom is very limited but suggests that physicians participating in these enhanced billing incentive programs were already completing the guideline-recommended care prior to the introduction of the incentive. A shift to pay-for-performance programs may have important implications for professionalism and patient-centred care. In the absence of definitive evidence that financial incentives drive the quality of diabetes management at the level of primary care, policy makers should proceed with caution. It is important to look beyond simply modifying physicians' behaviours and address the factors and systemic barriers that make it challenging for patients and physicians to manage diabetes in partnership. Copyright © 2015 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

Semiannual Report to Congress on the Effectiveness of the Civil Aviation Security Program.

DTIC Science & Technology

1987-12-31

This report also provides data on the initiatives being implemented as a result of the review of domestic airport security by the Secretary’s Safety...enforcement support for airline and airport security measures. Finally, the passengers-the ultimate beneficiaries of the security program--pay for...of these airports is required to implement a security program which provides a secure operating environment for these air carriers. Airport security programs

78 FR 45256 - Intent To Request Approval From OMB of One New Public Collection of Information: TSA Pre✓TM

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-26

...-begins . TSA seeks to establish enrollment sites and implement a mobile enrollment capability. Those... by submitting biographic information and paying the fee using a secure web portal (or by money order...

32 CFR 279.6 - Reporting.

Code of Federal Regulations, 2010 CFR

2010-07-01

... Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS RETROACTIVE STOP LOSS SPECIAL PAY COMPENSATION § 279.6 Reporting. The Department of Defense shall provide a consolidated report to the congressional defense committees on the implementation of section 310 of Public Law...

32 CFR 279.6 - Reporting.

Code of Federal Regulations, 2014 CFR

2014-07-01

... Department of Defense (Continued) OFFICE OF THE SECRETARY OF DEFENSE (CONTINUED) MISCELLANEOUS RETROACTIVE STOP LOSS SPECIAL PAY COMPENSATION § 279.6 Reporting. The Department of Defense shall provide a consolidated report to the congressional defense committees on the implementation of section 310 of Public Law...

Flexible Pay Programs for the 1990s and Beyond.

ERIC Educational Resources Information Center

Clark, Maureen; Luthman, Elmer

1988-01-01

Collaboration of faculty and staff with administration to design flexible total compensation programs that can be "customized" to their particular needs is discussed. The implementation of the Ford Motor Company's Employee Involvement Program when designing the Taurus automobile is described. (MLW)

Interventions to reduce racial and ethnic disparities in health care.

PubMed

Chin, Marshall H; Walters, Amy E; Cook, Scott C; Huang, Elbert S

2007-10-01

In 2005, the Robert Wood Johnson Foundation created Finding Answers: Disparities Research for Change, a program to identify, evaluate, and disseminate interventions to reduce racial and ethnic disparities in the care and outcomes of patients with cardiovascular disease, depression, and diabetes. In this introductory paper, we present a conceptual model for interventions that aim to reduce disparities. With this model as a framework, we summarize the key findings from the six other papers in this supplement on cardiovascular disease, diabetes, depression, breast cancer, interventions using cultural leverage, and pay-for-performance and public reporting of performance measures. Based on these findings, we present global conclusions regarding the current state of health disparities interventions and make recommendations for future interventions to reduce disparities. Multifactorial, culturally tailored interventions that target different causes of disparities hold the most promise, but much more research is needed to investigate potential solutions and their implementation.

Payment Reform

PubMed Central

Schneider, Eric C.; Hussey, Peter S.; Schnyer, Christopher

2011-01-01

Abstract Insurers and purchasers of health care in the United States are on the verge of potentially revolutionary changes in the approaches they use to pay for health care. Recently, purchasers and insurers have been experimenting with payment approaches that include incentives to improve quality and reduce the use of unnecessary and costly services. The Patient Protection and Affordable Care Act of 2010 is likely to accelerate payment reform based on performance measurement. This article provides details of the results of a technical report that catalogues nearly 100 implemented and proposed payment reform programs, classifies each of these programs into one of 11 payment reform models, and identifies the performance measurement needs associated with each model. A synthesis of the results suggests near-term priorities for performance measure development and identifies pertinent challenges related to the use of performance measures as a basis for payment reform. The report is also intended to create a shared framework for analysis of future performance measurement opportunities. This report is intended for the many stakeholders tasked with outlining a national quality strategy in the wake of health care reform legislation. PMID:28083159

Salary discrepancies between practicing male and female physician assistants.

PubMed

Coplan, Bettie; Essary, Alison C; Virden, Thomas B; Cawley, James; Stoehr, James D

2012-01-01

Salary discrepancies between male and female physicians are well documented; however, gender-based salary differences among clinically practicing physician assistants (PAs) have not been studied since 1992 (Willis, 1992). Therefore, the objectives of the current study are to evaluate the presence of salary discrepancies between clinically practicing male and female PAs and to analyze the effect of gender on income and practice characteristics. Using data from the 2009 American Academy of Physician Assistants' (AAPA) Annual Census Survey, we evaluated the salaries of PAs across multiple specialties. Differences between men and women were compared for practice characteristics (specialty, experience, etc) and salary (total pay, base pay, on-call pay, etc) in orthopedic surgery, emergency medicine, and family practice. Men reported working more years as a PA in their current specialty, working more hours per month on-call, providing more direct care to patients, and more funding available from their employers for professional development (p < .001, all comparisons). In addition, men reported a higher total income, base pay, overtime pay, administrative pay, on-call pay, and incentive pay based on productivity and performance (p < .001, all comparisons). Multivariate analysis of covariance and analysis of variance revealed that men reported higher total income (p < .0001) and base pay (p = .001) in orthopedic surgery, higher total income (p = .011) and base pay (p = .005) in emergency medicine, and higher base pay in family practice (p < .001), independent of clinical experience or workload. These results suggest that certain salary discrepancies remain between employed male and female PAs regardless of specialty, experience, or other practice characteristics. Copyright © 2012. Published by Elsevier Inc.

The impact of health reform on the Medicare Advantage program: realigning payment with performance.

