Employee incentives in the healthcare industry.

PubMed

McKinnies, Richard C; Collins, Sandra K; Collins, Kevin S

2008-01-01

*Employee incentives are an important part of a radiology department's ability to attract and maintain employees. For incentive programs to be successful, radiology managers must diligently look for the incentives that motivate each particular employee. *The types of incentives being used frequently in the field of healthcare vary between technical, managerial, and executive positions. The process of identifying the right employee incentive for each group of individuals may be challenging, but if the result is a more productive and satisfied group of employees, the process is worth the effort.

The Use and Efficacy of Capacity-Building Assistance for Low-Performing Districts: The Case of California's District Assistance and Intervention Teams

ERIC Educational Resources Information Center

Strunk, Katharine O.; McEachin, Andrew; Westover, Theresa N.

2014-01-01

The theory of action upon which high-stakes accountability policies are based calls for systemic reforms in educational systems that will emerge by pairing incentives for improvement with extensive and targeted technical assistance (TA) to build the capacity of low-performing schools and districts. To this end, a little discussed and often…

Database of Renewable Energy and Energy Efficiency Incentives and Policies Final Technical Report

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

Lips, Brian

The Database of State Incentives for Renewables and Efficiency (DSIRE) is an online resource that provides summaries of all financial incentives and regulatory policies that support the use of renewable energy and energy efficiency across all 50 states. This project involved making enhancements to the database and website, and the ongoing research and maintenance of the policy and incentive summaries.

Turning State Data and Research into Information: An Example from Washington State's Student Achievement Initiative

ERIC Educational Resources Information Center

Prince, David; Seppanen, Loretta; Stephens, Deborah; Stewart, Carmen

2010-01-01

This chapter discusses Washington State's Student Achievement Initiative, a new performance funding system for community and technical colleges. Its purposes are to improve public accountability by more accurately describing what students achieve from enrolling in state colleges each year and provide incentives through financial rewards to…

Incentives and Barriers That Influence Clinical Computerization in Hong Kong: A Population-based Physician Survey

PubMed Central

Leung, Gabriel M.; Yu, Philip L. H.; Wong, Irene O. L.; Johnston, Janice M.; Tin, Keith Y. K.

2003-01-01

Objective: Given the slow adoption of medical informatics in Hong Kong and Asia, we sought to understand the contributory barriers and potential incentives associated with information technology implementation. Design and Measurements: A representative sample of 949 doctors (response rate = 77.0%) was asked through a postal survey to rank a list of nine barriers associated with clinical computerization according to self-perceived importance. They ranked seven incentives or catalysts that may influence computerization. We generated mean rank scores and used multidimensional preference analysis to explore key explanatory dimensions of these variables. A hierarchical cluster analysis was performed to identify homogenous subgroups of respondents. We further determined the relationships between the sets of barriers and incentives/catalysts collectively using canonical correlation. Results: Time costs, lack of technical support and large capital investments were the biggest barriers to computerization, whereas improved office efficiency and better-quality care were ranked highest as potential incentives to computerize. Cost vs. noncost, physician-related vs. patient-related, and monetary vs. nonmonetary factors were the key dimensions explaining the barrier variables. Similarly, within-practice vs external and “push” vs “pull” factors accounted for the incentive variables. Four clusters were identified for barriers and three for incentives/catalysts. Canonical correlation revealed that respondents who were concerned with the costs of computerization also perceived financial incentives and government regulation to be important incentives/catalysts toward computerization. Those who found the potential interference with communication important also believed that the promise of improved care from computerization to be a significant incentive. Conclusion: This study provided evidence regarding common barriers associated with clinical computerization. Our findings also identified possible incentive strategies that may be employed to accelerate uptake of computer systems. PMID:12595409

The Perceived Presence and Effect of Incentives on Community College Faculty Members' Enthusiasm to Teach Online

ERIC Educational Resources Information Center

Beck, Burton Cornelius, Jr.

2012-01-01

The purpose of this study is to determine the perceived effects of incentives on community college faculty member enthusiasm to teach online courses. Ten incentives used with college faculty were identified in the literature: (a) release time, (b) personal satisfaction, (c) teaching development, (d) technical support, (e) professional prestige,…

A study of incentives to support and promote public health accreditation.

PubMed

Thielen, Lee; Leff, Marilyn; Corso, Liza; Monteiro, Erinn; Fisher, Jessica Solomon; Pearsol, Jim

2014-01-01

Accreditation of public health agencies through the Public Health Accreditation Board is voluntary. Incentives that encourage agencies to apply for accreditation have been suggested as important factors in facilitating participation by state and local agencies. The project describes both current and potential incentives that are available at the federal, state, and local levels. Thirty-nine key informants from local, state, tribal, federal, and academic settings were interviewed from March through May 2012. Through open-ended interviews, respondents were asked about incentives that were currently in use in their settings and incentives they thought would help encourage participation in Public Health Accreditation Board accreditation. Incentives currently in use by public health agencies based on interviews include (1) financial support, (2) legal mandates, (3) technical assistance, (4) peer support workgroups, and (5) state agencies serving as role models by seeking accreditation themselves. Key informants noted that state agencies are playing valuable and diverse roles in providing incentives for accreditation within their own states. Key informants also identified the Centers for Disease Control and Prevention and other players, such as private foundations, public health institutes, national and state associations, and academia as providing both technical and financial assistance to support accreditation efforts. State, tribal, local, and federal agencies, as well as related organizations can play an important role by providing incentives to move agencies toward accreditation.

20 CFR 637.230 - Use of incentive bonuses.

Code of Federal Regulations, 2010 CFR

2010-04-01

... in paragraph (d) of this section, technical assistance, data and information collection and compilation, management information systems, post-program followup activities, and research and evaluation... information collection and compilation, recordkeeping, or the preparation of applications for incentive...

20 CFR 666.220 - What information must be included in a State Board's application for an Incentive Grant?

Code of Federal Regulations, 2010 CFR

2010-04-01

... the Carl D. Perkins Vocational and Technical Education Act. (3) The State exceeded the State... vocational and technical programs under the Carl D. Perkins Vocational and Technical Education Act. (WIA sec...

20 CFR 666.220 - What information must be included in a State Board's application for an Incentive Grant?

Code of Federal Regulations, 2011 CFR

2011-04-01

... the Carl D. Perkins Vocational and Technical Education Act. (3) The State exceeded the State... vocational and technical programs under the Carl D. Perkins Vocational and Technical Education Act. (WIA sec...

Improving the cost effectiveness of financial incentives in managing travel demand management (TDM) : [technical summary].

DOT National Transportation Integrated Search

2013-10-01

During the last two decades, financial incentives : have become common in efforts to reduce : demand on roadways by motivating commuters to : use alternative modes of transportation. Despite : common use, limited effort has been made to : understand ...

Feasibility Study of Economics and Performance of Solar Photovoltaics at the Stringfellow Superfund Site in Riverside, California

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

Mosey, G.; Van Geet, O.

2010-12-01

This report presents the results of an assessment of the technical and economic feasibility of deploying a photovoltaics (PV) system on the Stringfellow Superfund Site in Riverside, California. The site was assessed for possible PV installations. The cost, performance, and site impacts of different PV options were estimated. The economics of the potential systems were analyzed using an electric rate of $0.13/kWh and incentives offered by Southern California Edison under the California Solar Initiative. According to the assessment, a government-owned, ground-mounted PV system represents a technically and economically feasible option. The report recommends financing options that could assist in themore » implementation of such a system.« less

Beyond Widgets -- Systems Incentive Programs for Utilities

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

Regnier, Cindy; Mathew, Paul; Robinson, Alastair

Utility incentive programs remain one of the most significant means of deploying commercialized, but underutilized building technologies to scale. However, these programs have been largely limited to component-based products (e.g., lamps, RTUs). While some utilities do provide ‘custom’ incentive programs with whole building and system level technical assistance, these programs require deeper levels of analysis, resulting in higher program costs. This results in custom programs being restricted to utilities with greater resources, and are typically applied mainly to large or energy-intensive facilities, leaving much of the market without cost effective access and incentives for these solutions. In addition, with increasinglymore » stringent energy codes, cost effective component-based solutions that achieve significant savings are dwindling. Building systems (e.g., integrated façade, HVAC and/or lighting solutions) can deliver higher savings that translate into large sector-wide savings if deployed at the scale of these programs. However, systems application poses a number of challenges – baseline energy use must be defined and measured; the metrics for energy and performance must be defined and tested against; in addition, system savings must be validated under well understood conditions. This paper presents a sample of findings of a project to develop validated utility incentive program packages for three specific integrated building systems, in collaboration with Xcel Energy (CO, MN), ComEd, and a consortium of California Public Owned Utilities (CA POUs) (Northern California Power Agency(NCPA) and the Southern California Public Power Authority(SCPPA)). Furthermore, these program packages consist of system specifications, system performance, M&V protocols, streamlined assessment methods, market assessment and implementation guidance.« less

Influential Effects of Intrinsic-Extrinsic Incentive Factors on Management Performance in New Energy Enterprises.

PubMed

Wang, Ping; Lu, Zhengnan; Sun, Jihong

2018-02-08

Background : New energy has become a key trend for global energy industry development. Talent plays a very critical role in the enhancement of new energy enterprise competitiveness. As a key component of talent, managers have been attracting more and more attention. The increase in job performance relies on, to a certain extent, incentive mechanism. Based on the Two-factor Theory, differences in influences and effects of different incentives on management performance have been checked in this paper from an empirical perspective. Methods : This paper selects the middle and low level managers in new energy enterprises as research samples and classifies the managers' performance into task performance, contextual performance and innovation performance. It uses manager performance questionnaires and intrinsic-extrinsic incentive factor questionnaires to investigate and study the effects and then uses Amos software to analyze the inner link between the intrinsic-extrinsic incentives and job performance. Results : Extrinsic incentives affect task performance and innovation performance positively. Intrinsic incentives impose active significant effects on task performance, contextual performance, and innovation performance. The intrinsic incentive plays a more important role than the extrinsic incentive. Conclusions : Both the intrinsic-extrinsic incentives affect manager performance positively and the intrinsic incentive plays a more important role than the extrinsic incentive. Several suggestions to management should be given based on these results.

Concentrating Solar Power Systems

NASA Astrophysics Data System (ADS)

Pitz-Paal, R.

2017-07-01

Development of Concentrating Solar Power Systems has started about 40 years ago. A first commercial implementation was performed between 1985 and 1991 in California. However, a drop in gas prices caused a longer period without further deployment. It was overcome in 2007 when new incentive schemes for renewables in Spain and the US enabled a commercial restart. In 2016, almost 100 commercial CSP plants with more than 5GW are installed worldwide. This paper describes the physical background of CSP technology, its technical characteristics and concepts. Furthermore, it discusses system performances, cost structures and the expected advancement.

Clean Energy Application Center

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

Freihaut, Jim

2013-09-30

The Mid Atlantic Clean Energy Application Center (MACEAC), managed by The Penn State College of Engineering, serves the six states in the Mid-Atlantic region (Pennsylvania, New Jersey, Delaware, Maryland, Virginia and West Virginia) plus the District of Columbia. The goals of the Mid-Atlantic CEAC are to promote the adoption of Combined Heat and Power (CHP), Waste Heat Recovery (WHR) and District Energy Systems (DES) in the Mid Atlantic area through education and technical support to more than 1,200 regional industry and government representatives in the region. The successful promotion of these technologies by the MACEAC was accomplished through the followingmore » efforts; (1)The MACEAC developed a series of technology transfer networks with State energy and environmental offices, Association of Energy Engineers local chapters, local community development organizations, utilities and, Penn State Department of Architectural Engineering alumni and their firms to effectively educate local practitioners about the energy utilization, environmental and economic advantages of CHP, WHR and DES; (2) Completed assessments of the regional technical and market potential for CHP, WHR and DE technologies application in the context of state specific energy prices, state energy and efficiency portfolio development. The studies were completed for Pennsylvania, New Jersey and Maryland and included a set of incentive adoption probability models used as a to guide during implementation discussions with State energy policy makers; (3) Using the technical and market assessments and adoption incentive models, the Mid Atlantic CEAC developed regional strategic action plans for the promotion of CHP Application technology for Pennsylvania, New Jersey and Maryland; (4) The CHP market assessment and incentive adoption model information was discussed, on a continuing basis, with relevant state agencies, policy makers and Public Utility Commission organizations resulting in CHP favorable incentive programs in New Jersey, Pennsylvania, Maryland and Delaware; (5) Developed and maintained a MACEAC website to provide technical information and regional CHP, WHR and DE case studies and site profiles for use by interested stakeholders in information transfer and policy discussions; (6) Provided Technical Assistance through feasibility studies and on site evaluations. The MACEAC completed 28 technical evaluations and 9 Level 1 CHP analyses ; and (7) the MACEAC provided Technical Education to the region through a series of 29 workshops and webinars, 37 technical presentations, 14 seminars and participation in 13 CHP conferences.« less

Results-Based Financing in Mozambique's Central Medical Store: A Review After 1 Year.

PubMed

Spisak, Cary; Morgan, Lindsay; Eichler, Rena; Rosen, James; Serumaga, Brian; Wang, Angela

2016-03-01

Public health commodity supply chains are typically weak in low-income countries, partly because they have many disparate yet interdependent functions and components. Approaches to strengthening supply chains in such settings have often fallen short-they address technical weaknesses, but not the incentives that motivate staff to perform better. We reviewed the first year of a results-based financing (RBF) program in Mozambique, which began in January 2013. The program aimed to improve the performance of the central medical store-Central de Medicamentos e Artigos Medicos (CMAM)-by realigning incentives. We completed in-depth interviews and focus group discussions with 33 key informants, including representatives from CMAM and donor agencies, and collected quantitative data on performance measures and use of funds. The RBF agreement linked CMAM performance payments to quarterly results on 5 performance indicators related to supply planning, distribution planning, and warehouse management. RBF is predicated on the theory that a combination of carrot and stick-i.e., shared financial incentives, plus increased accountability for results-will spur changes in behavior. Important design elements: (1) indicators were measured against quarterly targets, and payments were made only for indicators that met those targets; (2) targets were set based on documented performance, at levels that could be reasonably attained, yet pushed for improvement; (3) payment was shared with and dependent on all staff, encouraging teamwork and collaboration; (4) results were validated by verifiable data sources; and (5) CMAM had discretion over how to use the funds. We found that CMAM's performance continually improved over baseline and that CMAM achieved many of its performance targets, for example, timely submission of quarterly supply and distribution planning reports. Warehouse indicators, such as inventory management and order fulfillment, proved more challenging but were nonetheless positive. By linking payments to periodic verified results, and giving CMAM discretion over how to spend the funds, the RBF agreement motivated the workforce; focused attention on results; strengthened data collection; encouraged teamwork and innovation; and ultimately strengthened the central supply chain. Policy makers and program managers can use performance incentives to catalyze and leverage existing investments. To further strengthen the approach, such incentive programs can shift attention from quantity to quality indicators, improve verification processes, and aim to institutionalize the approach. © Mukuria et al.

Results-Based Financing in Mozambique’s Central Medical Store: A Review After 1 Year

PubMed Central

Spisak, Cary; Morgan, Lindsay; Eichler, Rena; Rosen, James; Serumaga, Brian; Wang, Angela

2016-01-01

ABSTRACT Background: Public health commodity supply chains are typically weak in low-income countries, partly because they have many disparate yet interdependent functions and components. Approaches to strengthening supply chains in such settings have often fallen short—they address technical weaknesses, but not the incentives that motivate staff to perform better. Methods: We reviewed the first year of a results-based financing (RBF) program in Mozambique, which began in January 2013. The program aimed to improve the performance of the central medical store—Central de Medicamentos e Artigos Medicos (CMAM)—by realigning incentives. We completed in-depth interviews and focus group discussions with 33 key informants, including representatives from CMAM and donor agencies, and collected quantitative data on performance measures and use of funds. Implementation: The RBF agreement linked CMAM performance payments to quarterly results on 5 performance indicators related to supply planning, distribution planning, and warehouse management. RBF is predicated on the theory that a combination of carrot and stick—i.e., shared financial incentives, plus increased accountability for results—will spur changes in behavior. Important design elements: (1) indicators were measured against quarterly targets, and payments were made only for indicators that met those targets; (2) targets were set based on documented performance, at levels that could be reasonably attained, yet pushed for improvement; (3) payment was shared with and dependent on all staff, encouraging teamwork and collaboration; (4) results were validated by verifiable data sources; and (5) CMAM had discretion over how to use the funds. Findings: We found that CMAM’s performance continually improved over baseline and that CMAM achieved many of its performance targets, for example, timely submission of quarterly supply and distribution planning reports. Warehouse indicators, such as inventory management and order fulfillment, proved more challenging but were nonetheless positive. By linking payments to periodic verified results, and giving CMAM discretion over how to spend the funds, the RBF agreement motivated the workforce; focused attention on results; strengthened data collection; encouraged teamwork and innovation; and ultimately strengthened the central supply chain. Conclusion: Policy makers and program managers can use performance incentives to catalyze and leverage existing investments. To further strengthen the approach, such incentive programs can shift attention from quantity to quality indicators, improve verification processes, and aim to institutionalize the approach. PMID:27016552

48 CFR 1852.216-88 - Performance incentive.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Performance incentive... 1852.216-88 Performance incentive. As prescribed in 1816.406-70(f), insert the following clause: Performance Incentive (JAN 1997) (a) A performance incentive applies to the following hardware item(s...

48 CFR 1852.216-88 - Performance incentive.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Performance incentive... 1852.216-88 Performance incentive. As prescribed in 1816.406-70(f), insert the following clause: Performance Incentive (JAN 1997) (a) A performance incentive applies to the following hardware item(s...

California Publicly-Owned Utilities (POUs) – LBNL ‘Beyond Widgets’ Project. Task: ambient lighting and occupancy-based plug load control. System Program Manual

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

Robinson, Alastair; Mathew, Paul A.; Regnier, Cynthia

This program manual contains detailed technical information for implementing an incentive program for task-ambient lighting and occupancy-based plug load control. This manual was developed by Lawrence Berkeley National Laboratory, in collaboration with the California Publicly-Owned Utilities (CA POUs) as a partner in the ‘Beyond Widgets’ program funded by the U.S. Department of Energy Building Technologies Office. The primary audience for this manual is the program staff of the various CA POUs. It may also be used by other utility incentive programs to help develop similar programs. It is anticipated that the content of this manual be utilized by the CAmore » POU staff for developing related documents such as the Technical Resource Manual and other filings pertaining to the rollout of an energy systems-based rebate incentive program.« less

Influential Effects of Intrinsic-Extrinsic Incentive Factors on Management Performance in New Energy Enterprises

PubMed Central

Wang, Ping; Lu, Zhengnan; Sun, Jihong

2018-01-01

Background: New energy has become a key trend for global energy industry development. Talent plays a very critical role in the enhancement of new energy enterprise competitiveness. As a key component of talent, managers have been attracting more and more attention. The increase in job performance relies on, to a certain extent, incentive mechanism. Based on the Two-factor Theory, differences in influences and effects of different incentives on management performance have been checked in this paper from an empirical perspective. Methods: This paper selects the middle and low level managers in new energy enterprises as research samples and classifies the managers’ performance into task performance, contextual performance and innovation performance. It uses manager performance questionnaires and intrinsic-extrinsic incentive factor questionnaires to investigate and study the effects and then uses Amos software to analyze the inner link between the intrinsic-extrinsic incentives and job performance. Results: Extrinsic incentives affect task performance and innovation performance positively. Intrinsic incentives impose active significant effects on task performance, contextual performance, and innovation performance. The intrinsic incentive plays a more important role than the extrinsic incentive. Conclusions: Both the intrinsic-extrinsic incentives affect manager performance positively and the intrinsic incentive plays a more important role than the extrinsic incentive. Several suggestions to management should be given based on these results. PMID:29419730

48 CFR 1852.216-88 - Performance incentive.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Performance incentive. 1852... 1852.216-88 Performance incentive. As prescribed in 1816.406-70(f), insert the following clause: Performance Incentive (JAN 1997) (a) A performance incentive applies to the following hardware item(s...

Feedback, Goal Setting, and Incentives Effects on Organizational Productivity.

ERIC Educational Resources Information Center

Pritchard, Robert D.; And Others

This technical paper is one of three produced by a large-scale effort aimed at implementing a new approach to measuring productivity, and using that approach to assess the impact of feedback, goal setting, and incentives on productivity. The productivity measurement system was developed for five units in the maintenance and supply areas at an Air…

77 FR 41956 - Relocation of and Spectrum Sharing by Federal Government Stations-Technical Panel and Dispute...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-17

... incentives to free up spectrum from both Federal Government users and non-Federal licensees.\\2\\ To that end... Act (CSEA) to provide additional incentives for Federal users.\\3\\ \\1\\ Presidential Memorandum..., between non-Federal users and Federal entities during the transition period. \\7\\ See id. at sections 113(h...

77 FR 31411 - Self-Regulatory Organizations; International Securities Exchange, LLC; Notice of Filing and...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-25

... program related to an incentive plan for certain Foreign Currency (``FX'') options traded on the Exchange... Rule Change to Terminate a Pilot Program Related to an Incentive Plan for Certain Foreign Currency Options Traded on the Exchange and To Make a Technical Change to the Schedule of Fees May 21, 2012...

48 CFR 16.402-2 - Performance incentives.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 1 2012-10-01 2012-10-01 false Performance incentives. 16... CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Incentive Contracts 16.402-2 Performance incentives. (a) Performance incentives may be considered in connection with specific product characteristics (e.g...

48 CFR 16.402-2 - Performance incentives.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 1 2014-10-01 2014-10-01 false Performance incentives. 16... CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Incentive Contracts 16.402-2 Performance incentives. (a) Performance incentives may be considered in connection with specific product characteristics (e.g...

48 CFR 16.402-2 - Performance incentives.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 1 2011-10-01 2011-10-01 false Performance incentives. 16... CONTRACTING METHODS AND CONTRACT TYPES TYPES OF CONTRACTS Incentive Contracts 16.402-2 Performance incentives. (a) Performance incentives may be considered in connection with specific product characteristics (e.g...

Carpool incentives: evaluation of operational experience

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

Not Available

1976-03-01

The report reviews both the published and unpublished literature with respect to various incentives that could increase carpooling and to determine, where possible, the effects of these incentives on carpooling. The coverage included theoretical and analytical work, as well as empirical observations of programs in operation both in this country and abroad. The primary focus is on the identification of actual examples of possible carpooling incentives, their description and implementation characteristics, applicability, institutional/legal barriers, public acceptability, and their effects on travel behavior and energy use. The relevant literature, applications, and existing data sources were canvassed and used to evaluate bothmore » the technical potential and the feasibility of implementation of the various policies selected for study.« less

Participatory development of incentives to coexist with jaguars and pumas.

PubMed

Amit, Ronit; Jacobson, Susan K

2018-01-22

Reducing costs and increasing benefits for rural communities coexisting with large carnivores is necessary for conservation of jaguar (Panthera onca) and puma (Puma concolor). To design acceptable incentives, stakeholders must be involved in the process. We conducted an innovative, structured, group communication process based on a Delphi technique as a template for identifying potential incentives. Community workshops with 133 members of 7 communities and surveys with 25 multidisciplinary experts from government, nongovernmental organizations, and academia provided iterative data to design a plan of incentives through 4 rounds of discussion. The final product integrated 862 ideas into 6 types of incentives: organization of communities, mechanisms for improved dialogue, citizen technical assistance, green labeling for community products, payment for the ecosystem service of biodiversity, and an assessment of financial alternatives. We used quantitative and qualitative techniques to indicate support for decisions about the design of incentives, which reduced researcher subjectivity. The diverse incentives developed and the cooperation from multiple stakeholders resulted in an incentive plan that integrated issues of governance, equity, and social norms. © 2018 Society for Conservation Biology.

The Practitioner View

NASA Astrophysics Data System (ADS)

Smart, Ian; Bestwick, Stuart; Jarrett, Neil; O'Conner, Richard; Gurnett, John

On paper, plans are most often technically "correct". But a large percentage of implementations fail - due to delay, missed targets or lack of sustainability. The most common pitfall is neglect of the "soft" side of change. All implementation projects imply change, and successful change requires leadership. What separates leaders from managers is the ability to engage and excite stakeholders, to lead by example and to drive the change agenda. In my opinion most people will be part of change if they understand the need for change, have the adequate competences to perform in their new role and have the right incentives. Therefore leaders that are able to communicate the need for change, provide for adequate training and aligned incentives will be most successful. In addition, leaders that engage and motivate their employees through role modelling and personal involvement will not only succeed in implementation - they will thrive.