PubMed

Biles, Brian; Casillas, Giselle; Arnold, Grace; Guterman, Stuart

2012-10-01

The Affordable Care Act enacts a new payment system for private health plans available to Medicare beneficiaries through the Medicare Advantage (MA) program. The system, which is being phased in through 2017, aims to (1) reduce the excess pay­ments received by private plans relative to per capita spending in traditional Medicare, and (2) reward plans that earn high performance ratings. Using 2009 data, this issue brief pres­ents analysis of the distributional impact on MA plan payments of these new policies as if they had been fully implemented in that year. We find that, when the polices [sic] are in place, they will bring overall MA plan payments nationwide down from 114 percent to 102 per­cent of what spending would have been for the same enrollees if they had been enrolled in traditional Medicare. While payments will vary across the nation, high-performing MA plans stand to benefit from this new arrangement.

Expanding Energy Performance Contracting in china: policy solutions and market mechanisms

DOE Office of Scientific and Technical Information (OSTI.GOV)

Shen, Bo; Price, Lynn; Liu, Xu

Energy performance contracting is an important market mechanism that uses energy savings to pay over time for the upfront costs of energy efficiency retrofits in buildings, industries, and other types of facilities. Through energy performance contracts (EPCs), Energy Service Companies (ESCOs) play an important role in implementing energy efficiency retrofits. Both China and the United States have large markets for EPCs and significant opportunities for growth. The Chinese government has made great efforts in promoting the country’s ESCO business and expanding its EPC markets. This paper makes a series of recommendations for China to adopt more ambitious policy measures tomore » encourage deep energy savings projects via EPCs. These recommendations are built on initial insights from a white paper developed by researchers at the Pacific Northwest National Laboratory and the Lawrence Berkeley National Laboratory with the assistance from the ESCO Committee of China’s Energy Conservation Association (EMCA). Key recommendations are listed below.« less

Do Clinical Standards for Diabetes Care Address Excess Risk for Hypoglycemia in Vulnerable Patients? A Systematic Review

PubMed Central

Berkowitz, Seth A; Aragon, Katherine; Hines, Jonas; Seligman, Hilary; Lee, Sei; Sarkar, Urmimala

2013-01-01

Objective To determine whether diabetes clinical standards consider increased hypoglycemia risk in vulnerable patients. Data Sources MEDLINE, the National Guidelines Clearinghouse, the National Quality Measures Clearinghouse, and supplemental sources. Study Design Systematic review of clinical standards (guidelines, quality metrics, or pay-for-performance programs) for glycemic control in adult diabetes patients. The primary outcome was discussion of increased risk for hypoglycemia in vulnerable populations. Data Collection/Extraction Methods Manuscripts identified were abstracted by two independent reviewers using prespecified inclusion/exclusion criteria and a standardized abstraction form. Principal Findings We screened 1,166 titles, and reviewed 220 manuscripts in full text. Forty-four guidelines, 17 quality metrics, and 8 pay-for-performance programs were included. Five (11 percent) guidelines and no quality metrics or pay-for-performance programs met the primary outcome. Conclusions Clinical standards do not substantively incorporate evidence about increased risk for hypoglycemia in vulnerable populations. PMID:23445498

Do clinical standards for diabetes care address excess risk for hypoglycemia in vulnerable patients? A systematic review.

PubMed

Berkowitz, Seth A; Aragon, Katherine; Hines, Jonas; Seligman, Hilary; Lee, Sei; Sarkar, Urmimala

2013-08-01

To determine whether diabetes clinical standards consider increased hypoglycemia risk in vulnerable patients. MEDLINE, the National Guidelines Clearinghouse, the National Quality Measures Clearinghouse, and supplemental sources. Systematic review of clinical standards (guidelines, quality metrics, or pay-for-performance programs) for glycemic control in adult diabetes patients. The primary outcome was discussion of increased risk for hypoglycemia in vulnerable populations. Manuscripts identified were abstracted by two independent reviewers using prespecified inclusion/exclusion criteria and a standardized abstraction form. We screened 1,166 titles, and reviewed 220 manuscripts in full text. Forty-four guidelines, 17 quality metrics, and 8 pay-for-performance programs were included. Five (11 percent) guidelines and no quality metrics or pay-for-performance programs met the primary outcome. Clinical standards do not substantively incorporate evidence about increased risk for hypoglycemia in vulnerable populations. © Health Research and Educational Trust.

Examining selected patient outcomes and staff satisfaction in a primary care clinic at a military treatment facility after implementation of the patient-centered medical home.

PubMed

Savage, Assanatu I; Lauby, Todd; Burkard, Joseph F

2013-02-01

The patient-centered medical home (PCMH) model is a holistic multidisciplinary approach to providing care in the primary care setting. Provider-led teams engage the patient and family in their own health care plan. It is linked to improve continuity of care and enhance access. This article describes comparison outcomes in access to care, emergency department (ED) utilization, and population health management 2 fiscal years before and after implementation of the PCMH. Staff satisfaction was measured after implementation. A mixed study design approach was elected. De-identified aggregate data were mined from the Command's Business Report portal, from the pay-for-performance-based "Get to Goal" report, and through an anonymous voluntary questionnaire survey providing both qualitative and quantitative data interpretation. Access to care increased by 7%, ED utilization decreased by 75.3%, and population health/healthcare effectiveness data and information set (HEDIS) measures improved overall. Seventy-five percent of the staff who volunteered to be surveyed was satisfied with the PCMH. After 2 years of implementation, the PCMH was associated with improvement in access to care, reduction of ED visits, improvement in population health/HEDIS measures, and a high degree of staff satisfaction.

Pay attention! The critical importance of assessing attention in older adults with dementia.

PubMed

Kolanowski, Ann M; Fick, Donna M; Yevchak, Andrea M; Hill, Nikki L; Mulhall, Paula M; McDowell, Jane A

2012-11-01

Attention is an important cognitive domain that is affected in Alzheimer's disease and other dementias. It influences performance in most other cognitive domains, as well as activities of daily living. Nurses are often unaware of the critical importance of assessing attention as part of the overall mental status examination. This article addresses an important gap in nurses' knowledge. The authors present a brief overview of attention as a critical cognitive domain in dementia; review instruments/methods for standardizing and enhancing the assessment of attention; and offer ways to help ensure that best practices in the assessment, recognition, and documentation of inattention are implemented in the clinical area. Clinical resources that practicing nurses may find helpful are included. Copyright 2012, SLACK Incorporated.

Fitting Community Based Newborn Care Package into the health systems of Nepal.

PubMed

Pradhan, Y V; Upreti, S R; Kc, N P; Thapa, K; Shrestha, P R; Shedain, P R; Dhakwa, J R; Aryal, D R; Aryal, S; Paudel, D C; Paudel, D; Khanal, S; Bhandari, A; Kc, A

2011-10-01

Community-based strategies for delivering effective newborn interventions are an essential step to avert newborn death, in settings where the health facilities are unable to effectively deliver the interventions and reach their population. Effective implementation of community-based interventions as a large scale program and within the existing health system depends on the appropriate design and planning, monitoring and support systems. This article provides an overview of implementation design of Community-Based Newborn Care Package (CB-NCP) program, its setup within the health system, and early results of the implementation from one of the pilot districts. The evaluation of CB-NCP in one of the pilot districts shows significant improvement in antenatal, intrapartum and post natal care. The implementation design of the CB-NCP has six different health system management functions: i) district planning and orientation, ii) training/human resource development, iii) monitoring and evaluation, iv) logistics and supply chain management, v) communication strategy, and vi) pay for performance. The CB-NCP program embraced the existing system of monitoring with some additional components for the pilot phase to test implementation feasibility, and aligns with existing safe motherhood and child health programs. Though CB-NCP interventions are proven independently in different local and global contexts, they are piloted in 10 districts as a "package" within the national health system settings of Nepal.

The Influence of Pay-To-Play Fees on Participation in Interscholastic Sports: A School-Level Analysis of Michigan's Public Schools.

PubMed

Zdroik, Jennifer; Veliz, Philip

2016-12-01

School districts in the United States are turning toward new sources of revenue to maintain their interscholastic sports programs. One common revenue generating policy is the implementation of participation fees, also known as pay-to-play. One concern of the growing trend of participation fees is how it impacts student participation opportunities. This study looks at how pay-to-play fees are impacting participation opportunities and participation rates in the state of Michigan. Through merging 3 school-level data sets, Civil Rights Data Collection, the Common Core of Data, and participation information from MHSAA (Michigan High School Athletic Association), bivariate analysis and ordinary least squares regression were used in our analysis. Our findings indicate that certain types of schools are able to support pay-to-play fees: relatively large schools that are located in suburban, white communities, with relatively low poverty rates. We also found that participation fees are not decreasing the number of sport opportunities for students, participation opportunities are higher in schools with fees; but participation rates are similar between schools with and without participation fees. Participation fee policy implications are discussed and we offer suggestions for future research.

5 CFR 531.403 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER THE GENERAL SCHEDULE... performance by an employee that warrants advancement of the employee's rate of basic pay to the next higher.... Calendar week means a period of any seven consecutive calendar days. Critical element has the meaning given...

Merit Pay Misfires

ERIC Educational Resources Information Center

Ramirez, Al

2011-01-01

Critics argue that the uniform salary schedule is unfair because it promotes mediocrity by rewarding poor performers while failing to recognize outstanding achievement on the job. Advocates for merit pay systems for preK-12 education also contend that the uniform salary schedule ignores the basic purpose of education--student learning. Although…

Using Credit Cards To Pay Bus Fares in Phoenix

DOT National Transportation Integrated Search

1996-01-01

In 1991 the City of Phoenix Public Transit System, first in the nation to install magnetic card readers on the electronic fareboxes in its buses, implemented a program known as Bus Card Plus, which billed employers for trips made by employees using e...

Drugs and Gender: A Women's Recovery Program.

ERIC Educational Resources Information Center

Levers, Lisa Lopez; Hawes, Anderson R.

1990-01-01

Describes a drug treatment program designed and implemented for women which takes into account gender differences. Claims by paying attention to the actual life worlds and needs of women, the program effectively modified the service delivery system to accommodate these women and facilitate their treatment. (ABL)

Effect of modest pay-for-performance financial incentive on time-to-discharge summary dictation among medical residents.

PubMed

Wolk, Adam; Wang, Erwin; Horak, Bernard; Cloonan, Patricia; Adams, Michael; Moore, Eileen; Jaipaul, Chitra Komal; Brown, Gabrielle; Dasgupta, Dabanjan; Deluca, Danielle; Grossman, Mila

2013-01-01

Evaluate the effect of a modest financial incentive on time-to-discharge summary dictation among medicine residents. Pay-for-performance incentives are used in a number of health care settings. Studies are lacking on their use with medical residents and other trainees. Timely completion of discharge summaries is necessary for effective follow-up after hospitalization, and residents perform the majority of discharge summary dictations in academic medical centers. Medicine residents with the lowest average discharge-to-dictation time during their 1-month inpatient medicine ward rotation were rewarded with a $50 gift card. Discharge data were captured using an autopopulating electronic database. The average discharge-to-dictation time was reduced from 7.44 to 1.84 days, representing a 75.3% decrease. Almost 90% of discharge summary dictations were performed on the day of discharge. A modest financial incentive resulted in a marked improvement in the time-to-discharge summary dictation by medicine residents. Pay-for-performance programs may be an effective strategy for improving the quality and efficiency of patient care in academic medical centers.

Exclusion of patients from pay-for-performance targets by English physicians.

PubMed

Doran, Tim; Fullwood, Catherine; Reeves, David; Gravelle, Hugh; Roland, Martin

2008-07-17

In the English pay-for-performance program, physicians use a range of criteria to exclude individual patients from the quality calculations that determine their pay. This process, which is called exception reporting, is intended to safeguard patients against inappropriate treatment by physicians seeking to maximize their income. However, exception reporting may allow physicians to inappropriately exclude patients for whom targets have been missed (a practice known as gaming). We analyzed data extracted automatically from clinical computing systems for 8105 family practices in England (96% of all practices), data from the U.K. Census, and data on practice characteristics from the U.K. Department of Health. We determined the rate of exception reporting for 65 clinical activities and the association between this rate and the characteristics of patients and medical practices. From April 2005 through March 2006, physicians excluded a median of 5.3% of patients (interquartile range, 4.0 to 6.9) from the quality calculations. Physicians were most likely to exclude patients from indicators that were related to providing treatments and achieving target levels of intermediate outcomes; they were least likely to exclude patients from indicators that were related to routine checks and measurements and to offers of treatment. The characteristics of patients and practices explained only 2.7% of the variance in exception reporting. We estimate that exception reporting accounted for approximately 1.5% of the cost of the pay-for-performance program. Exception reporting brings substantial benefits to pay-for-performance programs, providing that the process is used appropriately. In England, rates of exception reporting have generally been low, with little evidence of widespread gaming. 2008 Massachusetts Medical Society

Association of patient case-mix adjustment, hospital process performance rankings, and eligibility for financial incentives.