Professional Development Programs in Community and Technical Colleges: Are Occupational-Technical Faculty Well Served?

ERIC Educational Resources Information Center

Hoerner, James L.; And Others

1991-01-01

According to a survey receiving 878 responses from 1,252 community/technical colleges, (1) 708 have professional development programs; (2) 48% rarely offer programs to part-time faculty; (3) funding was healthy for full-time, but 74% had no funding for part-time faculty development; and (4) incentives included intrinsic reward (80%), travel funds…

Performance Limiting Flow Processes in High-State Loading High-Mach Number Compressors

DTIC Science & Technology

2008-03-13

the Doctoral Thesis Committee of the doctoral student. 3 3.0 Technical Background A strong incentive exists to reduce airfoil count in aircraft engine ...Advanced Turbine Engine ). A basic constraint on blade reduction is seen from the Euler turbine equation, which shows that, although a design can be carried...on the vane to rotor blade ratio of 8:11). Within the MSU Turbo code, specifying a small number of time steps requires more iteration at each time

Effects of Mental Fatigue on Physical Endurance Performance and Muscle Activation Are Attenuated by Monetary Incentives.

PubMed

Brown, Denver M Y; Bray, Steven R

2017-12-01

Physical performance is impaired following cognitive control exertion. Incentives can ameliorate adverse carryover effects of cognitive control exertion but have not been investigated for physical endurance. This study examined the effect of monetary incentives on physical performance and muscle activation following exposure to a mentally fatiguing, cognitive control task. Participants (N = 82) performed two isometric endurance handgrip trials separated by a 12-min cognitive control manipulation using a 2 (high cognitive control [HCC]/low cognitive control [LCC]) × 2 (incentive/no incentive) design. Mental fatigue was significantly higher in the HCC conditions. Performance decreased in the HCC/no incentive condition but was unaffected in the HCC/incentive condition, which did not differ from the low cognitive control conditions. Electromyography data revealed increased muscle activation in the HCC/no incentive condition, which was also attenuated in the HCC/incentive condition. Findings show that incentives counteract the negative effects of HCC on physical endurance and alter central drive to motor units.

Intrinsic motivation and extrinsic incentives jointly predict performance: a 40-year meta-analysis.

PubMed

Cerasoli, Christopher P; Nicklin, Jessica M; Ford, Michael T

2014-07-01

More than 4 decades of research and 9 meta-analyses have focused on the undermining effect: namely, the debate over whether the provision of extrinsic incentives erodes intrinsic motivation. This review and meta-analysis builds on such previous reviews by focusing on the interrelationship among intrinsic motivation, extrinsic incentives, and performance, with reference to 2 moderators: performance type (quality vs. quantity) and incentive contingency (directly performance-salient vs. indirectly performance-salient), which have not been systematically reviewed to date. Based on random-effects meta-analytic methods, findings from school, work, and physical domains (k = 183, N = 212,468) indicate that intrinsic motivation is a medium to strong predictor of performance (ρ = .21-45). The importance of intrinsic motivation to performance remained in place whether incentives were presented. In addition, incentive salience influenced the predictive validity of intrinsic motivation for performance: In a "crowding out" fashion, intrinsic motivation was less important to performance when incentives were directly tied to performance and was more important when incentives were indirectly tied to performance. Considered simultaneously through meta-analytic regression, intrinsic motivation predicted more unique variance in quality of performance, whereas incentives were a better predictor of quantity of performance. With respect to performance, incentives and intrinsic motivation are not necessarily antagonistic and are best considered simultaneously. Future research should consider using nonperformance criteria (e.g., well-being, job satisfaction) as well as applying the percent-of-maximum-possible (POMP) method in meta-analyses. PsycINFO Database Record (c) 2014 APA, all rights reserved.

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.

Neural Mechanisms Underlying Paradoxical Performance for Monetary Incentives Are Driven by Loss Aversion

PubMed Central

Chib, Vikram S.; De Martino, Benedetto; Shimojo, Shinsuke; O'Doherty, John P.

2012-01-01

Summary Employers often make payment contingent on performance in order to motivate workers. We used fMRI with a novel incentivized skill task to examine the neural processes underlying behavioral responses to performance-based pay. We found that individuals' performance increased with increasing incentives; however, very high incentive levels led to the paradoxical consequence of worse performance. Between initial incentive presentation and task execution, striatal activity rapidly switched between activation and deactivation in response to increasing incentives. Critically, decrements in performance and striatal deactivations were directly predicted by an independent measure of behavioral loss aversion. These results suggest that incentives associated with successful task performance are initially encoded as a potential gain; however, when actually performing a task, individuals encode the potential loss that would arise from failure. PMID:22578508

Effects of Strategy Training and Incentives on Students' Performance, Confidence, and Calibration

ERIC Educational Resources Information Center

Gutierrez, Antonio P.; Schraw, Gregory

2015-01-01

This study examined the effect of strategy instruction and incentives on performance, confidence, and calibration accuracy. Individuals (N = 107) in randomly assigned treatment groups received a multicomponent strategy instruction intervention, financial incentives for high performance, or both. The authors predicted that incentives would improve…

Increasing performance of health care services within economic constraints: working towards improved incentive structures.

PubMed

Custers, Thomas; Klazinga, Niek S; Brown, Adalsteinn D

2007-01-01

There is increasing evidence that health care systems can create better value for money by improving performance and setting the right incentives. Worldwide this has led to an emergence of financial and non-financial incentive structures as a strategy to improve performance. The role of incentives is not only to motivate high performance through the alignment of results and rewards (financial/non-financial as well as direct/indirect) but also to enable health care providers to perform better by mitigating financial barriers that typically result from funding schemes. Various incentive structures in health care, identified in the scientific literature, are described in this article and available evidence on effectiveness and side effects is summarized. Literature shows that there is no single best approach to create an incentive yet and that the ability of financial and non-financial incentives to achieve desired results depends on a number of circumstantial elements. Several incentive schemes that can be used by health care insurers or local health authorities are discussed and concrete examples are provided. Decision-making on incentive schemes requires a careful design with the involvement of those targeted by incentives.

Annotated Bibliography of the Air Force Human Resources Laboratory Technical Reports - 1978

DTIC Science & Technology

1980-06-01

selection of incentives for classroom use. Grade-related and non -grade-related incentives were described in this experiment in a manner designed to...information monitoring- feedback. The current piractice= materials and methods are an outgroiuth of experimental aJpproache-s to the design . dev...operated in a stand- alone mode, the R & M model can be utilized to analyze the impact of various avionics design configurations on system support

AIDS: An ICT Model for Integrating Teaching, Learning and Research in Technical University Education in Ghana

ERIC Educational Resources Information Center

Asabere, Nana; Togo, Gilbert; Acakpovi, Amevi; Torby, Wisdom; Ampadu, Kwame

2017-01-01

Information and Communication Technologies (ICT) has changed the way we communicate and carry out certain daily activities. Globally, ICT has become an essential means for disseminating information. Using Accra Technical University in Ghana as a case study, this paper proposes an ICT model called Awareness Incentives Demand and Support (AIDS). Our…

State Adoption of Incentives to Promote Evidence-Based Practices in Behavioral Health Systems.

PubMed

Stewart, Rebecca E; Marcus, Steven C; Hadley, Trevor R; Hepburn, Brian M; Mandell, David S

2018-06-01

Despite the critical role behavioral health care payers can play in creating an incentive to use evidence-based practices (EBPs), little research has examined which incentives are used in public mental health systems, the largest providers of mental health care in the United States. The authors surveyed state mental health directors from 44 states about whether they used any of seven strategies to increase the use of EBPs. Participants also ranked attributes of each incentive on the basis of key characteristics of diffusion of innovation theory (perceived advantage, simplicity, compatibility, observability, and gradually implementable) and perceived effectiveness. Almost three-quarters of state directors endorsed using at least one financial incentive; most paid for training and technical assistance. Few used other incentives. Strategies perceived as simple and compatible were more readily adopted. Enhanced rates and paying for better outcomes were perceived as the most effective but were the least deployed, suggesting that simplicity and organizational compatibility may be the most decisive factors when choosing incentives. Payers are not using the incentives they perceive as most effective, and they are mostly using only one strategy for reasons of simplicity and compatibility. Future work should focus on barriers to measurement that likely hinder the adoption and implementation of paying for better outcomes and enhanced reimbursement rates, with the ultimate goal of measuring the effectiveness of incentives on EBP implementation efforts.

Working under a clinic-level quality incentive: primary care clinicians' perceptions.

PubMed

Greene, Jessica; Kurtzman, Ellen T; Hibbard, Judith H; Overton, Valerie

2015-01-01

A key consideration in designing pay-for-performance programs is determining what entity the incentive should be awarded to-individual clinicians or to groups of clinicians working in teams. Some argue that team-level incentives, in which clinicians who are part of a team receive the same incentive based on the team's performance, are most effective; others argue for the efficacy of clinician-level incentives. This study examines primary care clinicians' perceptions of a team-based quality incentive awarded at the clinic level. This research was conducted with Fairview Health Services, where 40% of the primary care compensation model was based on clinic-level quality performance. We conducted 48 in-depth interviews to explore clinicians' perceptions of the clinic-level incentive, as well as an online survey of 150 clinicians (response rate 56%) to investigate which entity the clinicians would consider optimal to target for quality incentives. Clinicians reported the strengths of the clinic-based quality incentive were quality improvement for the team and less patient "dumping," or shifting patients with poor outcomes to other clinicians. The weaknesses were clinicians' lack of control and colleagues riding the coattails of higher performers. There were mixed reports on the model's impact on team dynamics. Although clinicians reported greater interaction with colleagues, some described an increase in tension. Most clinicians surveyed (73%) believed that there should be a mix of clinic and individual-level incentives to maintain collaboration and recognize individual performance. The study highlights the important advantages and disadvantages of using incentives based upon clinic-level performance. Future research should test whether hybrid incentives that mix group and individual incentives can maintain some of the best elements of each design while mitigating the negative impacts. © 2015 Annals of Family Medicine, Inc.

Applied economics: The use of monetary incentives to modulate behavior.

PubMed

Strang, S; Park, S Q; Strombach, T; Kenning, P

2016-01-01

According to standard economic theory higher monetary incentives will lead to higher performance and higher effort independent of task, context, or individual. In many contexts this standard economic advice is implemented. Monetary incentives are, for example, used to enhance performance at workplace or to increase health-related behavior. However, the fundamental positive impact of monetary incentives has been questioned by psychologists as well as behavioral economists during the last decade, arguing that monetary incentives can sometimes even backfire. In this chapter, studies from proponents as well as opponents of monetary incentives will be presented. Specifically, the impact of monetary incentives on performance, prosocial, and health behavior will be discussed. Furthermore, variables determining whether incentives have a positive or negative impact will be identified. © 2016 Elsevier B.V. All rights reserved.

48 CFR 1816.402-2 - Performance incentives.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 6 2013-10-01 2013-10-01 false Performance incentives. 1816.402-2 Section 1816.402-2 Federal Acquisition Regulations System NATIONAL AERONAUTICS AND SPACE... Performance incentives. ...

48 CFR 1816.402-2 - Performance incentives.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 6 2011-10-01 2011-10-01 false Performance incentives. 1816.402-2 Section 1816.402-2 Federal Acquisition Regulations System NATIONAL AERONAUTICS AND SPACE... Performance incentives. ...

48 CFR 1816.402-2 - Performance incentives.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 6 2010-10-01 2010-10-01 true Performance incentives. 1816.402-2 Section 1816.402-2 Federal Acquisition Regulations System NATIONAL AERONAUTICS AND SPACE... Performance incentives. ...

State Revolving Funds: Financing Drought Resilient Water Infrastructure Projects

EPA Pesticide Factsheets

This report highlights innovative funding policies and programmatic actions that states are using to support drought resilient investment and operations through incentives, state requirements, and technical assistance.

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…

Alternative Fuels Data Center

Science.gov Websites

of the following measures: Payment of incentives to customers that install EVSE; Time-of-use rates customers; and Technical assistance programs for government fleets and private organizations. Utilities may

48 CFR 3416.402-2 - Performance incentives.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 48 Federal Acquisition Regulations System 7 2014-10-01 2014-10-01 false Performance incentives. 3416.402-2 Section 3416.402-2 Federal Acquisition Regulations System DEPARTMENT OF EDUCATION...-2 Performance incentives. (b) Award-term contracting may be used for performance-based contracts or...

48 CFR 3416.402-2 - Performance incentives.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 48 Federal Acquisition Regulations System 7 2013-10-01 2012-10-01 true Performance incentives. 3416.402-2 Section 3416.402-2 Federal Acquisition Regulations System DEPARTMENT OF EDUCATION...-2 Performance incentives. (b) Award-term contracting may be used for performance-based contracts or...

48 CFR 3416.402-2 - Performance incentives.

Code of Federal Regulations, 2011 CFR

2011-10-01

... 48 Federal Acquisition Regulations System 7 2011-10-01 2011-10-01 false Performance incentives. 3416.402-2 Section 3416.402-2 Federal Acquisition Regulations System DEPARTMENT OF EDUCATION...-2 Performance incentives. (b) Award-term contracting may be used for performance-based contracts or...

48 CFR 3416.402-2 - Performance incentives.

Code of Federal Regulations, 2012 CFR

2012-10-01

... 48 Federal Acquisition Regulations System 7 2012-10-01 2012-10-01 false Performance incentives. 3416.402-2 Section 3416.402-2 Federal Acquisition Regulations System DEPARTMENT OF EDUCATION...-2 Performance incentives. (b) Award-term contracting may be used for performance-based contracts or...

The Effects of Incentives on Workplace Performance: A Meta-Analytic Review of Research Studies

ERIC Educational Resources Information Center

Condly, Steven J.; Clark, Richard E.; Stolovitch, Harold D.

2003-01-01

A meta-analytic review of all adequately designed field and laboratory research on the use of incentives to motivate performance is reported. Of approximately 600 studies, 45 qualified. The overall average effect of all incentive programs in all work settings and on all work tasks was a 22% gain in performance. Team-directed incentives had a…

Ahuachapan geothermal project: a technical and economic assessment

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

Bloomster, C.H.; DiPippo; Kuwada, J.T.

Theeconomic and technical factors involved in using geothermal energy at Ahuachapan are examined. The experience at Ahuachapan is evaluated in relation to conditions prevailing in El Salvador and to conditions in the U.S. technical characteristics considered are: geological characteristics, well programs and gathering system, well productivity and geofluid characteristics, and energy conversion systems. Economic factors considered for El Salvador are: construction costs; environmental control costs; operating experience and costs; financing; taxes, subsidies, or incentives; marketing; and electrical system characteristics. (MHR)

Planning and Designing Effective Defence and Related Information Services: Conference Proceedings of the Technical Information Panel Specialists’ Meeting Held in Ankara, Turkey on 10-11 September 1986.

DTIC Science & Technology

1987-04-01

managerial talent and management style and behaviour on the basis of fixed and practised managerial principles. However, the material aspect, that is...motivation is encouraged by - immaterial incentives extrinsic motivation - material incentives on the one hand and by - management style and bihaviour...Logistics Management & Information Programs 26 Bid Victor Division 75996 Pans Armees NASA Headquarters (Code NIT) France Washington DC 20546 USA

Strengthening Critical Infrastructure: Combined Heat and Power at Wastewater Treatment Facilities (Webinar) – November 15, 2011

EPA Pesticide Factsheets

This webinar provides information about CHP at wastewater treatment facilities (WWTFs), including advantages and challenges, financial incentives and funding programs, and technical and economic potential.

45 CFR 305.31 - Amount of incentive payment.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PROGRAM PERFORMANCE MEASURES, STANDARDS, FINANCIAL INCENTIVES, AND PENALTIES § 305.31 Amount of incentive... establishment, support order, and current collections performance measures and 75 percent of the State's collections base for the fiscal year for the arrearage collections and cost-effectiveness performance measures...

Value-Added and Other Methods for Measuring School Performance: An Analysis of Performance Measurement Strategies in Teacher Incentive Fund Proposals. Research Brief

ERIC Educational Resources Information Center

National Center on Performance Incentives, 2008

2008-01-01

In "Value-Added and Other Methods for Measuring School Performance: An Analysis of Performance Measurement Strategies in Teacher Incentive Fund Proposals"--a paper presented at the February 2008 National Center on Performance Incentives research to policy conference--Robert Meyer and Michael Christian examine select performance-pay plans…

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…

The association between incentive spirometry performance and pain in postoperative thoracic epidural analgesia.

PubMed

Harris, David J; Hilliard, Paul E; Jewell, Elizabeth S; Brummett, Chad M

2015-01-01

Effective use of postoperative incentive spirometry improves patient outcomes but is limited by pain after thoracic and upper abdominal surgery. Thoracic epidurals are frequently used to provide analgesia and attenuate postoperative pulmonary dysfunction. We hypothesized that, in patients with thoracic epidurals for thoracic and abdominal surgery, high pain scores would be associated with poorer incentive spirometry performance, even when accounting for other variables. Retrospective study of 468 patients who underwent upper abdominal or thoracic surgery using postoperative thoracic epidural analgesia between June 1, 2009, and August 31, 2013, at a single tertiary academic center. The association between incentive spirometry performance and pain was assessed as the primary outcome. Other independent predictors of incentive spirometry performance were also identified. Postoperative incentive spirometry performance was found to be inversely proportional to pain score, which correlated significantly stronger with deep breathing pain compared with pain at rest (-0.33 vs -0.14 on postoperative day 1; -0.23 vs -0.12 on postoperative day 2). Pain with deep breathing was independently associated with poorer incentive spirometry performance in the multivariable linear regression model (P < 0.0001), as was increasing age, female sex, thoracic surgery, and higher American Society of Anesthesiologists (ASA) physical status score. The present study suggests that pain with deep breathing is more indicative of thoracic epidural efficacy than is pain at rest. Furthermore, incentive spirometry performance could be used as another indicator of thoracic epidural efficacy. This may be particularly useful in patients reporting high pain scores postoperatively.

Maximizing Energy Savings Reliability in BC Hydro Industrial Demand-side Management Programs: An Assessment of Performance Incentive Models

NASA Astrophysics Data System (ADS)

Gosman, Nathaniel

For energy utilities faced with expanded jurisdictional energy efficiency requirements and pursuing demand-side management (DSM) incentive programs in the large industrial sector, performance incentive programs can be an effective means to maximize the reliability of planned energy savings. Performance incentive programs balance the objectives of high participation rates with persistent energy savings by: (1) providing financial incentives and resources to minimize constraints to investment in energy efficiency, and (2) requiring that incentive payments be dependent on measured energy savings over time. As BC Hydro increases its DSM initiatives to meet the Clean Energy Act objective to reduce at least 66 per cent of new electricity demand with DSM by 2020, the utility is faced with a higher level of DSM risk, or uncertainties that impact the costeffective acquisition of planned energy savings. For industrial DSM incentive programs, DSM risk can be broken down into project development and project performance risks. Development risk represents the project ramp-up phase and is the risk that planned energy savings do not materialize due to low customer response to program incentives. Performance risk represents the operational phase and is the risk that planned energy savings do not persist over the effective measure life. DSM project development and performance risks are, in turn, a result of industrial economic, technological and organizational conditions, or DSM risk factors. In the BC large industrial sector, and characteristic of large industrial sectors in general, these DSM risk factors include: (1) capital constraints to investment in energy efficiency, (2) commodity price volatility, (3) limited internal staffing resources to deploy towards energy efficiency, (4) variable load, process-based energy saving potential, and (5) a lack of organizational awareness of an operation's energy efficiency over time (energy performance). This research assessed the capacity of alternative performance incentive program models to manage DSM risk in BC. Three performance incentive program models were assessed and compared to BC Hydro's current large industrial DSM incentive program, Power Smart Partners -- Transmission Project Incentives, itself a performance incentive-based program. Together, the selected program models represent a continuum of program design and implementation in terms of the schedule and level of incentives provided, the duration and rigour of measurement and verification (M&V), energy efficiency measures targeted and involvement of the private sector. A multi criteria assessment framework was developed to rank the capacity of each program model to manage BC large industrial DSM risk factors. DSM risk management rankings were then compared to program costeffectiveness, targeted energy savings potential in BC and survey results from BC industrial firms on the program models. The findings indicate that the reliability of DSM energy savings in the BC large industrial sector can be maximized through performance incentive program models that: (1) offer incentives jointly for capital and low-cost operations and maintenance (O&M) measures, (2) allow flexible lead times for project development, (3) utilize rigorous M&V methods capable of measuring variable load, process-based energy savings, (4) use moderate contract lengths that align with effective measure life, and (5) integrate energy management software tools capable of providing energy performance feedback to customers to maximize the persistence of energy savings. While this study focuses exclusively on the BC large industrial sector, the findings of this research have applicability to all energy utilities serving large, energy intensive industrial sectors.

Electric power restructuring in iran: achievements and challenges

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

Khosroshahi, Kaveh Aflaki; Jadid, Shahram; Shahidehpour, Mohammad

2009-03-15

Although the power market in Iran is not fully constructed, several key steps have been taken to meet privatization and restructuring objectives. The addition of a power exchange sector has placed the power market on par with that in other countries. Operational concerns that still need to be addressed include technical and non-technical losses, enhancing new investment, and providing incentives for introducing energy efficiency and promoting green power generation. (author)

Incentive payments are not related to expected health gain in the pay for performance scheme for UK primary care: cross-sectional analysis

PubMed Central

2012-01-01

Background The General Medical Services primary care contract for the United Kingdom financially rewards performance in 19 clinical areas, through the Quality and Outcomes Framework. Little is known about how best to determine the size of financial incentives in pay for performance schemes. Our aim was to test the hypothesis that performance indicators with larger population health benefits receive larger financial incentives. Methods We performed cross sectional analyses to quantify associations between the size of financial incentives and expected health gain in the 2004 and 2006 versions of the Quality and Outcomes Framework. We used non-parametric two-sided Spearman rank correlation tests. Health gain was measured in expected lives saved in one year and in quality adjusted life years. For each quality indicator in an average sized general practice we tested for associations first, between the marginal increase in payment and the health gain resulting from a one percent point improvement in performance and second, between total payment and the health gain at the performance threshold for maximum payment. Results Evidence for lives saved or quality adjusted life years gained was found for 28 indicators accounting for 41% of the total incentive payments. No statistically significant associations were found between the expected health gain and incentive gained from a marginal 1% increase in performance in either the 2004 or 2006 version of the Quality and Outcomes Framework. In addition no associations were found between the size of financial payment for achievement of an indicator and the expected health gain at the performance threshold for maximum payment measured in lives saved or quality adjusted life years. Conclusions In this subgroup of indicators the financial incentives were not aligned to maximise health gain. This disconnection between incentive and expected health gain risks supporting clinical activities that are only marginally effective, at the expense of more effective activities receiving lower incentives. When designing pay for performance programmes decisions about the size of the financial incentive attached to an indicator should be informed by information on the health gain to be expected from that indicator. PMID:22507660

The response of physician groups to P4P incentives.

PubMed

Mehrotra, Ateev; Pearson, Steven D; Coltin, Kathryn L; Kleinman, Ken P; Singer, Janice A; Rabson, Barbra; Schneider, Eric C

2007-05-01

Despite substantial enthusiasm among insurers and federal policy makers for pay-for-performance incentives, little is known about the current scope of these incentives or their influence on the delivery of care. To assess the scope and magnitude of pay-for-performance (P4P) incentives among physician groups and to examine whether such incentives are associated with quality improvement initiatives. Structured telephone survey of leaders of physician groups delivering primary care in Massachusetts. ASSESSED METHODS: Prevalence of P4P incentives among physician groups tied to specific measures of quality or utilization and prevalence of physician group quality improvement initiatives. Most group leaders (89%) reported P4P incentives in at least 1 commercial health plan contract. Incentives were tied to performance on Health Employer Data and Information Set (HEDIS) quality measures (89% of all groups), utilization measures (66%), use of information technology (52%), and patient satisfaction (37%). Among the groups with P4P and knowledge of all revenue streams, the incentives accounted for 2.2% (range, 0.3%-8.8%) of revenue. P4P incentives tied to HEDIS quality measures were positively associated with groups' quality improvement initiatives (odds ratio, 1.6; P = .02). Thirty-six percent of group leaders with P4P incentives reported that they were very important or moderately important to the group's financial success. P4P incentives are now common among physician groups in Massachusetts, and these incentives most commonly reward higher clinical quality or lower utilization of care. Although the scope and magnitude of incentives are still modest for many groups, we found an association between P4P incentives and the use of quality improvement initiatives.