PubMed

Mehta, Rajendra H; Liang, Li; Karve, Amrita M; Hernandez, Adrian F; Rumsfeld, John S; Fonarow, Gregg C; Peterson, Eric D

2008-10-22

While most comparisons of hospital outcomes adjust for patient characteristics, process performance comparisons typically do not. To evaluate the degree to which hospital process performance ratings and eligibility for financial incentives are altered after accounting for hospitals' patient demographics, clinical characteristics, and mix of treatment opportunities. Using data from the American Heart Association's Get With the Guidelines program between January 2, 2000, and March 28, 2008, we analyzed hospital process performance based on the Centers for Medicare & Medicaid Services' defined core measures for acute myocardial infarction. Hospitals were initially ranked based on crude composite process performance and then ranked again after accounting for hospitals' patient demographics, clinical characteristics, and eligibility for measures using a hierarchical model. We then compared differences in hospital performance rankings and pay-for-performance financial incentive categories (top 20%, middle 60%, and bottom 20% institutions). Hospital process performance ranking and pay-for-performance financial incentive categories. A total of 148,472 acute myocardial infarction patients met the study criteria from 449 centers. Hospitals for which crude composite acute myocardial infarction performance was in the bottom quintile (n = 89) were smaller nonacademic institutions that treated a higher percentage of patients from racial or ethnic minority groups and also patients with greater comorbidities than hospitals ranked in the top quintile (n = 90). Although there was overall agreement on hospital rankings based on observed vs adjusted composite scores (weighted kappa, 0.74), individual hospital ranking changed with adjustment (median, 22 ranks; range, 0-214; interquartile range, 9-40). Additionally, 16.5% of institutions (n = 74) changed pay-for-performance financial status categories after accounting for patient and treatment opportunity mix. Our findings suggest that accounting for hospital differences in patient characteristics and treatment opportunities is associated with modest changes in hospital performance rankings and eligibility for financial benefits in pay-for-performance programs for treatment of myocardial infarction.

Using career ladders to motivate and retain employees: an implementation success story.

PubMed

Garletts, Joseph A

2002-01-01

In October 2000, Phoenix-based Sonora Quest Laboratories, LLC (SQL), commissioned The Gelfond Group to survey SQL employees. Responding to negative survey scores, SQL developed and implemented an entry-level career ladder for line staff of the specimen management/referral testing department. The program was piloted in February 2001, and was implemented fully shortly thereafter. The ladder was designed to provide job enrichment opportunities through company-conducted training and advancement provisions. It contained requirements for productivity and quality of work performed in addition to increasingly rigorous training and competency documentation. Employees were accountable for their own advancement and for ensuring that all documentation was complete. Advancement was automatic once requirements were completed. Pay increases accompanied each advancement on a predetermined scale. At the end of 12 months, employee turnover dropped from 39% to less than 20% annually. Both productivity and morale improved, and results on a second employee survey indicated dramatic improvement in five key areas. The career ladder concept has been replicated successfully in several other departments, including phlebotomy, and a six-tiered ladder is under development for the clinical laboratory. It will encompass CLA, MLT, and MT positions from entry level to technical coordinator.

Tightening up the performance-pay linkage: roles of contingent reward leadership and profit-sharing in the cross-level influence of individual pay-for-performance.

PubMed

Han, Joo Hun; Bartol, Kathryn M; Kim, Seongsu

2015-03-01

Drawing upon line-of-sight (Lawler, 1990, 2000; Murphy, 1999) as a unifying concept, we examine the cross-level influence of organizational use of individual pay-for-performance (PFP), theorizing that its impact on individual employees' performance-reward expectancy is boosted by the moderating effects of immediate group managers' contingent reward leadership and organizational use of profit-sharing. Performance-reward expectancy is then expected to mediate the interactive effects of individual PFP with contingent reward leadership and profit-sharing on employee job performance. Analyses of cross-organizational and cross-level data from 912 employees in 194 workgroups from 45 companies reveal that organizations' individual PFP was positively related to employees' performance-reward expectancy, which was strengthened when it was accompanied by higher levels of contingent reward leadership and profit-sharing. Also, performance-reward expectancy significantly transmitted the effects of individual PFP onto job performance under higher levels of contingent reward leadership and profit-sharing, thus delineating cross-level mediating and moderating processes by which organizations' individual PFP is linked to important individual-level employee outcomes. Several theoretical and practical implications are discussed. PsycINFO Database Record (c) 2015 APA, all rights reserved.

5 CFR 534.403 - SES rate range.

Code of Federal Regulations, 2010 CFR

2010-01-01

... Administrative Personnel OFFICE OF PERSONNEL MANAGEMENT CIVIL SERVICE REGULATIONS PAY UNDER OTHER SYSTEMS Pay and... meaningful distinctions based on relative performance, as certified by the Office of Personnel Management (OPM), with concurrence by the Office of Management and Budget (OMB), under 5 U.S.C. 5307(d) and 5 CFR...

The elements of human well-being with an emphasis on the contribution of ecosystem services

EPA Science Inventory

Natural ecosystems perform fundamental life-support services upon which human civilization depends. However, many people believe that Nature provides these services for free and therefore, they are of little or no value. While we do not pay for them, we pay significantly for th...

Merit Pay and Faculty Evaluation.

ERIC Educational Resources Information Center

Hudgins, James L.

A program linking merit pay and faculty evaluation was initiated at Sumter Area Technical College (SATC) in Sumter, South Carolina, in 1978. The performance-based evaluation system focuses on three elements: the job description, which identifies professional responsibilities and how they relate to the college's mission; the individual action plan;…

The Politics of Teacher Pay Reforms. Research Brief

ERIC Educational Resources Information Center

National Center on Performance Incentives, 2008

2008-01-01

In "The Politics of Teacher Pay Reforms"--a paper presented at the National Center on Performance Incentives research to policy conference in February--Dan Goldhaber, a research professor at the Center for Reinventing Public Education at the University of Washington and an affiliated scholar with the Urban Institute's Education Policy…

Hazard pay: An effective antagonist

NASA Technical Reports Server (NTRS)

Alexander, R. E.

1971-01-01

Procedures for allocating hazardous pay to employees are outlined. According to the guidelines, only top level management can authorize hazardous tasks and decide if said task is indeed hazardous. The guidelines also state that hazardous jobs may be performed only if it is essential to finish a project and cannot be adequately safequarded.

Reforming the Portuguese mental health system: an incentive-based approach.

PubMed

Perelman, Julian; Chaves, Pedro; de Almeida, José Miguel Caldas; Matias, Maria Ana

2018-01-01

To promote an effective mental health system, the World Health Organization recommends the involvement of primary care in prevention and treatment of mild diseases and community-based care for serious mental illnesses. Despite a prevalence of lifetime mental health disorders above 30%, Portugal is failing to achieve such recommendations. It was argued that this failure is partly due to inadequate financing mechanisms of mental health care providers. This study proposes an innovative payment model for mental health providers oriented toward incentivising best practices. We performed a comprehensive review of healthcare providers' payment schemes and their related incentives, and a narrative review of best practices in mental health prevention and care. We designed an alternative payment model, on the basis of the literature, and then we presented it individually, through face-to-face interviews, to a panel of 22 experts with different backgrounds and experience, and from southern and northern Portuguese regions, asking them to comment on the model and provide suggestions. Then, after a first round of interviews, we revised our model, which we presented to experts again for their approval, and provide new suggestions and comments, if deemed necessary. This approach is close to what is generally known as the Delphi technique, although it was not applied in a rigid way. We designed a four-dimension model that focused on (i) the prevention of mental disorders early in life; (ii) the detection of mental disorders in childhood and adolescence; (iii) the implementation of a collaborative stepped care model for depression; and (iv) the integrated community-based care for patients with serious mental illnesses. First, we recommend a bundled payment to primary care practices for the follow-up of children with special needs or at risk under 2 years of age. Second, we propose a pay-for-performance scheme for all primary care practices, based on the number of users under 18 years old who are provided with check-up consultations. Third, we propose a pay-for-performance scheme for all primary care practices, based on the implementation of collaborative stepped care for depression. Finally, we propose a value-based risk-adjusted bundled payment for patients with serious mental illness. The implementation of evidence-based best practices in mental health needs to be supported by adequate payment mechanisms. Our study shows that mental health experts, including decision makers, agree with using economic tools to support best practices, which were also consensual.

Implementing electronic identification for performance recording in sheep: II. Cost-benefit analysis in meat and dairy farms.

PubMed

Ait-Saidi, A; Caja, G; Salama, A A K; Milán, M J

2014-12-01

Costs and secondary benefits of implementing electronic identification (e-ID) for performance recording (i.e., lambing, body weight, inventory, and milk yield) in dairy and meat ewes were assessed by using the results from a previous study in which manual (M), semiautomatic (SA), and automatic (AU) data collection systems were compared. Ewes were identified with visual ear tags and electronic rumen boluses. The M system used visual identification, on-paper data recording, and manual data uploading to a computer. The SA system used e-ID with a handheld reader in which performances were typed and automatic uploaded to a computer. The use of a personal digital assistant (PDA) for recording and automatic data uploading, which transformed M in a SA system, was also considered. The AU system was only used for BW recording and consisted of e-ID, automatic data recording in an electronic scale, and uploading to a computer. The cost-benefit study was applied to 2 reference sheep farms of 700 meat ewes, under extensive or intensive production systems, and of 400 dairy ewes, practicing once- or twice-a-day machine milkings. Sensitivity analyses under voluntary and mandatory e-ID scenarios were also included. Benefits of using e-ID for SA or AU performance recording mainly depended on sheep farm purpose, number of test days per year, handheld reader and PDA prices, and flock size. Implementing e-ID for SA and AU performance recording saved approximately 50% of the time required by the M system, and increased the reliability of the data collected. Use of e-ID increased the cost of performance recording in a voluntary e-ID scenario, paying only partially the investment made (15 to 70%). For the mandatory e-ID scenario, in which the cost of e-ID devices was not included, savings paid 100% of the extra costs needed for using e-ID in all farm types and conditions. In both scenarios, the reader price was the most important extra cost (40 to 90%) for implementing e-ID in sheep farms. Calculated extra costs of using the PDA covered more than 100% of the implementation costs in all type of sheep farms, indicating that this device was cost-effective for sheep-performance recording. Copyright © 2014 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Dentists United to Extinguish Tobacco (DUET): a study protocol for a cluster randomized, controlled trial for enhancing implementation of clinical practice guidelines for treating tobacco dependence in dental care settings.

PubMed

Ostroff, Jamie S; Li, Yuelin; Shelley, Donna R

2014-02-21

Although dental care settings provide an exceptional opportunity to reach smokers and provide brief cessation advice and treatment to reduce oral and other tobacco-related health conditions, dental care providers demonstrate limited adherence to evidence-based guidelines for treatment of tobacco use and dependence. Guided by a multi-level, conceptual framework that emphasizes changes in provider beliefs and organizational characteristics as drivers of improvement in tobacco treatment delivery, the current protocol will use a cluster, randomized design and multiple data sources (patient exit interviews, provider surveys, site observations, chart audits, and semi-structured provider interviews) to study the process of implementing clinical practice guidelines for treating tobacco dependence in 18 public dental care clinics in New York City. The specific aims of this comparative-effectiveness research trial are to: compare the effectiveness of three promising strategies for implementation of tobacco use treatment guidelines-staff training and current best practices (CBP), CBP + provider performance feedback (PF), and CBP + PF + provider reimbursement for delivery of tobacco cessation treatment (pay-for-performance, or P4P); examine potential theory-driven mechanisms hypothesized to explain the comparative effectiveness of three strategies for implementation; and identify baseline organizational factors that influence the implementation of evidence-based tobacco use treatment practices in dental clinics. The primary outcome is change in providers' tobacco treatment practices and the secondary outcomes are cost per quit, use of tobacco cessation treatments, quit attempts, and smoking abstinence. We hypothesize that the value of these promising implementation strategies is additive and that incorporating all three strategies (CBP, PF, and P4P) will be superior to CBP alone and CBP + PF in improving delivery of cessation assistance to smokers. The findings will improve knowledge pertinent to the implementation, dissemination, and sustained utilization of evidence-based tobacco use treatment in dental practices. NCT01615237.