Data issues in the life sciences.

PubMed

Thessen, Anne E; Patterson, David J

2011-01-01

We review technical and sociological issues facing the Life Sciences as they transform into more data-centric disciplines - the "Big New Biology". Three major challenges are: 1) lack of comprehensive standards; 2) lack of incentives for individual scientists to share data; 3) lack of appropriate infrastructure and support. Technological advances with standards, bandwidth, distributed computing, exemplar successes, and a strong presence in the emerging world of Linked Open Data are sufficient to conclude that technical issues will be overcome in the foreseeable future. While motivated to have a shared open infrastructure and data pool, and pressured by funding agencies in move in this direction, the sociological issues determine progress. Major sociological issues include our lack of understanding of the heterogeneous data cultures within Life Sciences, and the impediments to progress include a lack of incentives to build appropriate infrastructures into projects and institutions or to encourage scientists to make data openly available.

Data issues in the life sciences

PubMed Central

Thessen, Anne E.; Patterson, David J.

2011-01-01

Abstract We review technical and sociological issues facing the Life Sciences as they transform into more data-centric disciplines - the “Big New Biology”. Three major challenges are: 1) lack of comprehensive standards; 2) lack of incentives for individual scientists to share data; 3) lack of appropriate infrastructure and support. Technological advances with standards, bandwidth, distributed computing, exemplar successes, and a strong presence in the emerging world of Linked Open Data are sufficient to conclude that technical issues will be overcome in the foreseeable future. While motivated to have a shared open infrastructure and data pool, and pressured by funding agencies in move in this direction, the sociological issues determine progress. Major sociological issues include our lack of understanding of the heterogeneous data cultures within Life Sciences, and the impediments to progress include a lack of incentives to build appropriate infrastructures into projects and institutions or to encourage scientists to make data openly available. PMID:22207805

Using incentives to achieve A/R goals.

PubMed

Kivimaki, John

2007-09-01

Offering incentives to patient accounts staff can motivate them to meet--and even exceed--hospital and department goals. Tying incentives to goals and key performance indicators shows staff why the goals are important to the success of A/R performance.

Review of the Community College System's Performance-Based Program Budgeting Measures and Incentive Fund. Report 97-49.

ERIC Educational Resources Information Center

Florida State Legislature, Tallahassee. Office of Program Policy Analysis and Government Accountability.

This report addresses the Florida Community College System's (FCCS) performance based on measures established by the General Appropriations Act. Discussed are: (1) FCCS' performance on the measures used in the performance-based budgeting (PBB) incentive fund; (2) improvements that can be made to the PBB incentive fund; and (3) changes to community…

Effects of incentives on psychosocial performances in simulated space-dwelling groups

NASA Astrophysics Data System (ADS)

Hienz, Robert D.; Brady, Joseph V.; Hursh, Steven R.; Gasior, Eric D.; Spence, Kevin R.; Emurian, Henry H.

Prior research with individually isolated 3-person crews in a distributed, interactive, planetary exploration simulation examined the effects of communication constraints and crew configuration changes on crew performance and psychosocial self-report measures. The present report extends these findings to a model of performance maintenance that operationalizes conditions under which disruptive affective responses by crew participants might be anticipated to emerge. Experiments evaluated the effects of changes in incentive conditions on crew performance and self-report measures in simulated space-dwelling groups. Crews participated in a simulated planetary exploration mission that required identification, collection, and analysis of geologic samples. Results showed that crew performance effectiveness was unaffected by either positive or negative incentive conditions, while self-report measures were differentially affected—negative incentive conditions produced pronounced increases in negative self-report ratings and decreases in positive self-report ratings, while positive incentive conditions produced increased positive self-report ratings only. Thus, incentive conditions associated with simulated spaceflight missions can significantly affect psychosocial adaptation without compromising task performance effectiveness in trained and experienced crews.

Selecting effective incentive structures in health care: A decision framework to support health care purchasers in finding the right incentives to drive performance

PubMed Central

Custers, Thomas; Hurley, Jeremiah; Klazinga, Niek S; Brown, Adalsteinn D

2008-01-01

Background The Ontario health care system is devolving planning and funding authority to community based organizations and moving from steering through rules and regulations to steering on performance. As part of this transformation, the Ontario Ministry of Health and Long-Term Care (MOHLTC) are interested in using incentives as a strategy to ensure alignment – that is, health service providers' goals are in accord with the goals of the health system. The objective of the study was to develop a decision framework to assist policymakers in choosing and designing effective incentive systems. Methods The first part of the study was an extensive review of the literature to identify incentives models that are used in the various health care systems and their effectiveness. The second part was the development of policy principles to ensure that the used incentive models are congruent with the values of the Ontario health care system. The principles were developed by reviewing the Ontario policy documents and through discussions with policymakers. The validation of the principles and the suggested incentive models for use in Ontario took place at two meetings. The first meeting was with experts from the research and policy community, the second with senior policymakers from the MOHLTC. Based on the outcome of those two meetings, the researchers built a decision framework for incentives. The framework was send to the participants of both meetings and four additional experts for validation. Results We identified several models that have proven, with a varying degree of evidence, to be effective in changing or enabling a health provider's performance. Overall, the literature suggests that there is no single best approach to create incentives yet and the ability of financial and non-financial incentives to achieve results depends on a number of contextual elements. After assessing the initial set of incentive models on their congruence with the four policy principles we defined nine incentive models to be appropriate for use in Ontario and potentially other health care systems that want to introduce incentives to improve performance. Subsequently, the models were incorporated in the resulting decision framework. Conclusion The design of an incentive must reflect the values and goals of the health care system, be well matched to the performance objectives and reflect a range of contextual factors that can influence the effectiveness of even well-designed incentives. As a consequence, a single policy recommendation around incentives is inappropriate. The decision framework provides health care policymakers and purchasers with a tool to support the selection of an incentive model that is the most appropriate to improve the targeted performance. PMID:18371198

The Impact of Social Pressure and Monetary Incentive on Cognitive Control.

PubMed

Ličen, Mina; Hartmann, Frank; Repovš, Grega; Slapničar, Sergeja

2016-01-01

We compare the effects of two prominent organizational control mechanisms-social pressure and monetary incentive-on cognitive control. Cognitive control underlies the human ability to regulate thoughts and actions in the pursuit of behavioral goals. Previous studies show that monetary incentives can contribute to goal-oriented behavior by activating proactive control. There is, however, much less evidence of how social pressure affects cognitive control and task performance. In a within-subject experimental design, we tested 47 subjects performing the AX-CPT task to compare the activation of cognitive control modes under social pressure and monetary incentive beyond mere instructions to perform better. Our results indicate that instructing participants to improve their performance on its own leads to a significant shift from a reactive to a proactive control mode and that both social pressure and monetary incentive further enhance performance.

The effects of incentives on visual-spatial working memory in children with attention-deficit/hyperactivity disorder.

PubMed

Shiels, Keri; Hawk, Larry W; Lysczek, Cynthia L; Tannock, Rosemary; Pelham, William E; Spencer, Sarah V; Gangloff, Brian P; Waschbusch, Daniel A

2008-08-01

Working memory is one of several putative core neurocognitive processes in attention-deficit/hyperactivity disorder (ADHD). The present work seeks to determine whether visual-spatial working memory is sensitive to motivational incentives, a laboratory analogue of behavioral treatment. Participants were 21 children (ages 7-10) with a diagnosis of ADHD-combined type. Participants completed a computerized spatial span task designed to assess storage of visual-spatial information (forward span) and manipulation of the stored information (backward span). The spatial span task was completed twice on the same day, once with a performance-based incentive (trial-wise feedback and points redeemable for prizes) and once without incentives. Participants performed significantly better on the backward span when rewarded for correct responses, compared to the no incentive condition. However, incentives had no effect on performance during the forward span. These findings may suggest the use of motivational incentives improved manipulation, but not storage, of visual-spatial information among children with ADHD. Possible explanations for the differential incentive effects are discussed, including the possibility that incentives prevented a vigilance decrement as task difficulty and time on task increased.

Humans Integrate Monetary and Liquid Incentives to Motivate Cognitive Task Performance

PubMed Central

Yee, Debbie M.; Krug, Marie K.; Allen, Ariel Z.; Braver, Todd S.

2016-01-01

It is unequivocal that a wide variety of incentives can motivate behavior. However, few studies have explicitly examined whether and how different incentives are integrated in terms of their motivational influence. The current study examines the combined effects of monetary and liquid incentives on cognitive processing, and whether appetitive and aversive incentives have distinct influences. We introduce a novel task paradigm, in which participants perform cued task-switching for monetary rewards that vary parametrically across trials, with liquid incentives serving as post-trial performance feedback. Critically, the symbolic meaning of the liquid was held constant (indicating successful reward attainment), while liquid valence was blocked. In the first experiment, monetary rewards combined additively with appetitive liquid feedback to improve subject task performance. Aversive liquid feedback counteracted monetary reward effects in low monetary reward trials, particularly in a subset of participants who tended to avoid responding under these conditions. Self-report motivation ratings predicted behavioral performance above and beyond experimental effects. A follow-up experiment replicated the predictive power of motivation ratings even when only appetitive liquids were used, suggesting that ratings reflect idiosyncratic subjective values of, rather than categorical differences between, the liquid incentives. Together, the findings indicate an integrative relationship between primary and secondary incentives and potentially dissociable influences in modulating motivational value, while informing hypotheses regarding candidate neural mechanisms. PMID:26834668

20 CFR 641.750 - Will there be performance-related incentives?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false Will there be performance-related incentives? 641.750 Section 641.750 Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF... incentive awards. The Department will exercise this authority at its discretion. ...

Incentive Funding Meets Incentive-Based Budgeting: Can They Coexist?

ERIC Educational Resources Information Center

Lang, Daniel W.

2016-01-01

Two major developments in the financial management of higher education have occurred more or less contemporaneously: incentive or performance funding on the part of government and incentive-based budgeting on the part of institutions. Both are based on fiscal incentives. Despite their several inherent and interconnected similarities, incentive…

Teacher Behaviors and Performance Incentives in Texas: Early Reactions to the GEEG Program. Research Brief

ERIC Educational Resources Information Center

National Center on Performance Incentives, 2008

2008-01-01

A recent report published by the National Center on Performance Incentives (NCPI) presents findings from the first-year evaluation of the Governor's Educator Excellence Grant (GEEG) program, one of several statewide performance incentive programs in Texas. The report provides an overview of changes to teacher behavior and instructional practices…

Factors influencing private health providers' technical quality of care for acute respiratory infections among under-five children in rural West Bengal, India.

PubMed

Chakraborty, Sarbani; Frick, Kevin

2002-11-01

In many developing countries, private health practitioners provide a significant portion of curative care for diseases which are of public health importance. Currently, health sector reform efforts in these countries are fostering increased participation of private providers in the delivery of health services, including those of public health importance. Guaranteeing good technical quality of care is critical to the process. However, little is known about private providers' technical quality of care (disease management practices) and the factors influencing these services. The purpose of this study was to contribute information on this topic. The study was conducted among private providers in rural West Bengal, India and focused on providers' disease management practices for acute respiratory infections (ARI) among under-five children. World Health Organization (WHO) guidelines for ARI case management were used as the expected standard of care. Observations of patient-provider encounters and interviews with the providers and mothers were the main sources of data. The study found that private health providers in rural West Bengal have inadequate technical quality of care. The problem was related both to low levels of performance (limited potential) and inconsistency in performance (within-provider variation). Limited potential for good technical quality for ARI among the providers was related to lack of knowledge (technical incompetence). One of the important factors influencing within-provider variation was patient load. Since rural private providers operate on a fee-for-service payment system, there are incentives related to seeing many patients. The study concluded that to bring about sustainable improvements in private providers' ARI disease management practices, training programs and interventions that improved compliance were necessary.

The Design of Schools' Performance Incentive Programs in Texas: Findings from Year One of TEEG. Research Brief

ERIC Educational Resources Information Center

National Center on Performance Incentives, 2008

2008-01-01

A recent report published by the National Center on Performance Incentives (NCPI) presents findings from the first-year evaluation of the Texas Educator Excellence Grant (TEEG) program, one of several statewide educator incentive programs in Texas. This report provides an overview of over 1,000 schools' locally designed TEEG performance incentive…

Issues in Perspective. Critical Issues Papers 1-17.

ERIC Educational Resources Information Center

Duttweiler, Patricia Cloud

The papers in this collection are based on the document "Perspectives on Performance-Based Incentive Plans" and offer brief overviews of the following critical issues in education: (1) performance-based incentive plans; (2) needed organizational changes; (3) successful and unsuccessful teacher incentive plans; (4) compensation strategies and…

20 CFR 628.325 - Incentive grants, capacity building, and technical assistance.

Code of Federal Regulations, 2011 CFR

2011-04-01

... for the development of Statewide communications and training mechanisms involving computer-based communication technologies that directly facilitate interaction with the National Capacity Building and... section 205(a) of the Act, in developing electronic communications, training mechanisms and/or...

20 CFR 628.325 - Incentive grants, capacity building, and technical assistance.

Code of Federal Regulations, 2012 CFR

2012-04-01

... for the development of Statewide communications and training mechanisms involving computer-based communication technologies that directly facilitate interaction with the National Capacity Building and... section 205(a) of the Act, in developing electronic communications, training mechanisms and/or...

Monetary Incentives in Speeded Perceptual Decision: Effects of Penalizing Errors Versus Slow Responses

PubMed Central

Dambacher, Michael; Hübner, Ronald; Schlösser, Jan

2011-01-01

The influence of monetary incentives on performance has been widely investigated among various disciplines. While the results reveal positive incentive effects only under specific conditions, the exact nature, and the contribution of mediating factors are largely unexplored. The present study examined influences of payoff schemes as one of these factors. In particular, we manipulated penalties for errors and slow responses in a speeded categorization task. The data show improved performance for monetary over symbolic incentives when (a) penalties are higher for slow responses than for errors, and (b) neither slow responses nor errors are punished. Conversely, payoff schemes with stronger punishment for errors than for slow responses resulted in worse performance under monetary incentives. The findings suggest that an emphasis of speed is favorable for positive influences of monetary incentives, whereas an emphasis of accuracy under time pressure has the opposite effect. PMID:21980316

48 CFR 48.105 - Relationship to other incentives.

Code of Federal Regulations, 2013 CFR

2013-10-01

... should not be rewarded both as value engineering shares and under performance, design-to-cost, or similar incentives of the contract. To that end, when performance, design-to-cost, or similar targets are set and... CONTRACT MANAGEMENT VALUE ENGINEERING Policies and Procedures 48.105 Relationship to other incentives...

48 CFR 48.105 - Relationship to other incentives.

Code of Federal Regulations, 2012 CFR

2012-10-01

... should not be rewarded both as value engineering shares and under performance, design-to-cost, or similar incentives of the contract. To that end, when performance, design-to-cost, or similar targets are set and... CONTRACT MANAGEMENT VALUE ENGINEERING Policies and Procedures 48.105 Relationship to other incentives...

48 CFR 48.105 - Relationship to other incentives.

Code of Federal Regulations, 2014 CFR

2014-10-01

... should not be rewarded both as value engineering shares and under performance, design-to-cost, or similar incentives of the contract. To that end, when performance, design-to-cost, or similar targets are set and... CONTRACT MANAGEMENT VALUE ENGINEERING Policies and Procedures 48.105 Relationship to other incentives...

Solar heating and cooling of buildings (SHACOB) commercialization report: options and strategies. Part A. Volume II. Technical report. Final report

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

Not Available

The national and regional perspectives for SHACOB are presented. An overview is given of the participants in SHACOB commercialization. Economic, institutional, legal, and other barriers constraining commercialization are discussed. Various analytical models are examined which project the future extent of SHACOB use or market penetration and future SHACOB to US energy supplies under alternative government policies. The results for the baseline case (no further government action, of several market penetration models are presented. Possible ways to overcome each of the barriers are presented. Qualitative analyses are given for the various incentives. Each incentive is examined to assess its impact onmore » barriers to SHACOB commercialization and its impact on various income and interest groups. Individual incentives are compared and combined into alternative policy strategies and options. (MHR)« less

An Assessment of Individualized Instruction in Navy Technical Training,

DTIC Science & Technology

1979-11-01

PAGE(Wh... D.i. Eni.r .d) 2O~ ’\\ ~management information systems , training of instructors and managers ,terminology , student —instructor incentives...Navy commitment to II is most visible in CMI. FY 78 data show an approximate student AOB and throughput for CMI courses of 7,000 and 65,000...respectively. There are an additional 3,000 student AOB and 59,000 student throughput for II courses which are not computer managed . CAl usage in technical

Effect of Leadership Style, Motivation, and Giving Incentives on the Performance of Employees--PT. Kurnia Wijaya Various Industries

ERIC Educational Resources Information Center

Elqadri, Zaenal Mustafa; Priyono; Suci, Rahayu Puji; Chandra, Teddy

2015-01-01

This study aims to identify and examine the importance of leadership style, motivation, and incentives to improve employee performance. Variables examined as factors that affect performance of employees were style of leadership (X1), motivation (X2), and the provision of incentives (X3). The population of this study was all employees in the Sales…

7 CFR 610.24 - Responsibilities of State Technical Committees.

Code of Federal Regulations, 2011 CFR

2011-01-01

... programs under Title XII of the Food Security Act of 1985 including, but not limited to, the Conservation Reserve Program, Wetlands Reserve Program, Conservation Security Program, Conservation Stewardship Program, Farm and Ranch Lands Protection Program, Grassland Reserve Program, Environmental Quality Incentives...

7 CFR 610.24 - Responsibilities of State Technical Committees.

Code of Federal Regulations, 2010 CFR

2010-01-01

... programs under Title XII of the Food Security Act of 1985 including, but not limited to, the Conservation Reserve Program, Wetlands Reserve Program, Conservation Security Program, Conservation Stewardship Program, Farm and Ranch Lands Protection Program, Grassland Reserve Program, Environmental Quality Incentives...

7 CFR 610.24 - Responsibilities of State Technical Committees.

Code of Federal Regulations, 2012 CFR

2012-01-01

... programs under Title XII of the Food Security Act of 1985 including, but not limited to, the Conservation Reserve Program, Wetlands Reserve Program, Conservation Security Program, Conservation Stewardship Program, Farm and Ranch Lands Protection Program, Grassland Reserve Program, Environmental Quality Incentives...

7 CFR 610.24 - Responsibilities of State Technical Committees.

Code of Federal Regulations, 2013 CFR

2013-01-01

... programs under Title XII of the Food Security Act of 1985 including, but not limited to, the Conservation Reserve Program, Wetlands Reserve Program, Conservation Security Program, Conservation Stewardship Program, Farm and Ranch Lands Protection Program, Grassland Reserve Program, Environmental Quality Incentives...

Surgical Procedures in Health Professional Shortage Areas: Impact of a Surgical Incentive Payment Plan.

PubMed

Diaz, Adrian; Merath, Katiuscha; Bagante, Fabio; Chen, Qinyu; Akgul, Ozgur; Beal, Eliza; Idrees, Jay; Olsen, Griffin; Gani, Faiz; Pawlik, Timothy M

2018-05-15

The Affordable Care Act established a Center for Medicare/Medicaid Services based 10% reimbursement bonus for general surgeons in Health Professional Shortage Areas. We sought to assess the impact of the Affordable Care Act Surgery Incentive Payment on surgical procedures performed in Health Professional Shortage Areas. Hospital utilization data from the California Office of Statewide Health Planning and Development between January 1, 2006, and December 31, 2015, were used to categorize hospitals according to Health Professional Shortage Area location. A difference-in-differences analysis measured the effect of the Surgery Incentive Payment on year-to-year differences for inpatient and outpatient surgical procedures by hospital type pre- (2006-2010) versus post- (2011-2015) Surgery Incentive Payment implementation. Among 409 unique hospitals that performed surgical procedures for at least 1 year of the study period, 2 performed surgery in a designated Health Professional Shortage Area. The two Health Professional Shortage Area -designated hospitals were located in a rural area, were non-teaching hospitals, and had 196 and 202 hospital beds, respectively. After the enactment of the Surgery Incentive Payment, while non- Health Professional Shortage Areas had only a modest relative decrease in total inpatient procedures (Pre-Surgery Incentive Payment: 4,666,938 versus Post-Surgery Incentive Payment: 4,451,612; Δ-4.6%), the proportional decrease in inpatient surgical procedures at Health Professional Shortage Area hospitals was more marked (Pre-Surgery Incentive Payment: 25,830 versus Post-Surgery Incentive Payment: 21,503; Δ-16.7%). In contrast, Health Professional Shortage Area hospitals proportionally had a greater increase in total outpatient procedures (Pre-Surgery Incentive Payment: 17,840 versus Post-Surgery Incentive Payment: 22,375: Δ+25.4%) versus non- Health Professional Shortage Area hospitals (Pre-Surgery Incentive Payment: 5,863,300 versus Post-Surgery Incentive Payment: 6,156,138; Δ+4.9%). Based on the difference-in-differences analysis, the increase in the trend of surgical procedures at Health Professional Shortage Area hospitals was much more notable after Surgery Incentive Payment implementation (Δ+75.2%). The Medicare Surgery Incentive Payment program was associated with an increase in the number of surgical procedures performed at Health Professional Shortage Area hospitals relative to non-Health Professional Shortage Area hospitals during the study period, reversing the trend from negative to positive. Copyright © 2018 Elsevier Inc. All rights reserved.

Financial incentives for quality in breast cancer care.

PubMed

Tisnado, Diana M; Rose-Ash, Danielle E; Malin, Jennifer L; Adams, John L; Ganz, Patricia A; Kahn, Katherine L

2008-07-01

To examine the use of financial incentives related to performance on quality measures reported by oncologists and surgeons associated with a population-based cohort of patients with breast cancer in Los Angeles County, California, and to explore the physician and practice characteristics associated with the use of these incentives among breast cancer care providers. Cross-sectional observational study. Physician self-reported financial arrangements from a survey of 348 medical oncologists, radiation oncologists, and surgeons caring for patients with breast cancer in Los Angeles County (response rate, 76%). Physicians were asked whether they were subject to financial incentives for quality (ie, patient satisfaction surveys and adherence to practice guidelines). We examined the prevalence and correlates of incentives and performed multivariate logistic regression analyses to assess predictors of incentives, controlling for other covariates. Twenty percent of respondents reported incentives based on patient satisfaction, and 15% reported incentives based on guideline adherence. The use of incentives for quality in this cohort of oncologists and surgeons was modest and was primarily associated with staff- or group-model health maintenance organization (HMO) settings. In other settings, important predictors were partial physician ownership interest, large practice size, and capitation. Most cancer care providers in Los Angeles County outside of staff- or group-model HMOs are not subject to explicit financial incentives based on quality-of-care measures. Those who are, seem more likely to be associated with large practice settings. New approaches are needed to direct financial incentives for quality toward specialists outside of staff- or group-model HMOs if pay-for-performance programs are to succeed in influencing care.

Age-related influence of contingencies on a saccade task

PubMed Central

Jazbec, Sandra; Hardin, Michael G.; Schroth, Elizabeth; McClure, Erin; Pine, Daniel S.; Ernst, Monique

2009-01-01

Adolescence is characterized by increased risk-taking and sensation-seeking, presumably brought about by developmental changes within reward-mediating brain circuits. A better understanding of the neural mechanisms underlying reward-seeking during adolescence can have critical implications for the development of strategies to enhance adolescent performance in potentially dangerous situations. Yet little research has investigated the influence of age on the modulation of behavior by incentives with neuroscience-based methods. A monetary reward antisaccade task (the RST) was used with 23 healthy adolescents and 30 healthy adults. Performance accuracy, latency and peak velocity of saccade responses (prosaccades and antisaccades) were analyzed. Performance accuracy across all groups was improved by incentives (obtain reward, avoid punishment) for both, prosaccades and antisaccades. However, modulation of antisaccade errors (direction errors) by incentives differed between groups: adolescents modulated saccade latency and peak velocity depending on contingencies, with incentives aligning their performance to that of adults; adults did not show a modulation by incentives. These findings suggest that incentives modulate a global measure of performance (percent direction errors) in adults and adolescents, and exert a more powerful influence on the control of incorrect motor responses in adolescents than in adults. These findings suggest that this task can be used in neuroimaging studies as a probe of the influence of incentives on cognitive control from a developmental perspective as well as in health and disease. PMID:16733706

Age-related influence of contingencies on a saccade task.

PubMed

Jazbec, Sandra; Hardin, Michael G; Schroth, Elizabeth; McClure, Erin; Pine, Daniel S; Ernst, Monique

2006-10-01

Adolescence is characterized by increased risk-taking and sensation-seeking, presumably brought about by developmental changes within reward-mediating brain circuits. A better understanding of the neural mechanisms underlying reward-seeking during adolescence can have critical implications for the development of strategies to enhance adolescent performance in potentially dangerous situations. Yet little research has investigated the influence of age on the modulation of behavior by incentives with neuroscience-based methods. A monetary reward antisaccade task (the RST) was used with 23 healthy adolescents and 30 healthy adults. Performance accuracy, latency and peak velocity of saccade responses (prosaccades and antisaccades) were analyzed. Performance accuracy across all groups was improved by incentives (obtain reward, avoid punishment) for both, prosaccades and antisaccades. However, modulation of antisaccade errors (direction errors) by incentives differed between groups: adolescents modulated saccade latency and peak velocity depending on contingencies, with incentives aligning their performance to that of adults; adults did not show a modulation by incentives. These findings suggest that incentives modulate a global measure of performance (percent direction errors) in adults and adolescents, and exert a more powerful influence on the control of incorrect motor responses in adolescents than in adults. These findings suggest that this task can be used in neuroimaging studies as a probe of the influence of incentives on cognitive control from a developmental perspective as well as in health and disease.

Recognising Behaviour that Increases Learning: The Possible Role of Incentives in the Teaching Profession. Research Article

ERIC Educational Resources Information Center

Mabogoane, Thabo; Patel, Firoz

2006-01-01

This article argues that incentives can help increase teacher performance and retention. Incentives send out a clear signal of what an education system expects from its teachers; at the same time teachers do respond to incentives inherent in the education system. Many education systems have weak incentives and therefore fail to signal to teachers…

Impact of monetary incentives on cognitive performance and error monitoring following sleep deprivation.

PubMed

Hsieh, Shulan; Li, Tzu-Hsien; Tsai, Ling-Ling

2010-04-01

To examine whether monetary incentives attenuate the negative effects of sleep deprivation on cognitive performance in a flanker task that requires higher-level cognitive-control processes, including error monitoring. Twenty-four healthy adults aged 18 to 23 years were randomly divided into 2 subject groups: one received and the other did not receive monetary incentives for performance accuracy. Both subject groups performed a flanker task and underwent electroencephalographic recordings for event-related brain potentials after normal sleep and after 1 night of total sleep deprivation in a within-subject, counterbalanced, repeated-measures study design. Monetary incentives significantly enhanced the response accuracy and reaction time variability under both normal sleep and sleep-deprived conditions, and they reduced the effects of sleep deprivation on the subjective effort level, the amplitude of the error-related negativity (an error-related event-related potential component), and the latency of the P300 (an event-related potential variable related to attention processes). However, monetary incentives could not attenuate the effects of sleep deprivation on any measures of behavior performance, such as the response accuracy, reaction time variability, or posterror accuracy adjustments; nor could they reduce the effects of sleep deprivation on the amplitude of the Pe, another error-related event-related potential component. This study shows that motivation incentives selectively reduce the effects of total sleep deprivation on some brain activities, but they cannot attenuate the effects of sleep deprivation on performance decrements in tasks that require high-level cognitive-control processes. Thus, monetary incentives and sleep deprivation may act through both common and different mechanisms to affect cognitive performance.

20 CFR 628.300 - Scope and purpose.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Employees' Benefits EMPLOYMENT AND TRAINING ADMINISTRATION, DEPARTMENT OF LABOR PROGRAMS UNDER TITLE II OF THE JOB TRAINING PARTNERSHIP ACT State Programs § 628.300 Scope and purpose. This subpart provides... workers, and incentive grants to SDA's and grants to SDA's for capacity building and technical assistance. ...

Organizational change: Incentives and resistance

NASA Technical Reports Server (NTRS)

Bishop, Peter C.

1992-01-01

Topics concerning Space Exploration Initiative technical interchange are presented in viewgraph form and include the following: models of change, elements of the current period, the signs of change, leaders' contribution, paradigms - our worldview, paradigm change, the effects of revealing paradigms, a checklist for change, and organizational control.

“Meaningful use” of electronic health records and its relevance to laboratories and pathologists

PubMed Central

Henricks, Walter H.

2011-01-01

Electronic health records (EHRs) have emerged as a major topic in health care and are central to the federal government’s strategy for transforming healthcare delivery in the United States. Recent federal actions that aim to promote the use of EHRs promise to have significant implications for laboratories and for pathology practices. Under the HITECH (Health Information Technology Economic and Clinical Health) Act, an EHR incentive program has been established through which individual physicians and hospitals can qualify to receive incentive payments if they achieve “meaningful use” of “certified” EHR technology. The rule also establishes payment penalties in future years for eligible providers who have not met the requirements for meaningful use of EHRs. Meaningful use must be achieved using EHR technology that has been certified in accordance with functional and technical criteria that are set forth a regulation that parallels the meaningful use criteria in the incentive program. These actions and regulations are important to laboratories and pathologists for a number of reasons. Several of the criteria and requirements in the meaningful use rules and EHR certification criteria relate directly or indirectly to laboratory testing and laboratory information management, and future stage requirements are expected to impact the laboratory as well. Furthermore, as EHR uptake expands, there will be greater expectations for electronic interchange of laboratory information and laboratory information system (LIS)-EHR interfaces. Laboratories will need to be aware of the technical, operational, and business challenges that they may face as expectations for LIS-EHR increase. This paper reviews the important recent federal efforts aimed at accelerating EHR use, including the incentive program for EHR meaningful use, provider eligibility, and EHR certification criteria, from a perspective of their relevance for laboratories and pathology practices. PMID:21383931

Higher incentives can impair performance: neural evidence on reinforcement and rationality

PubMed Central

Achtziger, Anja; Hügelschäfer, Sabine; Steinhauser, Marco

2015-01-01

Standard economic thinking postulates that increased monetary incentives should increase performance. Human decision makers, however, frequently focus on past performance, a form of reinforcement learning occasionally at odds with rational decision making. We used an incentivized belief-updating task from economics to investigate this conflict through measurements of neural correlates of reward processing. We found that higher incentives fail to improve performance when immediate feedback on decision outcomes is provided. Subsequent analysis of the feedback-related negativity, an early event-related potential following feedback, revealed the mechanism behind this paradoxical effect. As incentives increase, the win/lose feedback becomes more prominent, leading to an increased reliance on reinforcement and more errors. This mechanism is relevant for economic decision making and the debate on performance-based payment. PMID:25816816

Financial Incentives and Physician Practice Participation in Medicare's Value-Based Reforms.

PubMed

Markovitz, Adam A; Ramsay, Patricia P; Shortell, Stephen M; Ryan, Andrew M

2017-07-26

To evaluate whether greater experience and success with performance incentives among physician practices are related to increased participation in Medicare's voluntary value-based payment reforms. Publicly available data from Medicare's Physician Compare (n = 1,278; January 2012 to November 2013) and nationally representative physician practice data from the National Survey of Physician Organizations 3 (NSPO3; n = 907,538; 2013). We used regression analysis to examine practice-level relationships between prior exposure to performance incentives and participation in key Medicare value-based payment reforms: accountable care organization (ACO) programs, the Physician Quality Reporting System ("Physician Compare"), and the Meaningful Use of Health Information Technology program ("Meaningful Use"). Prior experience and success with financial incentives were measured as (1) the percentage of practices' revenue from financial incentives for quality or efficiency; and (2) practices' exposure to public reporting of quality measures. We linked physician participation data from Medicare's Physician Compare to the NSPO3 survey. There was wide variation in practices' exposure to performance incentives, with 64 percent exposed to financial incentives, 45 percent exposed to public reporting, and 2.2 percent of practice revenue coming from financial incentives. For each percentage-point increase in financial incentives, there was a 0.9 percentage-point increase in the probability of participating in ACOs (standard error [SE], 0.1, p < .001) and a 0.8 percentage-point increase in the probability of participating in Meaningful Use (SE, 0.1, p < .001), controlling for practice characteristics. Financial incentives were not associated with participation in Physician Compare. Among ACO participants, a 1 percentage-point increase in incentives was associated with a 0.7 percentage-point increase in the probability of being "very well" prepared to utilize cost and quality data (SE, 0.1, p < .001). Physicians organizations' prior experience and success with performance incentives were related to participation in Medicare ACO arrangements and participation in the meaningful use criteria but not to participation in Physician Compare. We conclude that Medicare must complement financial incentives with additional efforts to address the needs of practices with less experience with such incentives to promote value-based payment on a broader scale. © Health Research and Educational Trust.

[Pay for performance explained by transaction costs theory].

PubMed

Gorbaneff, Yuri; Cortes, Ariel; Torres, Sergio; Yepes, Francisco

2011-01-01

To evaluate the ability of transaction costs theory to explain incentives in the health care chain. We performed a case study of CPS, a health insurance company in Bogota (Colombia), which preferred not to publish its name. CPS moves in the environment of high transaction costs and uses the hybrid form of governance at the outpatient level. Incentive intensity, administrative control and the contract all agree with the theory. At the hospital level, the market is used, despite greater uncertainty. Because of the discrete form (1.0) of the incentives and the absence of administrative control, it is difficult for CPS to relate payment to hospital performance. Transaction costs theory explains the configuration of incentives. Another contribution made by this theory to the literature is the criterion to differentiate between the market and the hybrid. We propose that the market uses discrete-type (1.0) incentives, while the hybrid uses continuous, commission-like incentives. Copyright © 2011 SESPAS. Published by Elsevier Espana. All rights reserved.

The Best Laid Plans: Designing Incentive Programs for School Leaders. WCER Working Paper No. 2014-7

ERIC Educational Resources Information Center

Goff, Peter; Goldring, Ellen; Canney, Melissa

2014-01-01

Notable attention and effort has been directed toward improving educator productivity through the use of performance incentives. Little of this work has focused on incentive systems for school leaders (principals) and less yet examines performance pay systems used in practice. This research uses 34 funded grants from the federal Teacher Incentive…

Transfer Incentives for High-Performing Teachers: Final Results from a Multisite Randomized Experiment. NCEE 2014-4004

ERIC Educational Resources Information Center

Glazerman, Steven; Protik, Ali; Teh, Bing-ru; Bruch, Julie; Max, Jeffrey

2013-01-01

One way to improve struggling schools' access to effective teachers is to use selective transfer incentives. Such incentives offer bonuses for the highest-performing teachers to move into schools serving the most disadvantaged students. In this report, we provide evidence from a randomized experiment that tested whether such a policy intervention…

Teacher Attitudes about Performance Incentives in Texas: Early Reactions to the GEEG Program. Research Brief

ERIC Educational Resources Information Center

National Center on Performance Incentives, 2008

2008-01-01

A recent report published by the National Center on Performance Incentives (NCPI) presents findings from the first-year evaluation of the Governor's Educator Excellence Grant (GEEG) program, one of several statewide educator incentive programs in Texas. Findings are based on surveys administered to GEEG teachers during the 2006-07 school year, the…

The Design of Schools' Performance Incentive Programs in Texas: Findings from Year One of GEEG. Research Brief

ERIC Educational Resources Information Center

National Center on Performance Incentives, 2008

2008-01-01

A recent report published by the National Center on Performance Incentives (NCPI) presents findings from the first-year evaluation of the Governor's Educator Excellence Grant (GEEG) program, one of several statewide educator incentive programs in Texas. In this report, the authors provide an overview of 99 schools' locally designed educator…

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.

Evaluation of LADOTD traffic load data for determination of traffic load equivalency factors : technical summary.

DOT National Transportation Integrated Search

2002-04-01

Louisianan has established a traffic monitoring program, compliant with FHWA incentives, that is designed to collect and manage the traffic data needed for the design and management of LADOTD's network of current and future highways. In the early 198...

Emma Elgqvist | NREL

Science.gov Websites

Energy Opportunities, Society of Telecommunication Engineers Cable-Tec Expo (2016) Automotive Lithium-ion Federal Tax Incentives for Battery Storage Systems, NREL Fact Sheet (2017) Portfolio Analysis of Renewable Battery (LIB) Supply Chain and U.S. Competitiveness Considerations, NREL Technical Report (2015) REopt: A

Streamlining: Reducing costs and increasing STS operations effectiveness

NASA Technical Reports Server (NTRS)

Petersburg, R. K.

1985-01-01

The development of streamlining as a concept, its inclusion in the space transportation system engineering and operations support (STSEOS) contract, and how it serves as an incentive to management and technical support personnel is discussed. The mechanics of encouraging and processing streamlining suggestions, reviews, feedback to submitters, recognition, and how individual employee performance evaluations are used to motivation are discussed. Several items that were implemented are mentioned. Information reported and the methodology of determining estimated dollar savings are outlined. The overall effect of this activity on the ability of the McDonnell Douglas flight preparation and mission operations team to support a rapidly increasing flight rate without a proportional increase in cost is illustrated.

Can paying for results help to achieve the Millennium Development Goals? A critical review of selected evaluations of results-based financing.

PubMed

Oxman, Andrew D; Fretheim, Atle

2009-08-01

Results-based financing (RBF) refers to the transfer of money or material goods conditional on taking a measurable action or achieving a predetermined performance target. RBF is being promoted for helping to achieve the Millennium Development Goals (MDGs). We undertook a critical appraisal of selected evaluations of RBF schemes in the health sector in low and middle-income countries (LMIC). In addition, key informants were interviewed to identify literature relevant to the use of RBF in the health sector in LMIC, key examples, evaluations, and other key informants. The use of RBF in LMIC has commonly been a part of a package that may include increased funding, technical support, training, changes in management, and new information systems. It is not possible to disentangle the effects of financial incentives as one element of RBF schemes, and there is very limited evidence of RBF per se having an effect. RBF schemes can have unintended effects. When RBF schemes are used, they should be designed carefully, including the level at which they are targeted, the choice of targets and indicators, the type and magnitude of incentives, the proportion of financing that is paid based on results, and the ancillary components of the scheme. For RBF to be effective, it must be part of an appropriate package of interventions, and technical capacity or support must be available. RBF schemes should be monitored for possible unintended effects and evaluated using rigorous study designs. © 2009 Blackwell Publishing Asia Pty Ltd and Chinese Cochrane Center, West China Hospital of Sichuan University.

Teacher Incentive through Performance Contracting: A Programmatic Approach

ERIC Educational Resources Information Center

Quarles, Royce W.

1974-01-01

Describes an instructional program which applied the incentive theories of performance contracting--but with individualized, diagnostic-based instruction both designed and conducted by the teachers. (RB)

The Productivity Dynamics of China's Environmentally Friendly Production Technologies in terms of Wastewater Treatment Techniques

PubMed Central

Yang, Fuxia; Xu, Jiangchuan

2018-01-01

Low economic profit usually reduces the incentive of producers to operate their wastewater treatment technologies effectively. It is necessary to investigate the performance of environmentally friendly production technologies that reduce wastewater discharges and generate economic outputs simultaneously (EPTWs) in China over the past decade. In this paper, we apply the Malmquist-Luenberger productivity index widely used in the field of economics to evaluate the productivity change of EPTWs for 30 administrative provinces in China during 2003–2015. The pathways of the productivity change are further identified by decomposing the productivity index into two components: technological change and technical efficiency change. The results show that China's environmental productivity index associated with wastewater reduction had undergone a downward trend, and evident spatial disparities are observed among the 30 provincial regions. Moreover, the changes of China's environmental productivity over the whole studied period can mainly be attributed to technological progress, while the technical efficiency component has contributed little, although its annual contributing rate is in an increasing trend. PMID:29789803

Teacher Evaluation, Pay for Performance, and Learning around Instruction: Between Dissonant Incentives and Resonant Procedures

ERIC Educational Resources Information Center

Mintrop, Rick; Ordenes, Miguel; Coghlan, Erin; Pryor, Laura; Madero, Cristobal

2018-01-01

Purpose: The study examines why the logic of a performance management system, supported by the federal Teacher Incentive Fund, might be faulty. It does this by exploring the nuances of the interplay between teaching evaluations as formative and summative, the use of procedures, tools, and artifacts obligated by the local Teacher Incentive Fund…

Teacher Attitudes about Performance Incentives in Texas: Early Reactions to the TEEG Program. Research Brief

ERIC Educational Resources Information Center

National Center on Performance Incentives, 2008

2008-01-01

A recent report published by the National Center on Performance Incentives (NCPI) presents findings from the first-year evaluation of the Texas Educator Excellence Grant (TEEG) program, one of several statewide educator incentive programs in Texas. Findings are based on the responses of full-time instructional personnel at over 1,000 TEEG schools…

Transfer Incentives for High-Performing Teachers: Final Results from a Multisite Randomized Experiment. Executive Summary. NCEE 2014-4004

ERIC Educational Resources Information Center

Glazerman, Steven; Protik, Ali; Teh, Bing-ru; Bruch, Julie; Max, Jeffrey

2013-01-01

One way to improve struggling schools' access to effective teachers is to use selective transfer incentives. Such incentives offer bonuses for the highest-performing teachers to move into schools serving the most disadvantaged students. In this report, we provide evidence from a randomized experiment that tested whether such a policy intervention…

Teacher Work Motivation in the Era of Extrinsic Incentives: Performance Goals and Pro-Social Commitments in the Service of Equity

ERIC Educational Resources Information Center

Mintrop, Rick; Ordenes, Miguel

2017-01-01

Mindful of the withering of high-stakes accountability and disappointing data from pay for performance evaluations in the US, we ask why management by extrinsic incentives and organizational goal setting may have been far less powerful than designers of accountability and extrinsic incentive systems had expected. We explore how…

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…

The Motivation-Cognition Interface in Learning and Decision-Making.

PubMed

Maddox, W Todd; Markman, Arthur B

2010-04-01

In this article we discuss how incentive motivations and task demands affect performance. We present a three-factor framework that suggests that performance is determined from the interaction of global incentives, local incentives, and the psychological processes needed to achieve optimal task performance. We review work that examines the implications of the motivation-cognition interface in classification, choice and on phenomena such as stereotype threat and performance pressure. We show that under some conditions stereotype threat and pressure accentuate performance. We discuss the implications of this work for neuropsychological assessment, and outline a number of challenges for future research.

Value affect of construction incentive payments on pavement performance.

DOT National Transportation Integrated Search

2009-08-01

The Michigan Department of Transportation (MDOT) has been using monetary incentive payments : for many years to improve contractors conformance with specifications and their overall : workmanship. It was envisioned that incentive/disincentive (I/D...

Barriers to Electronic Health Record Adoption: a Systematic Literature Review.

PubMed

Kruse, Clemens Scott; Kristof, Caitlin; Jones, Beau; Mitchell, Erica; Martinez, Angelica

2016-12-01

Federal efforts and local initiatives to increase adoption and use of electronic health records (EHRs) continue, particularly since the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act. Roughly one in four hospitals not adopted even a basic EHR system. A review of the barriers may help in understanding the factors deterring certain healthcare organizations from implementation. We wanted to assemble an updated and comprehensive list of adoption barriers of EHR systems in the United States. Authors searched CINAHL, MEDLINE, and Google Scholar, and accepted only articles relevant to our primary objective. Reviewers independently assessed the works highlighted by our search and selected several for review. Through multiple consensus meetings, authors tapered articles to a final selection most germane to the topic (n = 27). Each article was thoroughly examined by multiple authors in order to achieve greater validity. Authors identified 39 barriers to EHR adoption within the literature selected for the review. These barriers appeared 125 times in the literature; the most frequently mentioned barriers were regarding cost, technical concerns, technical support, and resistance to change. Despite federal and local incentives, the initial cost of adopting an EHR is a common existing barrier. The other most commonly mentioned barriers include technical support, technical concerns, and maintenance/ongoing costs. Policy makers should consider incentives that continue to reduce implementation cost, possibly aimed more directly at organizations that are known to have lower adoption rates, such as small hospitals in rural areas.

Feasibility Study of Economics and Performance of Solar Photovoltaics in the Commonwealth of Puerto Rico

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

Salasovich, J.; Mosey, G.

2011-03-01

This report presents the results of an assessment of the technical and economic feasibility of deploying a photovoltaics (PV) system on brownfield sites in the Commonwealth of Puerto Rico. All of the assessed sites are landfills. The sites were assessed for possible PV installations. The cost, performance, and site impacts of different PV options were estimated. The economics of the potential systems were analyzed using an electric rate of $0.119/kWh and incentives offered by Puerto Rico and by the serving utility, PREPA. According to the site production calculations, the most cost-effective system in terms of return on investment is themore » thin-film fixed-tilt technology. The report recommends financing options that could assist in the implementation of such a system.« less

Feasibility Study of Economics and Performance of Solar Photovoltaics at the Former St. Marks Refinery in St. Marks, Florida

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

Lisell, L.; Mosey, G.

2010-09-01

This report presents the results of an assessment of the technical and economic feasibility of deploying a photovoltaics (PV) system on a brownfield site in St. Marks, Florida. The site was assessed for possible PV installations. The cost, performance, and site impacts of different PV options were estimated. The economics of the potential systems were analyzed using an electric rate of $0.08/kWh and incentives offered in the State of Florida and from the two accessible utilities, Progress Energy and the City of Tallahassee. According to the site production calculations, the most cost-effective system in terms of return on investment ismore » the fixed-tilt thin film technology. The report recommends financing options that could assist in the implementation of such a system.« less

NREL Suite of Tools for PV and Storage Analysis

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

Elgqvist, Emma M; Salasovich, James A

Many different factors such as the solar resource, technology costs and incentives, utility cost and consumption, space available, and financial parameters impact the technical and economic potential of a PV project. NREL has developed techno-economic modeling tools that can be used to evaluate PV projects at a site.

Problems of the Financing of Russian Science

ERIC Educational Resources Information Center

Mindeli, L.; Chernykh, S.

2010-01-01

One of the most important factors that determine the state of science potential and, in the long run, the successful results of scientific and technical activity, is its financing. All developed countries conduct an incentive policy to encourage their national science, including systematic support from state budgets for scientific research and…

Implementing Computer Integrated Manufacturing Technician Program.

ERIC Educational Resources Information Center

Gibbons, Roger

A computer-integrated manufacturing (CIM) technician program was developed to provide training and technical assistance to meet the needs of business and industry in the face of the demands of high technology. The Computer and Automated Systems Association (CASA) of the Society of Manufacturing Engineers provided the incentive and guidelines…

48 CFR 246.710 - Contract clauses.

Code of Federal Regulations, 2010 CFR

2010-10-01

... contracts that include the clause at 252.227-7013, Rights in Technical Data and Computer Software, when... Alternate I when extended liability is desired and a fixed price incentive contract is contemplated. (3) Use... and a firm fixed price contract is contemplated. (4) Use the clause at 252.246-7002, Warranty of...

Young Adult Capacity Initiative Cross-Site Analysis

ERIC Educational Resources Information Center

Academy for Educational Development, 2012

2012-01-01

This cross-site analysis presents findings about the implementation, impact, and outcomes of the Young Adult Capacity Initiative (YACI), at 13 community-based organizations in New York City. These agencies received technical assistance and small incentive grants from the Fund for the City of New York Youth Development Institute (YDI) to build…

Training and the Feds.

ERIC Educational Resources Information Center

Training, 1993

1993-01-01

In a survey of 4,635 training professionals (49% response), 49% were opposed to federally mandated minimum training expenditures; 68% thought tax incentives would increase amount companies spend on training; one-third of companies spend less than 1.5% of payroll on training. Technical assistance and tax credits were most popular roles for…

Safety belt and motorcycle helmet use in Virginia : results of the 1994 survey : technical assistance report.

DOT National Transportation Integrated Search

1994-01-01

This series of surveys was initiated to qualify the state for Intermodal Surface Transportation Efficiency Act 153 incentive funds. To qualify for funds in each of the 3 years the program was in operation, states had to meet specific standards with r...

A Graphical Approach to the Standard Principal-Agent Model.

ERIC Educational Resources Information Center

Zhou, Xianming

2002-01-01

States the principal-agent theory is difficult to teach because of its technical complexity and intractability. Indicates the equilibrium in the contract space is defined by the incentive parameter and insurance component of pay under a linear contract. Describes a graphical approach that students with basic knowledge of algebra and…

What to do? The effects of discrepancies, incentives, and time on dynamic goal prioritization.