42 CFR 408.200 - Statutory basis.

Code of Federal Regulations, 2010 CFR

2010-10-01

... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM... § 408.200 Statutory basis. This subpart implements provisions of section 1839(e) of the Social Security Act that allow State or local government agencies to enter into an agreement with the Secretary to pay...

42 CFR 408.200 - Statutory basis.

Code of Federal Regulations, 2011 CFR

2011-10-01

... Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM... § 408.200 Statutory basis. This subpart implements provisions of section 1839(e) of the Social Security Act that allow State or local government agencies to enter into an agreement with the Secretary to pay...

48 CFR 313.301 - Government-wide commercial purchase card.

Code of Federal Regulations, 2011 CFR

2011-10-01

..., Appendix B, “Improving the Management of Government Charge Card Programs;” GSA's SmartPay Program guidance; and HHS Purchase Card program standards. (2) The OPDIVs, through their designated Agency/Organization... training requirements to ensure effective implementation of the HHS purchase card program. (3) OPDIVs shall...

Adapting customer service to consumer-directed health care.

PubMed

Hammer, David C

2006-09-01

A growing number of hospitals are implementing new tools that provide convenient, more detailed patient access to billing information. These tools are paying off for hospitals through reduced calls to their billing offices, decreased mailing costs, and increased payments, as well as higher rates of customer satisfaction.

Text of 'Executive Summary' of TIAA-CREF Panel's Recommendations on Pension Funds.

ERIC Educational Resources Information Center

Chronicle of Higher Education, 1987

1987-01-01

The executive summary of of TIAA-CREF's Special Trustee Joint Committee's report "TIAA-CREF: The Future Agenda," cites new accumulation funds and pay-out vehicles; transferability of annuity accumulations; reporting, services, and planning for policy holders and institutions; and governance and implementation. (MLW)

A Comparable Worth Cyclone Is Swirling toward Your Schools.

ERIC Educational Resources Information Center

Zakariya, Sally Banks

1985-01-01

Describes the concept of comparable worth, discusses opposing views concerning whether inequities in pay are results of discrimination, considers efforts to determine the comparability of jobs, including teaching, notes the possible impact of implementing comparable worth legislation, and cites developments in state legislation and local school…

75 FR 62326 - Magnuson-Stevens Act Provisions; Fishing Capacity Reduction Framework

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-08

.... 100330171-0388-02] RIN 0648-AY79 Magnuson-Stevens Act Provisions; Fishing Capacity Reduction Framework... implementing fishing capacity reduction programs (reduction programs) in accordance with the Magnuson-Stevens... pays harvesters in a fishery that has more vessels than capacity either to surrender their fishing...

75 FR 82146 - Submission for OMB Review; Comment Request

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-29

... before January 28, 2011 to be assured of consideration. Domestic Finance/Terrorism Risk Insurance Program... Program Reauthorization Act of 2007, and by Treasury implementing regulations to pay Federal share to... Ahmed, Office of Management and Budget, New Executive Office Building, Room 10235, Washington, DC 20503...

Physician-Pharmacist collaboration in a pay for performance healthcare environment.

PubMed

Farley, T M; Izakovic, M

2015-01-01

Healthcare is becoming more complex and costly in both European (Slovak) and American models. Healthcare in the United States (U.S.) is undergoing a particularly dramatic change. Physician and hospital reimbursement are becoming less procedure focused and increasingly outcome focused. Efforts at Mercy Hospital have shown promise in terms of collaborative team based care improving performance on glucose control outcome metrics, linked to reimbursement. Our performance on the Centers for Medicare and Medicaid Services (CMS) post-operative glucose control metric for cardiac surgery patients increased from a 63.6% pass rate to a 95.1% pass rate after implementing interventions involving physician-pharmacist team based care.Having a multidisciplinary team that is able to adapt quickly to changing expectations in the healthcare environment has aided our institution. As healthcare becomes increasingly saturated with technology, data and quality metrics, collaborative efforts resulting in increased quality and physician efficiency are desirable. Multidisciplinary collaboration (including physician-pharmacist collaboration) appears to be a viable route to improved performance in an outcome based healthcare system (Fig. 2, Ref. 12).

Getting Real Performance Out of Pay-for-Performance

PubMed Central

Nicholson, Sean; Pauly, Mark V; Wu, Anita Ya Jung; Murray, James F; Teutsch, Steven M; Berger, Marc L

2008-01-01

Context Most private and public health insurers are implementing pay-for-performance (P4P) programs in an effort to improve the quality of medical care. This article offers a paradigm for evaluating how P4P programs should be structured and how effective they are likely to be. Methods This article assesses the current comprehensiveness of evidence-based medicine by estimating the percentage of outpatient medical spending for eighteen medical processes recommended by the Institute of Medicine. Findings Three conditions must be in place for outcomes-based P4P programs to improve the quality of care: (1) health insurers must not fully understand what medical processes improve health (i.e., the health production function); (2) providers must know more about the health production function than insurers do; and (3) health insurers must be able to measure a patient's risk-adjusted health. Only two of these conditions currently exist. Payers appear to have incomplete knowledge of the health production function, and providers appear to know more about the health production function than payers do, but accurate methods of adjusting the risk of a patient's health status are still being developed. Conclusions This article concludes that in three general situations, P4P will have a different impact on quality and costs and so should be structured differently. When information about patients’ health and the health production function is incomplete, as is currently the case, P4P payments should be kept small, should be based on outcomes rather than processes, and should target physicians’ practices and health systems. As information improves, P4P incentive payments could be increased, and P4P may become more powerful. Ironically, once information becomes complete, P4P can be replaced entirely by “optimal fee-for-service.” PMID:18798885

Assessment of economic instruments for countries with low municipal waste management performance: An approach based on the analytic hierarchy process.