PubMed

Schmidt, Aaron M; DeShon, Richard P

2007-07-01

This study examined factors that influence the dynamic pursuit of multiple goals over time. As hypothesized, goal-performance discrepancies were significantly related to subsequent time allocation. Greater distance from a given goal resulted in greater time subsequently allocated to that goal. In addition, the incentives offered for goal attainment determined the relative influence of discrepancies for each goal. When the incentives for each goal were equivalent, progress toward each goal exhibited equal influence, with greater time allocated to whichever goal was furthest from completion at the time. However, with an incentive available for only 1 of the 2 goals, time allocation was largely determined by progress toward the rewarded goal. Likewise, when incentives for each task differed in their approach-avoidance framing, progress toward the avoidance-framed goal was a stronger predictor of subsequent allocation than was progress toward the approach-framed goal. Finally, the influence of goal-performance discrepancies differed as a function of the time remaining for goal pursuit. The implications for future work on dynamic goal prioritization and the provision of performance incentives are discussed.

Design, rationale, and baseline characteristics of a cluster randomized controlled trial of pay for performance for hypertension treatment: study protocol

PubMed Central

2011-01-01

Background Despite compelling evidence of the benefits of treatment and well-accepted guidelines for treatment, hypertension is controlled in less than one-half of United States citizens. Methods/design This randomized controlled trial tests whether explicit financial incentives promote the translation of guideline-recommended care for hypertension into clinical practice and improve blood pressure (BP) control in the primary care setting. Using constrained randomization, we assigned 12 Veterans Affairs hospital outpatient clinics to four study arms: physician-level incentive; group-level incentive; combination of physician and group incentives; and no incentives (control). All participants at the hospital (cluster) were assigned to the same study arm. We enrolled 83 full-time primary care physicians and 42 non-physician personnel. The intervention consisted of an educational session about guideline-recommended care for hypertension, five audit and feedback reports, and five disbursements of incentive payments. Incentive payments rewarded participants for chart-documented use of guideline-recommended antihypertensive medications, BP control, and appropriate responses to uncontrolled BP during a prior four-month performance period over the 20-month intervention. To identify potential unintended consequences of the incentives, the study team interviewed study participants, as well as non-participant primary care personnel and leadership at study sites. Chart reviews included data collection on quality measures not related to hypertension. To evaluate the persistence of the effect of the incentives, the study design includes a washout period. Discussion We briefly describe the rationale for the interventions being studied, as well as the major design choices. Rigorous research designs such as the one described here are necessary to determine whether performance-based payment arrangements such as financial incentives result in meaningful quality improvements. Trial Registration http://www.clinicaltrials.gov NCT00302718 PMID:21967830

Comparison of Diaphragmatic Breathing Exercise, Volume and Flow Incentive Spirometry, on Diaphragm Excursion and Pulmonary Function in Patients Undergoing Laparoscopic Surgery: A Randomized Controlled Trial

PubMed Central

Anand, R.

2016-01-01

Objective. To evaluate the effects of diaphragmatic breathing exercises and flow and volume-oriented incentive spirometry on pulmonary function and diaphragm excursion in patients undergoing laparoscopic abdominal surgery. Methodology. We selected 260 patients posted for laparoscopic abdominal surgery and they were block randomization as follows: 65 patients performed diaphragmatic breathing exercises, 65 patients performed flow incentive spirometry, 65 patients performed volume incentive spirometry, and 65 patients participated as a control group. All of them underwent evaluation of pulmonary function with measurement of Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), Peak Expiratory Flow Rate (PEFR), and diaphragm excursion measurement by ultrasonography before the operation and on the first and second postoperative days. With the level of significance set at p < 0.05. Results. Pulmonary function and diaphragm excursion showed a significant decrease on the first postoperative day in all four groups (p < 0.001) but was evident more in the control group than in the experimental groups. On the second postoperative day pulmonary function (Forced Vital Capacity) and diaphragm excursion were found to be better preserved in volume incentive spirometry and diaphragmatic breathing exercise group than in the flow incentive spirometry group and the control group. Pulmonary function (Forced Vital Capacity) and diaphragm excursion showed statistically significant differences between volume incentive spirometry and diaphragmatic breathing exercise group (p < 0.05) as compared to that flow incentive spirometry group and the control group. Conclusion. Volume incentive spirometry and diaphragmatic breathing exercise can be recommended as an intervention for all patients pre- and postoperatively, over flow-oriented incentive spirometry for the generation and sustenance of pulmonary function and diaphragm excursion in the management of laparoscopic abdominal surgery. PMID:27525116

Comparison of Diaphragmatic Breathing Exercise, Volume and Flow Incentive Spirometry, on Diaphragm Excursion and Pulmonary Function in Patients Undergoing Laparoscopic Surgery: A Randomized Controlled Trial.

PubMed

Alaparthi, Gopala Krishna; Augustine, Alfred Joseph; Anand, R; Mahale, Ajith

2016-01-01

Objective. To evaluate the effects of diaphragmatic breathing exercises and flow and volume-oriented incentive spirometry on pulmonary function and diaphragm excursion in patients undergoing laparoscopic abdominal surgery. Methodology. We selected 260 patients posted for laparoscopic abdominal surgery and they were block randomization as follows: 65 patients performed diaphragmatic breathing exercises, 65 patients performed flow incentive spirometry, 65 patients performed volume incentive spirometry, and 65 patients participated as a control group. All of them underwent evaluation of pulmonary function with measurement of Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), Peak Expiratory Flow Rate (PEFR), and diaphragm excursion measurement by ultrasonography before the operation and on the first and second postoperative days. With the level of significance set at p < 0.05. Results. Pulmonary function and diaphragm excursion showed a significant decrease on the first postoperative day in all four groups (p < 0.001) but was evident more in the control group than in the experimental groups. On the second postoperative day pulmonary function (Forced Vital Capacity) and diaphragm excursion were found to be better preserved in volume incentive spirometry and diaphragmatic breathing exercise group than in the flow incentive spirometry group and the control group. Pulmonary function (Forced Vital Capacity) and diaphragm excursion showed statistically significant differences between volume incentive spirometry and diaphragmatic breathing exercise group (p < 0.05) as compared to that flow incentive spirometry group and the control group. Conclusion. Volume incentive spirometry and diaphragmatic breathing exercise can be recommended as an intervention for all patients pre- and postoperatively, over flow-oriented incentive spirometry for the generation and sustenance of pulmonary function and diaphragm excursion in the management of laparoscopic abdominal surgery.

Design, rationale, and baseline characteristics of a cluster randomized controlled trial of pay for performance for hypertension treatment: study protocol.

PubMed

Petersen, Laura A; Urech, Tracy; Simpson, Kate; Pietz, Kenneth; Hysong, Sylvia J; Profit, Jochen; Conrad, Douglas; Dudley, R Adams; Lutschg, Meghan Z; Petzel, Robert; Woodard, Lechauncy D

2011-10-03

Despite compelling evidence of the benefits of treatment and well-accepted guidelines for treatment, hypertension is controlled in less than one-half of United States citizens. This randomized controlled trial tests whether explicit financial incentives promote the translation of guideline-recommended care for hypertension into clinical practice and improve blood pressure (BP) control in the primary care setting. Using constrained randomization, we assigned 12 Veterans Affairs hospital outpatient clinics to four study arms: physician-level incentive; group-level incentive; combination of physician and group incentives; and no incentives (control). All participants at the hospital (cluster) were assigned to the same study arm. We enrolled 83 full-time primary care physicians and 42 non-physician personnel. The intervention consisted of an educational session about guideline-recommended care for hypertension, five audit and feedback reports, and five disbursements of incentive payments. Incentive payments rewarded participants for chart-documented use of guideline-recommended antihypertensive medications, BP control, and appropriate responses to uncontrolled BP during a prior four-month performance period over the 20-month intervention. To identify potential unintended consequences of the incentives, the study team interviewed study participants, as well as non-participant primary care personnel and leadership at study sites. Chart reviews included data collection on quality measures not related to hypertension. To evaluate the persistence of the effect of the incentives, the study design includes a washout period. We briefly describe the rationale for the interventions being studied, as well as the major design choices. Rigorous research designs such as the one described here are necessary to determine whether performance-based payment arrangements such as financial incentives result in meaningful quality improvements. http://www.clinicaltrials.govNCT00302718.

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…

42 CFR § 414.1320 - MIPS performance period.

Code of Federal Regulations, 2010 CFR

2017-10-01

... (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1320 MIPS performance period. (a) For purposes of the 2019 MIPS payment year, the performance period for all performance categories and...

48 CFR 48.105 - Relationship to other incentives.

Code of Federal Regulations, 2011 CFR

2011-10-01

... incentives of the contract. To that end, when performance, design-to-cost, or similar targets are set and incentivized, the targets of such incentives affected by the VECP are not to be adjusted because of the...

Monetary incentives to reinforce engagement and achievement in a job-skills training program for homeless, unemployed adults.

PubMed

Koffarnus, Mikhail N; Wong, Conrad J; Fingerhood, Michael; Svikis, Dace S; Bigelow, George E; Silverman, Kenneth

2013-01-01

The current study examined whether monetary incentives could increase engagement and achievement in a job-skills training program for unemployed, homeless, alcohol-dependent adults. Participants (n=124) were randomized to a no-reinforcement group (n=39), during which access to the training program was provided but no incentives were given; a training reinforcement group (n=42), during which incentives were contingent on attendance and performance; or an abstinence and training reinforcement group (n=43), during which incentives were contingent on attendance and performance, but access was granted only if participants demonstrated abstinence from alcohol. abstinence and training reinforcement and training reinforcement participants advanced further in training and attended more hours than no-reinforcement participants. Monetary incentives were effective in promoting engagement and achievement in a job-skills training program for individuals who often do not take advantage of training programs. © Society for the Experimental Analysis of Behavior.

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

Barbose, Galen; Wiser, Ryan; Bolinger, Mark

Increasing levels of financial support for customer-sited photovoltaic (PV) systems, provided through publicly-funded incentive programs, has heightened concerns about the long-term performance of these systems. Given the barriers that customers face to ensuring that their PV systems perform well, and the responsibility that PV incentive programs bear to ensure that public funds are prudently spent, these programs should, and often do, play a critical role in ensuring that PV systems receiving incentives perform well. To provide a point of reference for assessing the current state of the art, and to inform program design efforts going forward, we examine the approachesmore » to encouraging PV system performance used by 32 prominent PV incentive programs in the U.S. We identify eight general strategies or groups of related strategies that these programs have used to address performance issues, and highlight important differences in the implementation of these strategies among programs.« less

Higher incentives can impair performance: neural evidence on reinforcement and rationality.

PubMed

Achtziger, Anja; Alós-Ferrer, Carlos; Hügelschäfer, Sabine; Steinhauser, Marco

2015-11-01

Standard economic thinking postulates that increased monetary incentives should increase performance. Human decision makers, however, frequently focus on past performance, a form of reinforcement learning occasionally at odds with rational decision making. We used an incentivized belief-updating task from economics to investigate this conflict through measurements of neural correlates of reward processing. We found that higher incentives fail to improve performance when immediate feedback on decision outcomes is provided. Subsequent analysis of the feedback-related negativity, an early event-related potential following feedback, revealed the mechanism behind this paradoxical effect. As incentives increase, the win/lose feedback becomes more prominent, leading to an increased reliance on reinforcement and more errors. This mechanism is relevant for economic decision making and the debate on performance-based payment. © The Author (2015). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.

The Impact of Social Pressure and Monetary Incentive on Cognitive Control

PubMed Central

Ličen, Mina; Hartmann, Frank; Repovš, Grega; Slapničar, Sergeja

2016-01-01

We compare the effects of two prominent organizational control mechanisms—social pressure and monetary incentive—on cognitive control. Cognitive control underlies the human ability to regulate thoughts and actions in the pursuit of behavioral goals. Previous studies show that monetary incentives can contribute to goal-oriented behavior by activating proactive control. There is, however, much less evidence of how social pressure affects cognitive control and task performance. In a within-subject experimental design, we tested 47 subjects performing the AX-CPT task to compare the activation of cognitive control modes under social pressure and monetary incentive beyond mere instructions to perform better. Our results indicate that instructing participants to improve their performance on its own leads to a significant shift from a reactive to a proactive control mode and that both social pressure and monetary incentive further enhance performance. PMID:26903901

A Study on the Self-Adaption Incentive Performance Salary

NASA Astrophysics Data System (ADS)

Zhang, Chuanming; Wang, Yang

In project managing, the performance salary management mode is often used to motivate project managers and other similar staff to improve performance or reduce the cost. But the engineering activities who own a lot of internal and external uncertain factors can not be known by the principle. It is difficult for to develop a suitable incentive target to project managers etch. This paper thinks that the manager self master the maximum of information on engineering activities. So this paper sets up an incentive model: the project managers themselves report performance objectives; owner gives the managers reward or punishment combined with their reported performance and actual performance. The model to ensure that the project manager is only accurate self reported its results to get the maximum profit. At the same time, it cans incentive managers to improve performance or reduce the cost. This paper focuses on setting up the model, analyzing the model parameters. And cite an example analyze them.

Measuring Provider Performance for Physicians Participating in the Merit-Based Incentive Payment System.

PubMed

Squitieri, Lee; Chung, Kevin C

2017-07-01

In 2017, the Centers for Medicare and Medicaid Services began requiring all eligible providers to participate in the Quality Payment Program or face financial reimbursement penalty. The Quality Payment Program outlines two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. For the first performance period beginning in January of 2017, the Centers for Medicare and Medicaid Services estimates that approximately 83 to 90 percent of eligible providers will not qualify for participation in an Advanced Alternative Payment Model and therefore must participate in the Merit-Based Incentive Payment System program. The Merit-Based Incentive Payment System path replaces existing quality-reporting programs and adds several new measures to evaluate providers using four categories of data: (1) quality, (2) cost/resource use, (3) improvement activities, and (4) advancing care information. These categories will be combined to calculate a weighted composite score for each provider or provider group. Composite Merit-Based Incentive Payment System scores based on 2017 performance data will be used to adjust reimbursed payment in 2019. In this article, the authors provide relevant background for understanding value-based provider performance measurement. The authors also discuss Merit-Based Incentive Payment System reporting requirements and scoring methodology to provide plastic surgeons with the necessary information to critically evaluate their own practice capabilities in the context of current performance metrics under the Quality Payment Program.

Temporal Dynamics of Motivation-Cognitive Control Interactions Revealed by High-Resolution Pupillometry

PubMed Central

Chiew, Kimberly S.; Braver, Todd S.

2013-01-01

Motivational manipulations, such as the presence of performance-contingent reward incentives, can have substantial influences on cognitive control. Previous evidence suggests that reward incentives may enhance cognitive performance specifically through increased preparatory, or proactive, control processes. The present study examined reward influences on cognitive control dynamics in the AX-Continuous Performance Task (AX-CPT), using high-resolution pupillometry. In the AX-CPT, contextual cues must be actively maintained over a delay in order to appropriately respond to ambiguous target probes. A key feature of the task is that it permits dissociable characterization of preparatory, proactive control processes (i.e., utilization of context) and reactive control processes (i.e., target-evoked interference resolution). Task performance profiles suggested that reward incentives enhanced proactive control (context utilization). Critically, pupil dilation was also increased on reward incentive trials during context maintenance periods, suggesting trial-specific shifts in proactive control, particularly when context cues indicated the need to overcome the dominant target response bias. Reward incentives had both transient (i.e., trial-by-trial) and sustained (i.e., block-based) effects on pupil dilation, which may reflect distinct underlying processes. The transient pupillary effects were present even when comparing against trials matched in task performance, suggesting a unique motivational influence of reward incentives. These results suggest that pupillometry may be a useful technique for investigating reward motivational signals and their dynamic influence on cognitive control. PMID:23372557

48 CFR 16.402-2 - Performance incentives.

Code of Federal Regulations, 2010 CFR

2010-10-01

... 48 Federal Acquisition Regulations System 1 2010-10-01 2010-10-01 false Performance incentives. 16.402-2 Section 16.402-2 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION... appropriate in major systems contracts, both in development (when performance objectives are known and the...

45 CFR 305.34 - Payment of incentives.

Code of Federal Regulations, 2010 CFR

2010-10-01

... PROGRAM PERFORMANCE MEASURES, STANDARDS, FINANCIAL INCENTIVES, AND PENALTIES § 305.34 Payment of... performance data submitted by December 31st by the State and other States for that fiscal year. A positive or...

Shared vision and autonomous motivation vs. financial incentives driving success in corporate acquisitions

PubMed Central

Clayton, Byron C.

2015-01-01

Successful corporate acquisitions require its managers to achieve substantial performance improvements in order to sufficiently cover acquisition premiums, the expected return of debt and equity investors, and the additional resources needed to capture synergies and accelerate growth. Acquirers understand that achieving the performance improvements necessary to cover these costs and create value for investors will most likely require a significant effort from mergers and acquisitions (M&A) management teams. This understanding drives the common and longstanding practice of offering hefty performance incentive packages to key managers, assuming that financial incentives will induce in-role and extra-role behaviors that drive organizational change and growth. The present study debunks the assumptions of this common M&A practice, providing quantitative evidence that shared vision and autonomous motivation are far more effective drivers of managerial performance than financial incentives. PMID:25610406

Shared vision and autonomous motivation vs. financial incentives driving success in corporate acquisitions.

PubMed

Clayton, Byron C

2014-01-01

Successful corporate acquisitions require its managers to achieve substantial performance improvements in order to sufficiently cover acquisition premiums, the expected return of debt and equity investors, and the additional resources needed to capture synergies and accelerate growth. Acquirers understand that achieving the performance improvements necessary to cover these costs and create value for investors will most likely require a significant effort from mergers and acquisitions (M&A) management teams. This understanding drives the common and longstanding practice of offering hefty performance incentive packages to key managers, assuming that financial incentives will induce in-role and extra-role behaviors that drive organizational change and growth. The present study debunks the assumptions of this common M&A practice, providing quantitative evidence that shared vision and autonomous motivation are far more effective drivers of managerial performance than financial incentives.

Insights from transformations under way at four Brookings-Dartmouth accountable care organization pilot sites.

PubMed

Larson, Bridget K; Van Citters, Aricca D; Kreindler, Sara A; Carluzzo, Kathleen L; Gbemudu, Josette N; Wu, Frances M; Nelson, Eugene C; Shortell, Stephen M; Fisher, Elliott S

2012-11-01

This cross-site comparison of the early experience of four provider organizations participating in the Brookings-Dartmouth Accountable Care Organization Collaborative identifies factors that sites perceived as enablers of successful ACO formation and performance. The four pilots varied in size, with between 7,000 and 50,000 attributed patients and 90 to 2,700 participating physicians. The sites had varying degrees of experience with performance-based payments; however, all formed collaborative new relationships with payers and created shared savings agreements linked to performance on quality measures. Each organization devoted major efforts to physician engagement. Policy makers now need to consider how to support and provide incentives for the successful formation of multipayer ACOs, and how to align private-sector and CMS performance measures. Linking providers to learning networks where payers and providers can address common technical issues could help. These sites' transitions to the new payment model constitutes an ongoing journey that will require continual adaptation in the structure of contracts and organizational attributes.

The Incentive Grant Approach in Higher Education: A 15 Year Record. Institute for Educational Leadership Reports: Nine.

ERIC Educational Resources Information Center

Finkelstein, Martin

The incentive grant approach in higher Education is a resource allocation strategy that may have significant positive impact on educational performance. This document covers: (1) the incentive grant approach to resource allocation; (2) the evolution during the past 15 years of types of incentive grant programs and the contrasting roles played by…

Effect of extrinsic incentives on use of test anxiety as an anticipatory attributional defense: playing it cool when the stakes are high.

PubMed

Greenberg, J; Pyszczynski, T; Paisley, C

1984-11-01

We conducted an experiment to assess the effect of extrinsic incentives on the use of test anxiety as a self-handicapping strategy. We hypothesized that although reports of anxiety may be greater when such symptoms can serve a defensive function, this effect occurs only when extrinsic incentives are low and not under conditions of high extrinsic incentive. Eighty-four male undergraduates anticipated taking a test of intellectual abilities and either were led to believe that test anxiety has no effect on test performance or were given no particular information about the relation between test anxiety and performance. Subjects were offered either +5 or +25 for obtaining the highest score on the test. Consistent with predictions, no-information subjects reported greater test anxiety before the test than did those who believed that test anxiety was unrelated to performance, but only when the extrinsic incentive for performance was low. However, these subjects did not report greater cognitive interference or exhibit lower test scores than did subjects in other conditions. It is tentatively suggested that the defensive strategy used by these subjects consisted of altering perceptions of anxiety, rather than anxiety itself. The implications of the absence of self-handicapping under high incentive conditions are discussed.

Prospective memory in preschool children: influences of agency, incentive, and underlying cognitive mechanisms.

PubMed

Causey, Kayla B; Bjorklund, David F

2014-11-01

Prospective memory (PM) is remembering to perform an action in the future and is crucial to achieving goal-directed activities in everyday life. Doing so requires that an intention is encoded, retained during a delay interval, and retrieved at the appropriate time of execution. We examined PM ability in preschool children by manipulating factors related to agency and incentive. We further explored how metacognition, executive functioning, and theory of mind-factors known to account for individual differences in PM-influenced performance on these PM tasks. A sample of 31 preschool children were asked to carry out a delayed intention or to remind an adult to carry out an intention that was of high or low incentive to the children. Findings indicated that individual differences in theory of mind were related to individual differences in preschoolers' performance on low-incentive PM tasks, independent of executive functioning contributions, whereas individual differences in executive functioning were related to performance on the high-incentive tasks. These findings suggest that changes in theory of mind and executive functioning are important to consider in models of PM and that different PM tasks (e.g., high vs. low incentive) may involve different cognitive requirements for young children. Copyright © 2014 Elsevier Inc. All rights reserved.

Hospital responses to pay-for-performance incentives.

PubMed

Reiter, Kristin L; Nahra, Tammie A; Alexander, Jeffrey A; Wheeler, John R C

2006-05-01

Not-for-profit hospitals are complex organizations and, therefore, may face unique challenges in responding to financial incentives for quality. In this research, we explore the types of behavioural changes made by not-for-profit Michigan hospitals in response to a pay-for-performance system for quality. We also identify factors that motivate or facilitate changes in effort. We apply a conceptual framework based on agency theory to motivate our research questions. Using data derived from structured interviews and surveys administered to 86 hospitals participating in a pay-for-performance system, we compare hospitals reporting and not reporting behavioural changes. Separate analyses are performed for hospitals reporting structure-related changes and hospitals reporting process-related changes. Our findings confirm that hospitals respond to incentive payments; however, our findings also reveal that hospital responses are not universal. Rather, involvement by boards of trustees, willingness to exert leverage with physicians, and financial and competitive motivations are all associated with hospitals' behavioural responses to incentives. Results of this research will help inform payers and hospital managers considering the use of incentives about the nature of hospitals' responses.

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

Barbose, Galen; Wiser, Ryan; Bolinger, Mark

In the U.S., the increasing financial support for customer-sited photovoltaic (PV) systems provided through publicly-funded incentive programs has heightened concerns about the long-term performance of these systems. Given the barriers that customers face to ensuring that their PV systems perform well, and the responsibility that PV incentive programs bear to ensure that public funds are prudently spent, these programs should, and often do, play a critical role in addressing PV system performance. To provide a point of reference for assessing the current state of the art, and to inform program design efforts going forward, we examine the approaches to encouragingmore » PV system performance used by 32 prominent PV incentive programs in the U.S. We identify eight general strategies or groups of related strategies that these programs have used to address factors that affect performance, and describe key implementation details. Based on this review, we then offer recommendations for how PV incentive programs can be effectively designed to mitigate potential performance issues.« less

Paying for performance: Performance incentives increase desire for the reward object.

PubMed

Hur, Julia D; Nordgren, Loran F

2016-09-01

The current research examines how exposure to performance incentives affects one's desire for the reward object. We hypothesized that the flexible nature of performance incentives creates an attentional fixation on the reward object (e.g., money), which leads people to become more desirous of the rewards. Results from 5 laboratory experiments and 1 large-scale field study provide support for this prediction. When performance was incentivized with monetary rewards, participants reported being more desirous of money (Study 1), put in more effort to earn additional money in an ensuing task (Study 2), and were less willing to donate money to charity (Study 4). We replicated the result with nonmonetary rewards (Study 5). We also found that performance incentives increased attention to the reward object during the task, which in part explains the observed effects (Study 6). A large-scale field study replicated these findings in a real-world setting (Study 7). One laboratory experiment failed to replicate (Study 3). (PsycINFO Database Record (c) 2016 APA, all rights reserved).

Rewards and Performance Incentives.

ERIC Educational Resources Information Center

Zigon, Jack

1994-01-01

Discusses rewards and performance incentives for employees, including types of rewards; how rewards help in managing; dysfunctional awards; selecting the right reward; how to find rewards that fit; and delivering rewards effectively. Examples are included. (three references) (LRW)

Breakeven Prices for Photovoltaics on Supermarkets in the United States

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

Ong, S.; Clark, N.; Denholm, P.

The photovoltaic (PV) breakeven price is the PV system price at which the cost of PV-generated electricity equals the cost of electricity purchased from the grid. This point is also called 'grid parity' and can be expressed as dollars per watt ($/W) of installed PV system capacity. Achieving the PV breakeven price depends on many factors, including the solar resource, local electricity prices, customer load profile, PV incentives, and financing. In the United States, where these factors vary substantially across regions, breakeven prices vary substantially across regions as well. In this study, we estimate current and future breakeven prices formore » PV systems installed on supermarkets in the United States. We also evaluate key drivers of current and future commercial PV breakeven prices by region. The results suggest that breakeven prices for PV systems installed on supermarkets vary significantly across the United States. Non-technical factors -- including electricity rates, rate structures, incentives, and the availability of system financing -- drive break-even prices more than technical factors like solar resource or system orientation. In 2020 (where we assume higher electricity prices and lower PV incentives), under base-case assumptions, we estimate that about 17% of supermarkets will be in utility territories where breakeven conditions exist at a PV system price of $3/W; this increases to 79% at $1.25/W (the DOE SunShot Initiative's commercial PV price target for 2020). These percentages increase to 26% and 91%, respectively, when rate structures favorable to PV are used.« less

Farmer Participation in U.S. Farm Bill Conservation Programs

NASA Astrophysics Data System (ADS)

Reimer, Adam P.; Prokopy, Linda S.

2014-02-01

Conservation policy in agricultural systems in the United States relies primarily on voluntary action by farmers. Federal conservation programs, including the Environmental Quality Incentives Program, offer incentives, both financial and technical, to farmers in exchange for adoption of conservation practices. Understanding motivations for (as well as barriers to) participation in voluntary programs is important for the design of future policy and effective outreach. While a significant literature has explored motivations and barriers to conservation practice adoption and participation in single programs, few studies in the U.S. context have explored general participation by farmers in one place and time. A mixed-methods research approach was utilized to explore farmer participation in all U.S. Farm Bill programs in Indiana. Current and past program engagement was high, with nearly half of survey respondents reporting participation in at least one program. Most participants had experience with the Conservation Reserve Program, with much lower participation rates in other programs. Most interview participants who had experience in programs were motivated by the environmental benefits of practices, with incentives primarily serving to reduce the financial and technical barriers to practice adoption. The current policy arrangement, which offers multiple policy approaches to conservation, offers farmers with different needs and motivations a menu of options. However, evidence suggests that the complexity of the system may be a barrier that prevents participation by farmers with scarce time or resources. Outreach efforts should focus on increasing awareness of program options, while future policy must balance flexibility of programs with complexity.

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…

WWC Review of the Report "Incentives, Selection, and Teacher Performance: Evidence from IMPACT." What Works Clearinghouse Single Study Review

ERIC Educational Resources Information Center

What Works Clearinghouse, 2014

2014-01-01

The 2013 study, "Incentives, Selection, and Teacher Performance: Evidence from IMPACT" examined the effects of "IMPACT," a teacher evaluation system used in the District of Columbia Public Schools, on teacher retention and performance. "IMPACT" assigns each teacher a single performance score based on classroom…

Strategic and Market Analysis | Bioenergy | NREL

Science.gov Websites

recent efforts in comparative techno-economic analysis. Our analysis considers a wide range of conversion Intermediates NREL has developed first-of-its-kind process models and economic assessments of the co-processing work strives to understand the economic incentives, technical risks, and key data gaps that need to be

Recruiting Health Information Faculty: The Effects of Monetary Recruitment Incentives

ERIC Educational Resources Information Center

Winter, Paul A.; Logsdon, Marsha R.

2004-01-01

This paper addresses recruitment of Health Information faculty for community and technical colleges, an issue of crucial importance because many faculty hired during the enrollment boom of the 1960s are retiring. The design for this research was a factorial experiment, involving a two-way analysis of variance. The participants (N = 194) were…

Federal Programs Which May Support the Training of Neighborhood Residents for Jobs in Neighborhood Health Centers.

ERIC Educational Resources Information Center

Office of Economic Opportunity, Washington, DC. Community Action Program.

The following programs are included: (1) Manpower Development and Training Act, (2) New Careers, (3) Vocational and Technical Education, (4) Work Incentive (WIN), (5) Neighborhood Youth Corps, (6) Demonstration Projects, and (7) Veterans Administration Training Assistance. Information about each program includes nature and purpose, national and…

Technical assistance for intensive culture of northern forest types

Treesearch

Timothy G. OKeffe

1977-01-01

During this Bicentennial celebration, it is interesting to note that in America TA programs in forestry have evolved from both a formal and an informal foundation. European foresters, attempting to motivate many small forest landowners to practice more intensive forest management, have learned that incentive and educational TA programs are far more effective than...

Implicit activation of the aging stereotype influences effort-related cardiovascular response: The role of incentive.

PubMed

Zafeiriou, Athina; Gendolla, Guido H E

2017-09-01

Based on previous research on implicit effects on effort-related cardiovascular response and evidence that aging is associated with cognitive difficulties, we tested whether the mere activation of the aging stereotype can systematically influence young individuals' effort-mobilization during cognitive performance. Young participants performed an objectively difficult short-term memory task during which they processed elderly vs. youth primes and expected low vs. high incentive for success. When participants processed elderly primes during the task, we expected cardiovascular response to be weak in the low-incentive condition and strong in the high-incentive condition. Unaffected by incentive, effort in the youth-prime condition should fall in between the two elderly-prime cells. Effects on cardiac pre-ejection period (PEP) and heart rate (HR) largely supported these predictions. The present findings show for the first time that the mere activation of the aging stereotype can systematically influence effort mobilization during cognitive performance-even in young adults. Copyright © 2017 Elsevier B.V. All rights reserved.

The efficacy of postoperative incentive spirometry is influenced by the device-specific imposed work of breathing.

PubMed

Weindler, J; Kiefer, R T

2001-06-01

The study evaluated the impact of the additional imposed work of breathing (WBimp) generated by two different spirometers on postoperative incentive spirometry performance in patients at high risk and moderate risk for postoperative pulmonary complications (PPCs). Additionally, we investigated whether maximal inspiratory pressure (PImax) is an easy estimate of the WBimp imposed by incentive spirometers. Prospective, randomized, single-blind clinical trial. ICU of a university hospital. Thirty male patients were assigned to a group at high risk for PPCs (group A; inspiratory capacity [IC], < 1.6 L) or to a group at moderate risk for PPCs (group B; IC, 1.6 to 2.5 L) after upper-abdominal, thoracic, or two-cavity surgery. On the first or second postoperative day WBimp, IC, and PImax were recorded without spirometers (baseline) and during incentive spirometry with the Mediflo spirometer (Medimex; Hamburg, Germany) (high WBimp) and the Coach spirometer (Kendall; Neustadt, Germany) (low WBimp) using a pneumotachograph. In group A, the baseline and the ICs for both spirometers only differed slightly. In group B, the IC was significantly reduced for the Mediflo (p < 0.05), which imposed a WBimp twice as high as the Coach (p < 0.01). PImax was significantly increased for both the Mediflo and the Coach (p < 0.01). PImax was positively correlated with WBimp (r = 0.8). Incentive spirometers differ considerably in their additional Wbimp with a potential impact on the efficacy of postoperative incentive spirometry performance. PImax might be an easy clinical estimate for the WBimp during incentive spirometry. Incentive spirometers with low WBimp permit increased maximal sustained inspiration and, thus, enhanced incentive spirometry performance, and, therefore, it might be more suitable for use in postoperative respiratory care.

Incentive-related modulation of cognitive control in healthy, anxious, and depressed adolescents: development and psychopathology related differences.

PubMed

Hardin, Michael G; Schroth, Elizabeth; Pine, Daniel S; Ernst, Monique

2007-05-01

Developmental changes in cognitive and affective processes contribute to adolescent risk-taking behavior, emotional intensification, and psychopathology. The current study examined adolescent development of cognitive control processes and their modulation by incentive, in health and psychopathology. Predictions include 1) better cognitive control in adults than adolescents, and in healthy adolescents than anxious and depressed adolescents, and 2) a stronger influence of incentives in adolescents than adults, and in healthy adolescents than their depressed and anxious counterparts. Antisaccadic eye movement parameters, which provide a measure of cognitive control, were collected during a reward antisaccade task that included parameterized incentive levels. Participants were 20 healthy adults, 30 healthy adolescents, 16 adolescents with an anxiety disorder, and 11 adolescents with major depression. Performance accuracy and saccade latency were analyzed to test both developmental and psychopathology hypotheses. Development and psychopathology group differences in cognitive control were found. Specifically, adults performed better than healthy adolescents, and healthy adolescents than anxious and depressed adolescents. Incentive improved accuracy for all groups; however, incremental increases were not sufficiently large to further modulate performance. Incentives also affected saccade latencies, pushing healthy adolescent latencies to adult levels, while being less effective in adolescents with depression or anxiety. This latter effect was partially mediated by anxiety symptom severity. Current findings evidence the modulation of cognitive control processes by incentives. While seen in both healthy adults and healthy adolescents, this modulatory effect was stronger in youth. While anxious and depressed adolescents exhibited improved cognitive control under incentives, this effect was smaller than that in healthy adolescents. These findings suggest differential incentive and/or cognitive control processing in anxiety and depression, and across development. Differences could result from disorder specific, or combined developmental and pathological mechanisms.

Incentive-related modulation of cognitive control in healthy, anxious, and depressed adolescents

PubMed Central

Hardin, Michael G.; Schroth, Elizabeth; Pine, Daniel S.; Ernst, Monique

2009-01-01

Background Developmental changes in cognitive and affective processes contribute to adolescent risk-taking behavior, emotional intensification, and psychopathology. The current study examined adolescent development of cognitive control processes and their modulation by incentive, in health and psychopathology. Predictions include 1) better cognitive control in adults than adolescents, and in healthy adolescents than anxious and depressed adolescents, and 2) a stronger influence of incentives in adolescents than adults, and in healthy adolescents than their depressed and anxious counterparts. Methods Antisaccadic eye movement parameters, which provide a measure of cognitive control, were collected during a reward antisaccade task that included parameterized incentive levels. Participants were 20 healthy adults, 30 healthy adolescents, 16 adolescents with an anxiety disorder, and 11 adolescents with major depression. Performance accuracy and saccade latency were analyzed to test both developmental and psychopathology hypotheses. Results Development and psychopathology group differences in cognitive control were found. Specifically, adults performed better than healthy adolescents, and healthy adolescents than anxious and depressed adolescents. Incentive improved accuracy for all groups; however, incremental increases were not sufficiently large to further modulate performance. Incentives also affected saccade latencies, pushing healthy adolescent latencies to adult levels, while being less effective in adolescents with depression or anxiety. This latter effect was partially mediated by anxiety symptom severity. Conclusions Current findings evidence the modulation of cognitive control processes by incentives. While seen in both healthy adults and healthy adolescents, this modulatory effect was stronger in youth. While anxious and depressed adolescents exhibited improved cognitive control under incentives, this effect was smaller than that in healthy adolescents. These findings suggest differential incentive and/or cognitive control processing in anxiety and depression, and across development. Differences could result from disorder specific, or combined developmental and pathological mechanisms. PMID:17501725

Incentives for Better Performance in Health Care

PubMed Central

Abduljawad, Asaad; Al-Assaf, Assaf F.

2011-01-01

Incentives for better performance in health care have several modes and methods. They are designed to motivate and encourage people to perform well and improve their outcomes. They may include monetary or non-monetary incentives and may be applied to consumers, individual providers or institutions. One such model is the Pay-for-Performance system. In this system, beneficiaries are compared with one another based on a set of performance indicators and those that achieve a high level of performance are rewarded financially. This system is meant to recognise and primarily to reward high performers. Its goal is to encourage beneficiaries to strive for better performance. This system has been applied in several countries and for several recipients and settings. Early indications show that this system has had mixed effects on performance. PMID:21969891

Quality-based financial incentives in health care: can we improve quality by paying for it?

PubMed

Conrad, Douglas A; Perry, Lisa

2009-01-01

This article asks whether financial incentives can improve the quality of health care. A conceptual framework drawn from microeconomics, agency theory, behavioral economics, and cognitive psychology motivates a set of propositions about incentive effects on clinical quality. These propositions are evaluated through a synthesis of extant peer-reviewed empirical evidence. Comprehensive financial incentives--balancing rewards and penalties; blending structure, process, and outcome measures; emphasizing continuous, absolute performance standards; tailoring the size of incremental rewards to increasing marginal costs of quality improvement; and assuring certainty, frequency, and sustainability of incentive payoffs--offer the prospect of significantly enhancing quality beyond the modest impacts of prevailing pay-for-performance (P4P) programs. Such organizational innovations as the primary care medical home and accountable health care organizations are expected to catalyze more powerful quality incentive models: risk- and quality-adjusted capitation, episode of care payments, and enhanced fee-for-service payments for quality dimensions (e.g., prevention) most amenable to piece-rate delivery.

An economic analysis of the electricity generation potential from biogas resources in the state of Indiana

NASA Astrophysics Data System (ADS)

Giraldo, Juan S.

Anaerobic digestion is a process that is a common part of organic waste management systems and is used in concentrated animal feeding operations (CAFOs), wastewater treatment plants (WWTPs), and municipal solid waste (MSW) landfills. The process produces biogas, which contains methane, and it can be burned to generate electricity. Previous reports have indicated that based on the availability of feedstocks there is a large potential for biogas production and use for electricity generation in the state of Indiana. However, these reports varied in their consideration of important factors that affect the technical and economic feasibility of being able to develop the resources available. The goal of this thesis is to make a more targeted assessment of the electricity generation potential from biogas resources at CAFOs, WWTPs, and MSW landfills in Indiana. A capital budgeting model is used to estimate the net present value (NPV) of biogas electricity projects at facilities that are identified as technically suitable. A statewide estimate of the potential generation capacity is made by estimating the number of facilities that could profitably undertake a biogas electricity project. In addition this thesis explored the impact that different incentive policies would have on the economic viability of these projects. The results indicated that the electricity generation potential is much smaller when technical and economic factors are taken into account in addition to feedstock availability. In particular it was found that projects at hog farms are unlikely to be economically feasible in the present even when financial incentives are considered. In total, 47.94 MW of potential generating capacity is estimated from biogas production at CAFOs, WWTPs, and MSW landfills. Though results indicated that 37.10 MW of capacity are economically feasible under current operating conditions, sensitivity analysis reveals that these projects are very sensitive to capital cost assumptions and incentives are likely needed to encourage investment.

45 CFR 305.32 - Requirements applicable to calculations.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES PROGRAM PERFORMANCE MEASURES, STANDARDS, FINANCIAL INCENTIVES, AND PENALTIES § 305.32... necessary to calculate performance for incentives and penalties for a fiscal year must be submitted to the... fiscal year. Only data submitted as of December 31st will be used to determine the State's performance...

Perspectives on Performance-Based Incentive Plans.

ERIC Educational Resources Information Center

Duttweiler, Patricia Cloud; Ramos-Cancel, Maria L.

This document is a synthesis of the current literature on performance-based incentive systems for teachers and administrators. Section one provides an introduction to the reform movement and to performance-based pay initiatives; a definition of terms; a brief discussion of funding sources; a discussion of compensation strategies; a description of…

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…

48 CFR 1609.7101-1 - Community-rated carrier incentive performance elements.

Code of Federal Regulations, 2012 CFR

2012-10-01

... incentive performance elements. 1609.7101-1 Section 1609.7101-1 Federal Acquisition Regulations System... performance elements. (a) Customer Service. This element is intended to assist OPM in achieving the goal of... and other measures as required contractually between OPM and the carrier. (This element will be...

48 CFR 1609.7101-1 - Community-rated carrier incentive performance elements.

Code of Federal Regulations, 2014 CFR

2014-10-01

... incentive performance elements. 1609.7101-1 Section 1609.7101-1 Federal Acquisition Regulations System... performance elements. (a) Customer Service. This element is intended to assist OPM in achieving the goal of... and other measures as required contractually between OPM and the carrier. (This element will be...

48 CFR 1609.7101-1 - Community-rated carrier incentive performance elements.

Code of Federal Regulations, 2013 CFR

2013-10-01

... incentive performance elements. 1609.7101-1 Section 1609.7101-1 Federal Acquisition Regulations System... performance elements. (a) Customer Service. This element is intended to assist OPM in achieving the goal of... and other measures as required contractually between OPM and the carrier. (This element will be...

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.

Feasibility Study of Economics and Performance of Solar Photovoltaics at Massachusetts Military Reservation. A Study Prepared in Partnership with the Environmental Protection Agency for the RE-Powering America's Land Initiative: Siting Renewable Energy on Potentially Contaminated Land and Mine Sites

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

Stafford, B.; Robichaud, R.; Mosey, G.

2011-07-01

This report presents the results of an assessment of the technical and economic feasibility of deploying photovoltaics (PV) systems on a superfund site located within the Massachusetts Military Reservation (MMR). The site was assessed for possible PV installations. The cost, performance, and site impacts of different PV options were estimated. The economics of the potential systems were analyzed using an electric rate of $0.17/kWh and incentives offered in the State of Massachusetts, such as the solar renewable energy credits. According to calculations, MMR can place 8 MW of ballast-weighted, ground-mounted PV systems on the crowns of the three landfill capsmore » and the borrow pit with the PV modules tilted at 30 degrees.« less

Feasibility Study of Economics and Performance of Solar Photovoltaics at the Refuse Hideaway Landfill in Middleton, Wisconsin

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

Salasovich, J.; Mosey, G.

2011-08-01

This report presents the results of an assessment of the technical and economic feasibility of deploying a photovoltaics (PV) system on a brownfield site at the Refuse Hideaway Landfill in Middleton, Wisconsin. The site currently has a PV system in place and was assessed for further PV installations. The cost, performance, and site impacts of different PV options were estimated. The economics of the potential systems were analyzed using an electric rate of $0.1333/kWh and incentives offered by the State of Wisconsin and by the serving utility, Madison Gas and Electric. According to the site production calculations, the most cost-effectivemore » system in terms of return on investment is the thin-film fixed-tilt technology. The report recommends financing options that could assist in the implementation of such a system.« less

Effectiveness of provider incentives for anaemia reduction in rural China: a cluster randomised trial

PubMed Central

Luo, Renfu; Zhang, Linxiu; Sylvia, Sean; Shi, Yaojiang; Foo, Patricia; Zhao, Qiran; Martorell, Reynaldo; Medina, Alexis; Rozelle, Scott

2012-01-01

Objectives To test the impact of provider performance pay for anaemia reduction in rural China. Design A cluster randomised trial of information, subsidies, and incentives for school principals to reduce anaemia among their students. Enumerators and study participants were not informed of study arm assignment. Setting 72 randomly selected rural primary schools across northwest China. Participants 3553 fourth and fifth grade students aged 9-11 years. All fourth and fifth grade students in sample schools participated in the study. Interventions Sample schools were randomly assigned to a control group, with no intervention, or one of three treatment arms: (a) an information arm, in which principals received information about anaemia; (b) a subsidy arm, in which principals received information and unconditional subsidies; and (c) an incentive arm, in which principals received information, subsidies, and financial incentives for reducing anaemia among students. Twenty seven schools were assigned to the control arm (1816 students at baseline, 1623 at end point), 15 were assigned to the information arm (659 students at baseline, 596 at end point), 15 to the subsidy arm (726 students at baseline, 667 at end point), and 15 to the incentive arm (743 students at baseline, 667 at end point). Main outcome measures Student haemoglobin concentrations. Results Mean student haemoglobin concentration rose by 1.5 g/L (95% CI –1.1 to 4.1) in information schools, 0.8 g/L (–1.8 to 3.3) in subsidy schools, and 2.4 g/L (0 to 4.9) in incentive schools compared with the control group. This increase in haemoglobin corresponded to a reduction in prevalence of anaemia (Hb <115 g/L) of 24% in incentive schools. Interactions with pre-existing incentives for principals to achieve good academic performance led to substantially larger gains in the information and incentive arms: when combined with incentives for good academic performance, associated effects on student haemoglobin concentration were 9.8 g/L (4.1 to 15.5) larger in information schools and 8.6 g/L (2.1 to 15.1) larger in incentive schools. Conclusions Financial incentives for health improvement were modestly effective. Understanding interactions with other motives and pre-existing incentives is critical. Trial registration number ISRCTN76158086. PMID:22842354

Modulation of working memory function by motivation through loss-aversion

PubMed Central

Krawczyk, Daniel C.; D’Esposito, Mark

2012-01-01

Cognitive performance is affected by motivation. Few studies, however, have investigated the neural mechanisms of the influence of motivation through potential monetary punishment on working memory. We employed functional MRI during a delayed recognition task that manipulated top-down control demands with added monetary incentives to some trials in the form of potential losses of bonus money. Behavioral performance on the task was influenced by loss-threatening incentives in the form of faster and more accurate performance. As shown previously, we found enhancement of activity for relevant stimuli occurs throughout all task periods (e.g. stimulus encoding, maintenance, and response) in both prefrontal and visual association cortex. Further, these activation patterns were enhanced for trials with possible monetary loss relative to non-incentive trials. During the incentive cue, the amygdala and striatum showed significantly greater activation when money was at a possible loss on the trial. We also evaluated patterns of functional connectivity between regions responsive to monetary consequences and prefrontal areas responsive to the task. This analysis revealed greater delay period connectivity between and the left insula and prefrontal cortex with possible monetary loss relative to non-incentive trials. Overall, these results reveal that incentive motivation can modulate performance on working memory tasks through top-down signals via amplification of activity within prefrontal and visual association regions selective to processing the perceptual inputs of the stimuli to be remembered. PMID:22113962

Health worker preferences for performance-based payment schemes in a rural health district in Burkina Faso.

PubMed

Yé, Maurice; Diboulo, Eric; Kagoné, Moubassira; Sié, Ali; Sauerborn, Rainer; Loukanova, Svetla

2016-01-01

One promising way to improve the motivation of healthcare providers and the quality of healthcare services is performance-based incentives (PBIs) also referred as performance-based financing. Our study aims to explore healthcare providers' preferences for an incentive scheme based on local resources, which aimed at improving the quality of maternal and child health care in the Nouna Health District. A qualitative and quantitative survey was carried out in 2010 involving 94 healthcare providers within 34 health facilities. In addition, in-depth interviews involving a total of 33 key informants were conducted at health facility levels. Overall, 85% of health workers were in favour of an incentive scheme based on the health district's own financial resources (95% CI: [71.91; 88.08]). Most health workers (95 and 96%) expressed a preference for financial incentives (95% CI: [66.64; 85.36]) and team-based incentives (95% CI: [67.78; 86.22]), respectively. The suggested performance indicators were those linked to antenatal care services, prevention of mother-to-child human immunodeficiency virus transmission, neonatal care, and immunization. The early involvement of health workers and other stakeholders in designing an incentive scheme proved to be valuable. It ensured their effective participation in the process and overall acceptance of the scheme at the end. This study is an important contribution towards the designing of effective PBI schemes.

Health worker preferences for performance-based payment schemes in a rural health district in Burkina Faso

PubMed Central

Yé, Maurice; Diboulo, Eric; Kagoné, Moubassira; Sié, Ali; Sauerborn, Rainer; Loukanova, Svetla

2016-01-01

Background One promising way to improve the motivation of healthcare providers and the quality of healthcare services is performance-based incentives (PBIs) also referred as performance-based financing. Our study aims to explore healthcare providers’ preferences for an incentive scheme based on local resources, which aimed at improving the quality of maternal and child health care in the Nouna Health District. Design A qualitative and quantitative survey was carried out in 2010 involving 94 healthcare providers within 34 health facilities. In addition, in-depth interviews involving a total of 33 key informants were conducted at health facility levels. Results Overall, 85% of health workers were in favour of an incentive scheme based on the health district's own financial resources (95% CI: [71.91; 88.08]). Most health workers (95 and 96%) expressed a preference for financial incentives (95% CI: [66.64; 85.36]) and team-based incentives (95% CI: [67.78; 86.22]), respectively. The suggested performance indicators were those linked to antenatal care services, prevention of mother-to-child human immunodeficiency virus transmission, neonatal care, and immunization. Conclusions The early involvement of health workers and other stakeholders in designing an incentive scheme proved to be valuable. It ensured their effective participation in the process and overall acceptance of the scheme at the end. This study is an important contribution towards the designing of effective PBI schemes. PMID:26739784

Teacher Incentives in Developing Countries: Experimental Evidence from India. Research Brief

ERIC Educational Resources Information Center

National Center on Performance Incentives, 2008

2008-01-01

In "Teacher Incentives in Developing Countries: Experimental Evidence from India"--a paper presented at the National Center on Performance Incentives research to policy conference in February--Karthik Muralidharan (Harvard University) and Venkatesh Sundararaman (The World Bank) present findings from a randomized experiment conducted in…

Financial disincentives? A three-armed randomised controlled trial of the effect of financial Incentives  in Diabetic Eye Assessment  by Screening (IDEAS) trial.