PubMed

Kling, Maximilian; Seyring, Nicole; Tzanova, Polia

2016-09-01

Economic instruments provide significant potential for countries with low municipal waste management performance in decreasing landfill rates and increasing recycling rates for municipal waste. In this research, strengths and weaknesses of landfill tax, pay-as-you-throw charging systems, deposit-refund systems and extended producer responsibility schemes are compared, focusing on conditions in countries with low waste management performance. In order to prioritise instruments for implementation in these countries, the analytic hierarchy process is applied using results of a literature review as input for the comparison. The assessment reveals that pay-as-you-throw is the most preferable instrument when utility-related criteria are regarded (wb = 0.35; analytic hierarchy process distributive mode; absolute comparison) mainly owing to its waste prevention effect, closely followed by landfill tax (wb = 0.32). Deposit-refund systems (wb = 0.17) and extended producer responsibility (wb = 0.16) rank third and fourth, with marginal differences owing to their similar nature. When cost-related criteria are additionally included in the comparison, landfill tax seems to provide the highest utility-cost ratio. Data from literature concerning cost (contrary to utility-related criteria) is currently not sufficiently available for a robust ranking according to the utility-cost ratio. In general, the analytic hierarchy process is seen as a suitable method for assessing economic instruments in waste management. Independent from the chosen analytic hierarchy process mode, results provide valuable indications for policy-makers on the application of economic instruments, as well as on their specific strengths and weaknesses. Nevertheless, the instruments need to be put in the country-specific context along with the results of this analytic hierarchy process application before practical decisions are made. © The Author(s) 2016.

Comparing the cost-effectiveness of simulation modalities: a case study of peripheral intravenous catheterization training.

PubMed

Isaranuwatchai, Wanrudee; Brydges, Ryan; Carnahan, Heather; Backstein, David; Dubrowski, Adam

2014-05-01

While the ultimate goal of simulation training is to enhance learning, cost-effectiveness is a critical factor. Research that compares simulation training in terms of educational- and cost-effectiveness will lead to better-informed curricular decisions. Using previously published data we conducted a cost-effectiveness analysis of three simulation-based programs. Medical students (n = 15 per group) practiced in one of three 2-h intravenous catheterization skills training programs: low-fidelity (virtual reality), high-fidelity (mannequin), or progressive (consisting of virtual reality, task trainer, and mannequin simulator). One week later, all performed a transfer test on a hybrid simulation (standardized patient with a task trainer). We used a net benefit regression model to identify the most cost-effective training program via paired comparisons. We also created a cost-effectiveness acceptability curve to visually represent the probability that one program is more cost-effective when compared to its comparator at various 'willingness-to-pay' values. We conducted separate analyses for implementation and total costs. The results showed that the progressive program had the highest total cost (p < 0.001) whereas the high-fidelity program had the highest implementation cost (p < 0.001). While the most cost-effective program depended on the decision makers' willingness-to-pay value, the progressive training program was generally most educationally- and cost-effective. Our analyses suggest that a progressive program that strategically combines simulation modalities provides a cost-effective solution. More generally, we have introduced how a cost-effectiveness analysis may be applied to simulation training; a method that medical educators may use to investment decisions (e.g., purchasing cost-effective and educationally sound simulators).

The business case for pediatric asthma quality improvement in low-income populations: examining a provider-based pay-for-reporting intervention.

PubMed

Reiter, Kristin L; Lemos, Kristin Andrews; Williams, Charlotte E; Esposito, Dominick; Greene, Sandra B

2015-06-01

To measure the return on investment (ROI) for a pediatric asthma pay-for-reporting intervention initiated by a Medicaid managed care plan in New York State. Practice-level, randomized prospective evaluation. Twenty-five primary care practices providing care to children enrolled in the Monroe Plan for Medical Care (the Monroe Plan). Practices were randomized to either treatment (13 practices, 11 participated) or control (12 practices). For each of its eligible members assigned to a treatment group practice, the Monroe plan paid a low monthly incentive fee to the practice. To receive the incentive, treatment group practices were required to conduct, and report to the Monroe Plan, the results of chart audits on eligible members. Chart audits were conducted by practices every 6 months. After each chart audit, the Monroe Plan provided performance feedback to each practice comparing its adherence to asthma care guidelines with averages from all other treatment group practices. Control practices continued with usual care. Intervention implementation and operating costs and per member, per month claims costs. ROI was measured by net present value (discounted cash flow analysis). The ROI to the Monroe Plan was negative, primarily due to high intervention costs and lack of reductions in spending on emergency department and hospital utilization for children in treatment relative to control practices. A pay-for-reporting, chart audit intervention is unlikely to achieve the meaningful reductions in utilization of high-cost services that would be necessary to produce a financial ROI in 2.5 years. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Maurer, D.

In January 1986, the Becon Construction Company - an open-shop contractor based in Houston, Texas - mobilized a work force to a construction project location at the Belridge Oil Field, near Bakersfield, California. The construction craftsmen and helpers in Becon's work force were expected to improve their level of productivity as the work proceeded because of the knowledge and skills that they would acquire as a result of the repetitive nature of the work. As it was originally organized, the Becon HOTS project represented almost a pure laboratory environment in which to collect data concerning the learning effect on workermore » productivity as well as to statistically isolate the impact on productivity of such external factors as weather, absenteeism, turnover, and especially work methods improvement techniques and pay incentives. From the outset of the HOTS project, the project manager had established an accurate system to quantitatively measure and compare the total manhours that each crew - civil, mechanical, electrical, and prefabrication -- performed at individual HOTS construction locations. Additionally, it was initially assumed that the project manager would be relatively free to implement changes to the job site conditions involving incentive pay and work methods improvement. The subsequent effect of these changes on the productivity of separate work crews could then be evaluated in terms of measured manhours per crew per HOTS.« less

78 FR 25818 - Truth in Lending (Regulation Z)

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-03

...The Bureau of Consumer Financial Protection (Bureau) issues this final rule to amend Regulation Z, which implements the Truth in Lending Act (TILA), and the official interpretations to the regulation. Regulation Z generally prohibits a card issuer from opening a credit card account for a consumer, or increasing the credit limit applicable to a credit card account, unless the card issuer considers the consumer's ability to make the required payments under the terms of such account. Regulation Z currently requires that issuers consider the consumer's independent ability to pay, regardless of the consumer's age; in contrast, TILA expressly requires consideration of an independent ability to pay only for applicants who are under the age of 21. The final rule amends Regulation Z to remove the requirement that issuers consider the consumer's independent ability to pay for applicants who are 21 or older, and permits issuers to consider income and assets to which such consumers have a reasonable expectation of access.