PubMed

Judah, Gaby; Darzi, Ara; Vlaev, Ivo; Gunn, Laura; King, Derek; King, Dominic; Valabhji, Jonathan; Bicknell, Colin

2018-05-23

Conflicting evidence exists regarding the impact of financial incentives on encouraging attendance at medical screening appointments. The primary aim was to determine whether financial incentives increase attendance at diabetic eye screening in persistent non-attenders. A three-armed randomised controlled trial was conducted in London in 2015. 1051 participants aged over 16 years, who had not attended eye screening appointments for 2 years or more, were randomised (1.4:1:1 randomisation ratio) to receive the usual invitation letter (control), an offer of £10 cash for attending screening (fixed incentive) or a 1 in 100 chance of winning £1000 (lottery incentive) if they attend. The primary outcome was the proportion of invitees attending screening, and a comparative analysis was performed to assess group differences. Pairwise comparisons of attendance rates were performed, using a conservative Bonferroni correction for independent comparisons. 34/435 (7.8%) of control, 17/312 (5.5%) of fixed incentive and 10/304 (3.3%) of lottery incentive groups attended. Participants who received any incentive were significantly less likely to attend their appointment compared with controls (risk ratio (RR)=0.56; 95% CI 0.34 to 0.92). Those in the probabilistic incentive group (RR=0.42; 95% CI 0.18 to 0.98), but not the fixed incentive group (RR=1.66; 95% CI 0.65 to 4.21), were significantly less likely to attend than those in the control group. Financial incentives, particularly lottery-based incentives, attract fewer patients to diabetic eye screening than standard invites in this population. Financial incentives should not be used to promote screening unless tested in context, as they may negatively affect attendance rates. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

National policies for technical change: Where are the increasing returns to economic research?

PubMed Central

Pavitt, Keith

1996-01-01

Improvements over the past 30 years in statistical data, analysis, and related theory have strengthened the basis for science and technology policy by confirming the importance of technical change in national economic performance. But two important features of scientific and technological activities in the Organization for Economic Cooperation and Development countries are still not addressed adequately in mainstream economics: (i) the justification of public funding for basic research and (ii) persistent international differences in investment in research and development and related activities. In addition, one major gap is now emerging in our systems of empirical measurement—the development of software technology, especially in the service sector. There are therefore dangers of diminishing returns to the usefulness of economic research, which continues to rely completely on established theory and established statistical sources. Alternative propositions that deserve serious consideration are: (i) the economic usefulness of basic research is in the provision of (mainly tacit) skills rather than codified and applicable information; (ii) in developing and exploiting technological opportunities, institutional competencies are just as important as the incentive structures that they face; and (iii) software technology developed in traditional service sectors may now be a more important locus of technical change than software technology developed in “high-tech” manufacturing. PMID:8917481

Should we pay the student? A randomised trial of financial incentives in medical education.

PubMed

Raupach, Tobias; Brown, Jamie; Wieland, Anna; Anders, Sven; Harendza, Sigrid

2013-09-01

Financial incentives are effective in moderating physician and patient behaviour, but they have not been studied in the context of medical education. This study assessed whether financial incentives can motivate students to acquire electrocardiogram (ECG) interpretation skills. Students enrolled for a cardio-respiratory teaching module (n = 121) were randomised to an intervention (financial incentive) or a control (book voucher raffle) condition. All students took three validated exams of ECG interpretation skills (at module entry, module exit and seven weeks later). Only the exit exam was financially incentivised in the intervention group. The primary outcome was the proportion of students who correctly identified ≥60% of clinically important diagnoses in the exit exam. Financial incentives more than doubled the odds of correctly identifying ≥60% of diagnoses in the exit exam (adjusted odds ratio 2.44, 95% confidence interval 1.05-5.67) and significantly increased student learning time. However, there was no significant effect on performance levels in the retention exam. Financial incentives increase reported learning time and examination results in the short-term. The lack of a sustained effect on performance suggests that financial incentives may foster a superficial or strategic rather than a deep approach to learning.

Changes in Incentives, Rewards and Sanctions.

ERIC Educational Resources Information Center

Lonsdale, Alan

1993-01-01

A review of the literature over the past decade reflects substantial changes in rewards, incentives, and sanctions used with college faculty. These changes parallel changes in the public sector generally. Increasing emphasis on formal evaluation and on use of money as an incentive and reward for performance is noted. (MSE)

Toward a Culture of Consequences: Performance-Based Accountability Systems for Public Services. Monograph

ERIC Educational Resources Information Center

Stecher, Brian M.; Camm, Frank; Damberg, Cheryl L.; Hamilton, Laura S.; Mullen, Kathleen J.; Nelson, Christopher; Sorensen, Paul; Wachs, Martin; Yoh, Allison; Zellman, Gail L.

2010-01-01

Performance-based accountability systems (PBASs), which link incentives to measured performance as a means of improving services to the public, have gained popularity. While PBASs can vary widely across sectors, they share three main components: goals, incentives, and measures. Research suggests that PBASs influence provider behaviors, but little…

Performance Incentives: Their Growing Impact on American K-12 Education

ERIC Educational Resources Information Center

Springer, Matthew G., Ed.

2009-01-01

The concept of "pay for performance" for public school teachers is once again growing in popularity and use. U.S. education is now at a critical juncture that requires thoughtful and informed consideration of this policy innovation. "Performance Incentives" offers the most up-to-date and complete analysis yet of the…

Incentives, Selection, and Teacher Performance: Evidence from IMPACT

ERIC Educational Resources Information Center

Dee, Thomas S.; Wyckoff, James

2015-01-01

Teachers in the United States are compensated largely on the basis of fixed schedules that reward experience and credentials. However, there is a growing interest in whether performance-based incentives based on rigorous teacher evaluations can improve teacher retention and performance. The evidence available to date has been mixed at best. This…

Incentives and Their Dynamics in Public Sector Performance Management Systems

ERIC Educational Resources Information Center

Heinrich, Carolyn J.; Marschke, Gerald

2010-01-01

We use the principal-agent model as a focal theoretical frame for synthesizing what we know, both theoretically and empirically, about the design and dynamics of the implementation of performance management systems in the public sector. In this context, we review the growing body of evidence about how performance measurement and incentive systems…

Peninsula Academies Replications: 1985-86 Evaluation Report.

ERIC Educational Resources Information Center

Dayton, Charles; And Others

The Peninsula Academies is a three-year high school program for at-risk students, designed to provide them with incentives both to graduate and to acquire labor market-relevant skills. An academy combines academic and technical training in a school-within-a-school setting, and is based on school-business partnerships. In the fall of 1985, 10…

Solar/hydrogen systems for the 1985-2000 time frame - A review and assessment

NASA Technical Reports Server (NTRS)

Hanson, J. A.; Foster, R. W.; Escher, W. J. D.; Tison, R. R.

1982-01-01

A comprehensive state-of-the-art review of solar/hydrogen technologies has been conducted. From this, solar/hydrogen production systems which could be commercialized by the year 2000 have been characterized technically and economically. Incentives and disincentives for the early commercialization of four solar/hydrogen systems have been explored, conclusions drawn and recommendations made.

Choice modeling: public preferences for enhancing benefits from private forests in the Adirondacks

Treesearch

Donald F. Dennis; Mark J. Twery

2007-01-01

Recognizing the importance of private land in meeting society's needs for forest-related benefits, public agencies fund programs that provide aid to private landowners to enhance public benefits derived from these lands. This may include technical help, education, tax incentives, and cost-share programs for various management activities. It is important that...

Technical Report and Data File User's Manual for the 1992 National Adult Literacy Survey.

ERIC Educational Resources Information Center

Kirsch, Irwin; Yamamoto, Kentaro; Norris, Norma; Rock, Donald; Jungeblut, Ann; O'Reilly, Patricia; Berlin, Martha; Mohadjer, Leyla; Waksberg, Joseph; Goksel, Huseyin; Burke, John; Rieger, Susan; Green, James; Klein, Merle; Campbell, Anne; Jenkins, Lynn; Kolstad, Andrew; Mosenthal, Peter; Baldi, Stephane

Chapter 1 of this report and user's manual describes design and implementation of the 1992 National Adult Literacy Survey (NALS). Chapter 2 reviews stages of sampling for national and state survey components; presents weighted and unweighted response rates for the household component; and describes non-incentive and prison sample designs. Chapter…

Education: A Reciprocal Civic-Military Objective.

ERIC Educational Resources Information Center

Tamburello, G. B.

The Navy's Associate Degree Completion Program was set up as a career incentive to retain able enlisted men in critical ratings whether ashore or at sea. It aims to increase their value to the Navy and their chances for promotion. The author feels the community/junior college is the best answer to the problem of providing technical, vocational, or…

48 CFR 215.404-71-2 - Performance risk.

Code of Federal Regulations, 2011 CFR

2011-10-01

... incentive range when contract performance includes the introduction of new, significant technological innovation. Use the technology incentive range only for the most innovative contract efforts. Innovation may... reliability, or reduced costs; or (B) New products or systems that contain significant technological advances...

Improving working memory in children with attention-deficit/hyperactivity disorder: the separate and combined effects of incentives and stimulant medication.

PubMed

Strand, Michael T; Hawk, Larry W; Bubnik, Michelle; Shiels, Keri; Pelham, William E; Waxmonsky, James G

2012-10-01

Working memory (WM) is considered a core deficit in Attention-Deficit/ Hyperactivity Disorder (ADHD), with numerous studies demonstrating impaired WM among children with ADHD. We tested the degree to which WM in children with ADHD was improved by performance-based incentives, an analog of behavioral intervention. In two studies, WM performance was assessed using a visuo-spatial n-back task. Study 1 compared children (ages 9-12 years) with ADHD-Combined type (n = 24) to a group of typically developing (TD) children (n = 32). Study 1 replicated WM deficits among children with ADHD. Incentives improved WM, particularly among children with ADHD. The provision of incentives reduced the ADHD-control group difference by approximately half but did not normalize WM. Study 2 examined the separate and combined effects of incentives and stimulant medication among 17 children with ADHD-Combined type. Both incentives and a moderate dose of long-acting methylphenidate (MPH; ~0.3 mg/kg t.i.d. equivalent) robustly improved WM relative to the no-incentive, placebo condition. The combination of incentives and medication improved WM significantly more than either incentives or MPH alone. These studies indicate that contingencies markedly improve WM among children with ADHD-Combined type, with effect sizes comparable to a moderate dose of stimulant medication. More broadly, this work calls attention to the role of motivation in studying cognitive deficits in ADHD and in testing multifactorial models of ADHD.

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

Optimisation of Healthcare Contracts: Tensions Between Standardisation and Innovation

PubMed Central

Mikkers, Misja; Ryan, Padhraig

2016-01-01

An important determinant of health system performance is contracting. Providers often respond to financial incentives, despite the ethical underpinnings of medicine, and payers can craft contracts to influence performance. Yet contracting is highly imperfect in both single-payer and multi-payer health systems. Arguably, in a competitive, multi-payer environment, contractual innovation may occur more rapidly than in a single-payer system. This innovation in contract design could enhance performance. However, contractual innovation often fails to improve performance as payer incentives are misaligned with public policy objectives. Numerous countries seek to improve healthcare contracts, but thus far no health system has demonstrably crafted the necessary blend of incentives to stimulate optimal contracting. PMID:26927400

Malaysia Country Analysis Brief

EIA Publications

2017-01-01

Malaysia's energy industry is a critical sector of growth for the entire economy, and it makes up almost 20% of the total gross domestic product. New tax and investment incentives, starting in 2010, aim to promote oil and natural gas exploration and development in the country's deepwater and marginal fields as well as promote energy efficiency measures and use of alternative energy sources. These fiscal incentives are part of the country's economic transformation program to leverage its resources and geographic location to be one of Asia's top energy players by 2020. Another key pillar in Malaysia's energy strategy is to become a regional oil and natural gas storage, trading, and development hub that will attract technical expertise and downstream services that can compete in Asia.

Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models. Final rule with comment period.

PubMed

2016-11-04

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repeals the Medicare sustainable growth rate (SGR) methodology for updates to the physician fee schedule (PFS) and replaces it with a new approach to payment called the Quality Payment Program that rewards the delivery of high-quality patient care through two avenues: Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS) for eligible clinicians or groups under the PFS. This final rule with comment period establishes incentives for participation in certain alternative payment models (APMs) and includes the criteria for use by the Physician-Focused Payment Model Technical Advisory Committee (PTAC) in making comments and recommendations on physician-focused payment models (PFPMs). Alternative Payment Models are payment approaches, developed in partnership with the clinician community, that provide added incentives to deliver high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. This final rule with comment period also establishes the MIPS, a new program for certain Medicare-enrolled practitioners. MIPS will consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals (EPs), and will continue the focus on quality, cost, and use of certified EHR technology (CEHRT) in a cohesive program that avoids redundancies. In this final rule with comment period we have rebranded key terminology based on feedback from stakeholders, with the goal of selecting terms that will be more easily identified and understood by our stakeholders.

Profit incentives and the hospital industry: are we expecting too much?

PubMed Central

Register, C A; Sharp, A M; Bivin, D G

1985-01-01

In the recent past, a great deal of faith has been placed in the idea that the performance of the hospital industry could be improved significantly by relying more heavily on profit incentives. This article considers the effect of profit incentives on hospital behavior and finds that the existence of profit incentives has not led the for-profit hospitals in the sample to behave in significantly different economic fashions than the nonprofits. PMID:3924860

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.

Motivation and Organizational Incentives for High Vitality Teachers: A Qualitative Perspective.

ERIC Educational Resources Information Center

Sederberg, Charles H.; Clark, Shirley M.

1990-01-01

Minnesota teachers of the year (N=18) were interviewed to identify motivation and organizational incentives for exemplary classroom performance. Values and role behaviors of high-vitality teachers differ from those assumed by rational management models calling for incentives such as increased academic preparation, career ladders, and merit pay.…

An Alternative Classification Scheme for Teaching Performance Incentives Using a Factor Analytic Approach.

ERIC Educational Resources Information Center

Mertler, Craig A.

This study attempted to (1) expand the dichotomous classification scheme typically used by educators and researchers to describe teaching incentives and (2) offer administrators and teachers an alternative framework within which to develop incentive systems. Elementary, middle, and high school teachers in Ohio rated 10 commonly instituted teaching…

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.

Impact of early incentive spirometry in an enhanced recovery program after laparoscopic donor nephrectomy.

PubMed

Rollins, K E; Aggarwal, S; Fletcher, A; Knight, A; Rigg, K; Williams, A R; Bhattacharjya, S

2013-05-01

This study aimed to assess the impact of early incentive spirometry on the incidence of chest infection in patients undergoing laparoscopic donor nephrectomy. A retrospective review on all consecutive laparoscopic donor nephrectomies (LDN) performed at a single institution from January 2008 to August 2012 was performed. We performed 84 LDN. Seventy patients had epidural analgesia continued for 48 hours postoperatively and 14 had a combination of spinal followed by oral analgesia. Incentive spirometry was introduced from July 2010 and 45 of the 84 donors used the spirometer as taught, both pre- and postoperatively. We performed 84 LDN; 39 patients did not receive incentive spirometers and had postoperative chest physiotherapy started on postoperative day 1. Of the 45 patients given incentive spirometers, 44 started using their spirometers as taught, after recovery once they were settled in the ward, 1 patient started the exercises the following day. In the group who received no spirometer, 5 patients had a chest infection. In the group of patients who started using their spirometers in the early perioperative period (44/45), no patient developed a chest infection. One patient in this group was excluded from the analysis because he started spirometer exercises on postoperative day 1. This patient did develop a chest infection. Our results suggest that early introduction of incentive spirometry after LDN significantly reduces the incidence of chest infection (P < .05); however, this benefit may be lost if the introduction of spirometry is delayed. Copyright © 2013 Elsevier Inc. All rights reserved.

20 CFR 666.230 - How does the Department determine the amounts for Incentive Grant awards?

Code of Federal Regulations, 2010 CFR

2010-04-01

... under WIA section 136(g)(2) resulting from funds withheld for poor performance by States; and (4) The... ADMINISTRATION, DEPARTMENT OF LABOR PERFORMANCE ACCOUNTABILITY UNDER TITLE I OF THE WORKFORCE INVESTMENT ACT Incentives and Sanctions for State Performance § 666.230 How does the Department determine the amounts for...

Incentives, Selection, and Teacher Performance: Evidence from IMPACT. NBER Working Paper No. 19529

ERIC Educational Resources Information Center

Dee, Thomas; Wyckoff, James

2013-01-01

Teachers in the United States are compensated largely on the basis of fixed schedules that reward experience and credentials. However, there is a growing interest in whether performance-based incentives based on rigorous teacher evaluations can improve teacher retention and performance. The evidence available to date has been mixed at best. This…

What Works Clearinghouse Quick Review: "Transfer Incentives for High-Performing Teachers: Final Results from a Multisite Experiment"

ERIC Educational Resources Information Center

What Works Clearinghouse, 2014

2014-01-01

"Transfer Incentives for High-Performing Teachers: Final Results from a Multisite Experiment," examined the impact of the Talent Transfer Initiative (TTI) on both student achievement and teacher retention in 10 school districts across seven states. The initiative gave bonuses to high-performing teachers for them to transfer to and stay…

Staffing a Low-Performing School: Behavioral Responses to Selective Teacher Transfer Incentives

ERIC Educational Resources Information Center

Protik, Ali; Glazerman, Steven; Bruch, Julie; Teh, Bing-ru

2015-01-01

We examine behavioral responses to an incentive program that offers high-performing teachers in ten school districts across the country $20,000 to transfer into the district's hardest-to-staff schools. We discuss behavioral responses to the program on high-performing teachers' willingness to transfer (supply) and the effect of the transfer offer…

Comparing the effectiveness of individualistic, altruistic, and competitive incentives in motivating completion of mental exercises.

PubMed

Schofield, Heather; Loewenstein, George; Kopsic, Jessica; Volpp, Kevin G

2015-12-01

This study examines the impact of individually oriented, purely altruistic, and a hybrid of competitive and cooperative monetary reward incentives on older adults' completion of cognitive exercises and cognitive function. We find that all three incentive structures approximately double the number of exercises completed during the six-week active experimental period relative to a no incentive control condition. However, the altruistic and cooperative/competitive incentives led to different patterns of participation, with significantly higher inter-partner correlations in utilization of the software, as well as greater persistence once incentives were removed. Provision of all incentives significantly improved performance on the incentivized exercises. However, results of an independent cognitive testing battery suggest no generalizable gains in cognitive function resulted from the training. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

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.

Effects of Social Incentives on Task Performance in the Elderly

ERIC Educational Resources Information Center

Levendusky, Philip G.

1978-01-01

The performance of 60 elderly volunteers on two cancellation tasks was examined under one of three experimental conditions: social praise, social reproof, or no comment. The clear implications from these data are that social incentives may well facilitate behavioral change in the aged. (Author)

45 CFR 305.0 - Scope.

Code of Federal Regulations, 2010 CFR

2010-10-01

...), ADMINISTRATION FOR CHILDREN AND FAMILIES, DEPARTMENT OF HEALTH AND HUMAN SERVICES PROGRAM PERFORMANCE MEASURES, STANDARDS, FINANCIAL INCENTIVES, AND PENALTIES § 305.0 Scope. This part implements the incentive system...

An Update: Changes Abound in Forestry Cost-Share Assistance Programs

Treesearch

Robert J. Moulton

1999-01-01

There have been some major changes in the line-up and funding for federal incentive programs that provide technical and financial assistance to non-industrial private forest (NIPF) landowners since I last reported on this subject ("Sorting Through Cost-Share Assistance Programs," Nov./Dec. 1994 Tree Farmer). The purpose of this article is to bring you up to...

A Strategic Plan for Promoting and Expanding Apprenticeship in the U.S. (Phase II). Recommendations of the Federal Committee on Apprenticeship.

ERIC Educational Resources Information Center

Employment and Training Administration (DOL), Washington, DC. Office of Work-Based Learning.

In preparing Phase I of the Strategic Plan, the Federal Committee on Apprenticeship noted that efforts beyond education and technical assistance may be needed to develop apprenticeship fully in the United States. Specifically, the committee would examine and make recommendations with respect to such issues as incentives for participation,…

The Missouri Career Development and Teacher Excellence Plan: An Initial Study of Missouri's Career Ladder Program. A Technical Report.

ERIC Educational Resources Information Center

Schofer, Richard C.; And Others

The Missouri Plan provides for direct participation of teachers in the planning, development, and implementation of the district career ladder plan. This study analyzed the appropriateness of the Missouri teacher incentive plan. In particular, the study sought to determine why districts did or did not choose to implement career ladder programs;…

Student Participation and Performance on Advanced Placement Exams: Do State-Sponsored Incentives Make a Difference?

ERIC Educational Resources Information Center

Jeong, Dong Wook

2009-01-01

Many states provide incentives to students, teachers, and schools for the participation and success of students on Advanced Placement (AP) examinations administered by the College Board. The purpose of this article is to examine whether these incentives help students enroll and succeed in AP exams. An analysis of nationally representative AP exam…

Context-specific energy strategies: coupling energy system visions with feasible implementation scenarios.

PubMed

Trutnevyte, Evelina; Stauffacher, Michael; Schlegel, Matthias; Scholz, Roland W

2012-09-04

Conventional energy strategy defines an energy system vision (the goal), energy scenarios with technical choices and an implementation mechanism (such as economic incentives). Due to the lead of a generic vision, when applied in a specific regional context, such a strategy can deviate from the optimal one with, for instance, the lowest environmental impacts. This paper proposes an approach for developing energy strategies by simultaneously, rather than sequentially, combining multiple energy system visions and technically feasible, cost-effective energy scenarios that meet environmental constraints at a given place. The approach is illustrated by developing a residential heat supply strategy for a Swiss region. In the analyzed case, urban municipalities should focus on reducing heat demand, and rural municipalities should focus on harvesting local energy sources, primarily wood. Solar thermal units are cost-competitive in all municipalities, and their deployment should be fostered by information campaigns. Heat pumps and building refurbishment are not competitive; thus, economic incentives are essential, especially for urban municipalities. In rural municipalities, wood is cost-competitive, and community-based initiatives are likely to be most successful. Thus, the paper shows that energy strategies should be spatially differentiated. The suggested approach can be transferred to other regions and spatial scales.

Medicare program; End-Stage Renal Disease prospective payment system, quality incentive program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies. Final rule.

PubMed

2014-11-06

This final rule will update and make revisions to the End-Stage Renal Disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2015. This rule also finalizes requirements for the ESRD quality incentive program (QIP), including for payment years (PYs) 2017 and 2018. This rule will also make a technical correction to remove outdated terms and definitions. In addition, this final rule sets forth the methodology for adjusting Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) fee schedule payment amounts using information from the Medicare DMEPOS Competitive Bidding Program (CBP); makes alternative payment rules for certain DME under the Medicare DMEPOS CBP; clarifies the statutory Medicare hearing aid coverage exclusion and specifies devices not subject to the hearing aid exclusion; will not update the definition of minimal self-adjustment; clarifies the Change of Ownership (CHOW) and provides for an exception to the current requirements; revises the appeal provisions for termination of a CBP contract, including the beneficiary notification requirement under the Medicare DMEPOS CBP, and makes a technical change to the regulation related to the conditions for awarding contracts for furnishing infusion drugs under the Medicare DMEPOS CBP.

Defending Against Advanced Persistent Threats Using Game-Theory.

PubMed

Rass, Stefan; König, Sandra; Schauer, Stefan

2017-01-01

Advanced persistent threats (APT) combine a variety of different attack forms ranging from social engineering to technical exploits. The diversity and usual stealthiness of APT turns them into a central problem of contemporary practical system security, since information on attacks, the current system status or the attacker's incentives is often vague, uncertain and in many cases even unavailable. Game theory is a natural approach to model the conflict between the attacker and the defender, and this work investigates a generalized class of matrix games as a risk mitigation tool for an advanced persistent threat (APT) defense. Unlike standard game and decision theory, our model is tailored to capture and handle the full uncertainty that is immanent to APTs, such as disagreement among qualitative expert risk assessments, unknown adversarial incentives and uncertainty about the current system state (in terms of how deeply the attacker may have penetrated into the system's protective shells already). Practically, game-theoretic APT models can be derived straightforwardly from topological vulnerability analysis, together with risk assessments as they are done in common risk management standards like the ISO 31000 family. Theoretically, these models come with different properties than classical game theoretic models, whose technical solution presented in this work may be of independent interest.