Disseminating and implementing guidelines: article 13 in Integrating and coordinating efforts in COPD guideline development. An official ATS/ERS workshop report.

PubMed

Grimshaw, Jeremy M; Schünemann, Holger J; Burgers, Jako; Cruz, Alvaro A; Heffner, John; Metersky, Mark; Cook, Deborah

2012-12-01

Professional societies, like many other organizations around the world, have recognized the need to use rigorous processes to ensure that health care recommendations are informed by the best available research evidence. This is the thirteenth of a series of 14 articles that were prepared to advise guideline developers in respiratory and other diseases. This article focuses on current concepts and research evidence about how to disseminate and implement guidelines optimally on a national and international level to improve quality of care. In this article we address the following questions: What frameworks can aid guideline dissemination and implementation; what are the effects of different guideline dissemination and implementation strategies; and, what is the role of guideline developers in guideline dissemination and implementation? We identified existing systematic reviews and relevant methodological research. Our conclusions are based on evidence from published literature, experience from guideline developers, and workshop discussions. The Knowledge to Action cycle proposed by Graham and colleagues (J Contin Educ Health Prof 2006;26:13-24) provides a useful framework for planning dissemination and implementation activities that emphasize the need for tailored approaches based on an assessment of local barriers. There are a broad range of interventions that are generally effective at improving the uptake of evidence. The best intervention depends on likely barriers, available resources, and other practical considerations. Financial interventions (such as pay for performance) appear to be as effective as other interventions that aim to change professional behavior. Guideline developers who do not have responsibility for guideline implementation in their jurisdiction should support those with responsibility for implementation by considering the "implementability" of their guidelines.

[Estimation of cost-saving for reducing radioactive waste from nuclear medicine facilities by implementing decay in storage (DIS) in Japan].

PubMed

Kida, Tetsuo; Hiraki, Hitoshi; Yamaguchi, Ichirou; Fujibuchi, Toshioh; Watanabe, Hiroshi

2012-01-01

DIS has not yet been implemented in Japan as of 2011. Therefore, even if risk was negligible, medical institutions have to entrust radioactive temporal waste disposal to Japan Radio Isotopes Association (JRIA) in the current situation. To decide whether DIS should be implemented in Japan or not, cost-saving effect of DIS was estimated by comparing the cost that nuclear medical facilities pay. By implementing DIS, the total annual cost for all nuclear medical facilities in Japan is estimated to be decreased to 30 million yen or less from 710 million yen. DIS would save 680 million yen (96%) per year.

At what cost? Payment for abortion care by U.S. women.

PubMed

Jones, Rachel K; Upadhyay, Ushma D; Weitz, Tracy A

2013-01-01

Most U.S. abortion patients are poor or low-income, yet most pay several hundred dollars out of pocket for these services. This study explores how women procure these funds. iPad-administered surveys were implemented among 639 women obtaining abortions at six geographically diverse healthcare facilities. Women provided information about insurance coverage, payment for service, acquisition of funds, and ancillary costs incurred. Only 36% of the sample lacked health insurance, but at least 69% were paying out of pocket for abortion care. Women were twice as likely to pay using Medicaid (16% of abortions) than private health insurance (7%). The most common reason women were not using private insurance was because it did not cover the procedure (46%), or they were unsure if it was covered (29%). Among women who did not use insurance for their abortion, 52% found it difficult to pay for the procedure. One half of patients relied on someone else to help cover costs, most commonly the man involved in the pregnancy. Most women incurred ancillary expenses in the form of transportation (mean, $44), and a minority also reported lost wages (mean, $198), childcare expenses (mean, $57) and other travel-related costs (mean, $140). Substantial minorities also delayed or did not pay bills such as rent (14%), food (16%), or utilities and other bills (30%) to pay for the abortion. Public and private health insurance plan coverage of abortion care services could ease the financial strain experienced by abortion patients, many of whom are low income. Copyright © 2013 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Latent class analysis of acceptability and willingness to pay for self-HIV testing in a United States urban neighbourhood with high rates of HIV infection.

PubMed

Nunn, Amy; Brinkley-Rubinstein, Lauren; Rose, Jennifer; Mayer, Kenneth; Stopka, Thomas; Towey, Caitlin; Harvey, Julia; Santamaria, Karina; Sabatino, Kelly; Trooskin, Stacey; Chan, Philip A

2017-01-17

Acceptability and willingness to both take and pay for HIV self-tests (HIVSTs) in US neighbourhoods with high rates of HIV infection are not well understood. We surveyed 1,535 individuals about acceptability and willingness to take and pay for an HIVST in a predominately African American neighbourhood with 3% HIV seroprevalence. We recruited individuals presenting for HIV screening services in a community-based programme. Latent class analysis (LCA) grouped individuals with similar patterns of HIV-risk behaviours and determined which groups would be most willing to use and buy HIVSTs. Nearly 90% of respondents were willing to use an HIVST; 55% were willing to buy HIVSTs, but only 23% were willing to pay the market price of US $40. Four distinct groups emerged and were characterized by risk behaviours: (1) low risk ( N  = 324); (2) concurrent partnerships ( N  = 346); (3) incarceration and substance use ( N  = 293); and (4) condomless sex/multiple partners ( N  = 538). Individuals in the low-risk class were less willing to self-test compared to concurrent sexual partners (OR = 0.39, p  = .003) and incarceration and substance use (OR = 0.46, p  = .011) classes. There were no significant differences across classes in the amount individuals were willing to pay for an HIVST. HIVSTs were overwhelmingly acceptable but cost prohibitive; most participants were unwilling to pay the market rate of US $40. Subsidizing and implementing HIVST programmes in communities with high rates of infection present a public health opportunity, particularly among individuals reporting condomless sex with multiple partners, concurrent sexual partnerships and those with incarceration and substance use histories.