Revisiting physicians' financial incentives in Quebec: a panel system approach.

PubMed

Nassiri, Abdelhak; Rochaix, Lise

2006-01-01

Do Primary Care Physicians (PCPs) react strategically to financial incentives and if so how? To address this question, we follow a quasi-natural experiment in Quebec, using a panel system technique. In so doing, we both correct for underestimation biases in earlier time series findings and generate new results on the issue of complementarity/substitution between consultations with varying levels of technicality. Under both techniques, we show that PCPs are sensitive to the enforcement and subsequent temporary removals of expenditure caps and more generally, to changes in consultations' relative prices over time. These results support the existence of a discretionary power over the choice of consultation, PCPs increasing strategically the number of the more technical (and therefore more lucrative) consultations when pressed to defend their income. This finding for primary care parallels the now well-established DRG creep in hospitals. The panel system approach offers a better account of the complexity surrounding PCPs' decision-making process. In particular, it successfully addresses issues of physician heterogeneity, jointness between consultations and temporal breaks and generates robust estimates of PCPs volume and quality reactions to regulatory changes. Copyright (c) 2005 John Wiley & Sons, Ltd.

42 CFR § 512.2 - Definitions.

Code of Federal Regulations, 2010 CFR

2017-10-01

...) HEALTH CARE INFRASTRUCTURE AND MODEL PROGRAMS EPISODE PAYMENT MODEL General Provisions § 512.2... model means the model testing CR incentive payments for CR/ICR service use made in accordance with... performance year means one of the years in which the CR incentive payment model is being tested. Performance...

42 CFR § 414.1360 - Data submission criteria for the improvement activities performance category.

Code of Federal Regulations, 2010 CFR

2017-10-01

... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1360 Data submission criteria for the improvement activities performance...

42 CFR § 414.1350 - Cost performance category.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1350 Cost performance... category comprises: (1) 0 percent of a MIPS eligible clinician's final score for MIPS payment year 2019. (2...

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.…

Increased Health Information Technology Adoption and Use Among Small Primary Care Physician Practices Over Time: A National Cohort Study.

PubMed

Rittenhouse, Diane R; Ramsay, Patricia P; Casalino, Lawrence P; McClellan, Sean; Kandel, Zosha K; Shortell, Stephen M

2017-01-01

Implementation and meaningful use of health information technology (HIT) has been shown to facilitate delivery system transformation, yet implementation is far from universal. This study examined correlates of greater HIT implementation over time among a national cohort of small primary care practices in the United States. We used data from a 40-minute telephone panel survey of 566 small primary care practices having 8 or fewer physicians to investigate adoption and use of HIT in 2007-2010 and 2012-2013. We used generalized estimating equations (GEE) to estimate the association of practice characteristics and external incentives with the adoption and use of HIT. We studied 18 measures of HIT functionalities, including record keeping, clinical decision support, patient communication, and health information exchange with hospitals and pharmacies. Overall, use of 16 HIT functionalities increased significantly over time, whereas use of 2 decreased significantly. On average, compared with physician-owned practices, hospital-owned practices used 1.48 (95% CI, 1.07-1.88; P <.001) more HIT processes. And relative to smaller practices, practices with 3 to 8 physicians used 2.49 (95% CI, 2.26-2.72; P <.001) more HIT processes. Participation in pay-for-performance programs, participation in public reporting of clinical quality data, and a larger proportion of revenue from Medicare were also associated with greater adoption and use of HIT. The new Medicare Access and CHIP Reauthorization Act (MACRA) will provide payment incentives and technical support to speed HIT adoption and use by small practices. We found that external incentives were, indeed, positively associated with greater adoption and use of HIT. Our findings also support a strategy of targeting assistance to smaller physician practices and those that are physician owned. © 2017 Annals of Family Medicine, Inc.

Effects of Deployment Investment on the Growth of the Biofuels Industry. 2016 Update

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

Vimmerstedt, Laura J.; Warner, Ethan S.; Stright, Dana

This report updates the 2013 report of the same title. Some text originally published in that report is retained and indicated in gray. In support of the national goals for biofuel use in the United States, numerous technologies have been developed that convert biomass to biofuels. Some of these biomass to biofuel conversion technology pathways are operating at commercial scales, while others are in earlier stages of development. The advancement of a new pathway toward commercialization involves various types of progress, including yield improvements, process engineering, and financial performance. Actions of private investors and public programs can accelerate the demonstrationmore » and deployment of new conversion technology pathways. These investors (both private and public) will pursue a range of pilot, demonstration, and pioneer scale biorefinery investments; the most cost-effective set of investments for advancing the maturity of any given biomass to biofuel conversion technology pathway is unknown. In some cases, whether or not the pathway itself will ultimately be technically and financially successful is also unknown. This report presents results from the Biomass Scenario Model--a system dynamics model of the biomass to biofuels system--that estimate effects of investments in biorefineries at different maturity levels and operational scales. The report discusses challenges in estimating effects of such investments and explores the interaction between this deployment investment and a volumetric production incentive. Model results show that investments in demonstration and deployment have a substantial growth impact on the development of the biofuels industry. Results also show that other conditions, such as accompanying incentives, have major impacts on the effectiveness of such investments. Results from the 2013 report are compared to new results. This report does not advocate for or against investments, incentives, or policies, but analyzes simulations of their hypothetical effects.« less

20 CFR 666.205 - What are the time frames under which States submit performance progress reports and apply for...

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false What are the time frames under which States submit performance progress reports and apply for incentive grants? 666.205 Section 666.205 Employees... the time frames under which States submit performance progress reports and apply for incentive grants...

WWC Review of the Report "Transfer Incentives for High-Performing Teachers: Final Results from a Multisite Randomized Experiment." What Works Clearinghouse Single Study Review

ERIC Educational Resources Information Center

What Works Clearinghouse, 2015

2015-01-01

For the 2013 study, "Transfer Incentives for High-Performing Teachers: Final Results from a Multisite Randomized Experiment," researchers examined the impact of the Talent Transfer Initiative (TTI) on students' reading and mathematics achievement in 10 school districts. The TTI enabled principals of low-performing schools to provide…

The Effects of Strategy Training and an Extrinsic Incentive on Fourth- and Fifth-Grade Students' Performance, Confidence, and Calibration Accuracy

ERIC Educational Resources Information Center

Gutierrez de Blume, Antonio P.

2017-01-01

This study investigated the influence of strategy training instruction and an extrinsic incentive on American fourth- and fifth-grade students' (N = 35) performance, confidence in performance, and calibration accuracy. Using an experimental design, children were randomized to either an experimental group (strategy training and an extrinsic…

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…

Going national with HERS and EEMs: Issues and impacts. The collected papers of the national collaborative

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

None

This collection of papers is a companion volume to A National Program for Energy-Efficient Mortgages and Home Energy Rating Systems: A Blueprint for Action (NREL/TP-261-4677). The Blueprint reports the findings and recommendations of the National Collaborative on Home Energy Rating Systems and Mortgage Incentives for Energy Efficiency about a voluntary national program linking energy-efficient mortgages and home energy rating systems. This volume provides technical documentation for A Blueprint for Action. It consists of 55 technical issue papers and 13 special papers prepared by the technical advisory committees and some members of the Collaborative Consensus Committee of the National Collaborative. Itmore » also contains the bibliography and the glossary written by the members and staff of the National Collaborative.« less

Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care.

PubMed

Emanuel, Ezekiel J; Ubel, Peter A; Kessler, Judd B; Meyer, Gregg; Muller, Ralph W; Navathe, Amol S; Patel, Pankaj; Pearl, Robert; Rosenthal, Meredith B; Sacks, Lee; Sen, Aditi P; Sherman, Paul; Volpp, Kevin G

2016-01-19

Behavioral economics provides insights about the development of effective incentives for physicians to deliver high-value care. It suggests that the structure and delivery of incentives can shape behavior, as can thoughtful design of the decision-making environment. This article discusses several principles of behavioral economics, including inertia, loss aversion, choice overload, and relative social ranking. Whereas these principles have been applied to motivate personal health decisions, retirement planning, and savings behavior, they have been largely ignored in the design of physician incentive programs. Applying these principles to physician incentives can improve their effectiveness through better alignment with performance goals. Anecdotal examples of successful incentive programs that apply behavioral economics principles are provided, even as the authors recognize that its application to the design of physician incentives is largely untested, and many outstanding questions exist. Application and rigorous evaluation of infrastructure changes and incentives are needed to design payment systems that incentivize high-quality, cost-conscious care.

What's good for the goose is good for the gander. Guiding principles for the use of financial incentives in health behaviour change.

PubMed

Lynagh, Marita C; Sanson-Fisher, Rob W; Bonevski, Billie

2013-03-01

The use of financial incentives or pay-for-performance programs for health care providers has triggered emerging interest in the use of financial incentives for encouraging health behaviour change. This paper aims to identify key conditions under which the use of financial incentives for improvements in public health outcomes is most likely to be effective and appropriate. We review recent systematic reviews on their effectiveness in changing health behaviour and identify existing moral concerns concerning personal financial incentives. Current evidence indicates that incentives can be effective in driving health behaviour change under certain provisos, while a number of misgivings continue to be deliberated on. We outline a number of key principles for consideration in decisions about the potential use of incentives in leading to public health improvements. These key principles can assist policy makers in making decisions on the use of financial incentives directed at achieving improvements in public health.

Incentive-Based Primary Care: Cost and Utilization Analysis.

PubMed

Hollander, Marcus J; Kadlec, Helena

2015-01-01

In its fee-for-service funding model for primary care, British Columbia, Canada, introduced incentive payments to general practitioners as pay for performance for providing enhanced, guidelines-based care to patients with chronic conditions. Evaluation of the program was conducted at the health care system level. To examine the impact of the incentive payments on annual health care costs and hospital utilization patterns in British Columbia. The study used Ministry of Health administrative data for Fiscal Year 2010-2011 for patients with diabetes, congestive heart failure, chronic obstructive pulmonary disease, and/or hypertension. In each disease group, cost and utilization were compared across patients who did, and did not, receive incentive-based care. Health care costs (eg, primary care, hospital) and utilization measures (eg, hospital days, readmissions). After controlling for patients' age, sex, service needs level, and continuity of care (defined as attachment to a general practice), the incentives reduced the net annual health care costs, in Canadian dollars, for patients with hypertension (by approximately Can$308 per patient), chronic obstructive pulmonary disease (by Can$496), and congestive heart failure (by Can$96), but not diabetes (incentives cost about Can$148 more per patient). The incentives were also associated with fewer hospital days, fewer admissions and readmissions, and shorter lengths of hospital stays for all 4 groups. Although the available literature on pay for performance shows mixed results, we showed that the funding model used in British Columbia using incentive payments for primary care might reduce health care costs and hospital utilization.

Financial incentives and physician commitment to guideline-recommended hypertension management.

PubMed

Hysong, Sylvia J; Simpson, Kate; Pietz, Kenneth; SoRelle, Richard; Broussard Smitham, Kristen; Petersen, Laura A

2012-10-01

To examine the impact of financial incentives on physician goal commitment to guideline-recommended hypertension care. Clinic-level cluster-randomized trial with 4 arms: individual, group, or combined incentives, and control. A total of 83 full-time primary care physicians at 12 Veterans Affairs medical centers completed web-based surveys measuring their goal commitment to guideline-recommended hypertension care every 4 months and telephone interviews at months 8 and 16. Intervention arm participants received performance-based incentives every 4 months for 5 periods. All participants received guideline education at baseline and audit and feedback every 4 months. Physician goal commitment did not vary over time or across arms. Participants reported patient nonadherence was a perceived barrier and consistent follow-up was a perceived facilitator to successful hypertension care, suggesting that providers may perceive hypertension management as more of a patient responsibility (external locus of control). Financial incentives may constitute an insufficiently strong intervention to influence goal commitment when providers attribute performance to external forces beyond their control.

Financial Incentives and Physician Commitment to Guideline-Recommended Hypertension Management: A Mixed Methods Approach

PubMed Central

Hysong, Sylvia J.; Simpson, Kate; Pietz, Kenneth; SoRelle, Richard; Broussard, Kristen; Petersen, Laura A.

2014-01-01

Objective To examine the impact of financial incentives on physician goal commitment to guideline-recommended hypertension care. Study design Clinic-level cluster-randomized controlled trial with four arms: control, individual-, group-, or combined incentives. Intervention arm participants received performance-based incentives every four months for five periods. All participants received guideline education at baseline and audit and feedback every four months. Methods 83 full-time primary care physicians at 12 VA Medical Centers completed web-based survey responses to Hollenbeck’s goal commitment scale every four months and telephone interviews at months 8 and 16. Results Physician goal commitment did not vary over time or across arms. Participants reported patient non-adherence and consistent follow-up as perceived barriers and facilitators to successful hypertension care, suggesting providers may perceive hypertension management as more of a patient responsibility (external locus of control). Conclusions Financial incentives may constitute an insufficiently strong intervention to influence goal commitment when providers attribute performance to external forces beyond their control. PMID:23145846

Using the lessons of behavioral economics to design more effective pay-for-performance programs.

PubMed

Mehrotra, Ateev; Sorbero, Melony E S; Damberg, Cheryl L

2010-07-01

To describe improvements in the design of pay-for-performance (P4P) programs that reflect the psychology of how people respond to incentives. Investigation of the behavioral economics literature. We describe 7 ways to improve P4P program design in terms of frequency and types of incentive payments. After discussing why P4P incentives can have unintended adverse consequences, we outline potential ways to mitigate these. Although P4P incentives are increasingly popular, the healthcare literature shows that these have had minimal effect. Design improvements in P4P programs can enhance their effectiveness. Lessons from behavioral economics may greatly enhance the design and effectiveness of P4P programs in healthcare, but future work is needed to demonstrate this empirically.

When Payment Undermines the Pitch.

PubMed

Barasch, Alixandra; Berman, Jonathan Z; Small, Deborah A

2016-10-01

Studies on crowding out document that incentives sometimes backfire-decreasing motivation in prosocial tasks. In the present research, we demonstrated an additional channel through which incentives can be harmful. Incentivized advocates for a cause are perceived as less sincere than nonincentivized advocates and are ultimately less effective in persuading other people to donate. Further, the negative effects of incentives hold only when the incentives imply a selfish motive; advocates who are offered a matching incentive (i.e., who are told that the donations they successfully solicit will be matched), which is not incompatible with altruism, perform just as well as those who are not incentivized. Thus, incentives may affect prosocial outcomes in ways not previously investigated: by crowding out individuals' sincerity of expression and thus their ability to gain support for a cause.

Acceptability of Financial Incentives for Health Behaviours: A Discrete Choice Experiment.

PubMed

Giles, Emma L; Becker, Frauke; Ternent, Laura; Sniehotta, Falko F; McColl, Elaine; Adams, Jean

2016-01-01

Healthy behaviours are important determinants of health and disease, but many people find it difficult to perform these behaviours. Systematic reviews support the use of personal financial incentives to encourage healthy behaviours. There is concern that financial incentives may be unacceptable to the public, those delivering services and policymakers, but this has been poorly studied. Without widespread acceptability, financial incentives are unlikely to be widely implemented. We sought to answer two questions: what are the relative preferences of UK adults for attributes of financial incentives for healthy behaviours? Do preferences vary according to the respondents' socio-demographic characteristics? We conducted an online discrete choice experiment. Participants were adult members of a market research panel living in the UK selected using quota sampling. Preferences were examined for financial incentives for: smoking cessation, regular physical activity, attendance for vaccination, and attendance for screening. Attributes of interest (and their levels) were: type of incentive (none, cash, shopping vouchers or lottery tickets); value of incentive (a continuous variable); schedule of incentive (same value each week, or value increases as behaviour change is sustained); other information provided (none, written information, face-to-face discussion, or both); and recipients (all eligible individuals, people living in low-income households, or pregnant women). Cash or shopping voucher incentives were preferred as much as, or more than, no incentive in all cases. Lower value incentives and those offered to all eligible individuals were preferred. Preferences for additional information provided alongside incentives varied between behaviours. Younger participants and men were more likely to prefer incentives. There were no clear differences in preference according to educational attainment. Cash or shopping voucher-type financial incentives for healthy behaviours are not necessarily less acceptable than no incentives to UK adults.

The Influence of Incentive towards Their Motivation and Discipline (A Case Study at Rectorate of Andalas University, West Sumatera, Indonesia)

ERIC Educational Resources Information Center

Frengki; Hubeis, Aida Vitayala; Affandi, M. Joko

2017-01-01

There are several ways that can be done to improve employee performance, among others, by motivating employees and improving work discipline. Increased motivation and discipline can be pursued by the provision of incentive. This study aims to analyze the influence of incentive on Andalas University's employee motivation and discipline and analyze…

Teacher Incentives and Student Achievement: Evidence from New York City Public Schools. NBER Working Paper No. 16850

ERIC Educational Resources Information Center

Fryer, Roland G.

2011-01-01

Financial incentives for teachers to increase student performance is an increasingly popular education policy around the world. This paper describes a school-based randomized trial in over two-hundred New York City public schools designed to better understand the impact of teacher incentives on student achievement. I find no evidence that teacher…

78 FR 72155 - Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-12-02

...This rule updates and makes revisions to the End-Stage Renal Disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2014. This rule also sets forth requirements for the ESRD quality incentive program (QIP), including for payment year (PY) 2016 and beyond. In addition, this rule clarifies the grandfathering provision related to the 3-year minimum lifetime requirement (MLR) for Durable Medical Equipment (DME), and provides clarification of the definition of routinely purchased DME. This rule also implements budget-neutral fee schedules for splints and casts, and intraocular lenses (IOLs) inserted in a physician's office. Finally, this rule makes a few technical amendments and corrections to existing regulations related to payment for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items and services.

Avenues and incentives for commercial use of a low-g environment

NASA Technical Reports Server (NTRS)

Brown, R. L.; Zoller, L. K.

1981-01-01

The processing of materials in a low-gravity (low-g) or microgravity environment is investigated by NASA for scientific and commercial utilization, and process and product development. The elimination of gravity is shown to create unique materials, and improve ground-based processes, such as convection, sedimentation, buoyancy, and containerless processing. Commercial applications are discussed, including the manufacturing of silicon ribbon, turbine blades, and various pharmaceuticals in space. Commercial incentives and needs are also discussed, including the technical exchange agreement, in which NASA and a company agree to cooperate in the conduct and analysis of research programs. In addition to establishing and demonstrating scientific and technological precepts for analyzing and using low-g environments, NASA is establishing legal and management mechanisms to share cost and risk of early commercial ventures.

[Remunerations, benefits and labor incentives perceived by health care workers in Peru: an analysis comparing the Ministry of Health and the Social Insurance, 2009].

PubMed

Pardo, Karim; Andia, Marcelino; Rodriguez, Amado; Pérez, Walter; Moscoso, Betsy

2011-06-01

To describe the main characteristics of the general salaries situation and the incentive policies of health care workers of Peru, comparing them by their origin institution and type of contract. A mixed design study was done including both quantitative and qualitative components during 2008 and 2009 with both professional and technical personnel of the Ministry of Health (MINSA) and the Social Insurance (EsSalud) in Peru. The salary structure was primarily evaluated considering incentives, bonuses and other remunerations according to position, type of contract and work place. Remuneration and bonus policies at the national level are determined by the responsibilities and amount of time served. The type of contract is determined by the programs of the public system (DL 276) and the private system (DL 728), also by the Special Program of Contract Services Administration (CAS) and exclusively in MINSA contracting is determined by local health administration Committees (CLAS). The salary structure differs between both types of institutions, especially with respect to incentives and benefits. An special economic incentive for assistance (AETA) is unique to MINSA, but the proportion of assistance varies by region. The professionals of MINSA have lower salaries than those of EsSalud, in all types of contracts. A professional contracted through CAS generally has a lower salary than staff peers in MINSA, though this situation is reversed in EsSalud. The lowest salaries are found in contracts made through CLAS. The structure and salary amounts differ between MINSA and EsSalud, just as they differ by existing contracting types.

A multi-disciplinary perspective on emergent and future innovations in peer review

PubMed Central

Tennant, Jonathan P.; Dugan, Jonathan M.; Graziotin, Daniel; Jacques, Damien C.; Waldner, François; Mietchen, Daniel; Elkhatib, Yehia; B. Collister, Lauren; Pikas, Christina K.; Crick, Tom; Masuzzo, Paola; Caravaggi, Anthony; Berg, Devin R.; Niemeyer, Kyle E.; Ross-Hellauer, Tony; Mannheimer, Sara; Rigling, Lillian; Katz, Daniel S.; Greshake Tzovaras, Bastian; Pacheco-Mendoza, Josmel; Fatima, Nazeefa; Poblet, Marta; Isaakidis, Marios; Irawan, Dasapta Erwin; Renaut, Sébastien; Madan, Christopher R.; Matthias, Lisa; Nørgaard Kjær, Jesper; O'Donnell, Daniel Paul; Neylon, Cameron; Kearns, Sarah; Selvaraju, Manojkumar; Colomb, Julien

2017-01-01

Peer review of research articles is a core part of our scholarly communication system. In spite of its importance, the status and purpose of peer review is often contested. What is its role in our modern digital research and communications infrastructure? Does it perform to the high standards with which it is generally regarded? Studies of peer review have shown that it is prone to bias and abuse in numerous dimensions, frequently unreliable, and can fail to detect even fraudulent research. With the advent of web technologies, we are now witnessing a phase of innovation and experimentation in our approaches to peer review. These developments prompted us to examine emerging models of peer review from a range of disciplines and venues, and to ask how they might address some of the issues with our current systems of peer review. We examine the functionality of a range of social Web platforms, and compare these with the traits underlying a viable peer review system: quality control, quantified performance metrics as engagement incentives, and certification and reputation. Ideally, any new systems will demonstrate that they out-perform and reduce the biases of existing models as much as possible. We conclude that there is considerable scope for new peer review initiatives to be developed, each with their own potential issues and advantages. We also propose a novel hybrid platform model that could, at least partially, resolve many of the socio-technical issues associated with peer review, and potentially disrupt the entire scholarly communication system. Success for any such development relies on reaching a critical threshold of research community engagement with both the process and the platform, and therefore cannot be achieved without a significant change of incentives in research environments. PMID:29188015

A multi-disciplinary perspective on emergent and future innovations in peer review.

PubMed

Tennant, Jonathan P; Dugan, Jonathan M; Graziotin, Daniel; Jacques, Damien C; Waldner, François; Mietchen, Daniel; Elkhatib, Yehia; B Collister, Lauren; Pikas, Christina K; Crick, Tom; Masuzzo, Paola; Caravaggi, Anthony; Berg, Devin R; Niemeyer, Kyle E; Ross-Hellauer, Tony; Mannheimer, Sara; Rigling, Lillian; Katz, Daniel S; Greshake Tzovaras, Bastian; Pacheco-Mendoza, Josmel; Fatima, Nazeefa; Poblet, Marta; Isaakidis, Marios; Irawan, Dasapta Erwin; Renaut, Sébastien; Madan, Christopher R; Matthias, Lisa; Nørgaard Kjær, Jesper; O'Donnell, Daniel Paul; Neylon, Cameron; Kearns, Sarah; Selvaraju, Manojkumar; Colomb, Julien

2017-01-01

Peer review of research articles is a core part of our scholarly communication system. In spite of its importance, the status and purpose of peer review is often contested. What is its role in our modern digital research and communications infrastructure? Does it perform to the high standards with which it is generally regarded? Studies of peer review have shown that it is prone to bias and abuse in numerous dimensions, frequently unreliable, and can fail to detect even fraudulent research. With the advent of web technologies, we are now witnessing a phase of innovation and experimentation in our approaches to peer review. These developments prompted us to examine emerging models of peer review from a range of disciplines and venues, and to ask how they might address some of the issues with our current systems of peer review. We examine the functionality of a range of social Web platforms, and compare these with the traits underlying a viable peer review system: quality control, quantified performance metrics as engagement incentives, and certification and reputation. Ideally, any new systems will demonstrate that they out-perform and reduce the biases of existing models as much as possible. We conclude that there is considerable scope for new peer review initiatives to be developed, each with their own potential issues and advantages. We also propose a novel hybrid platform model that could, at least partially, resolve many of the socio-technical issues associated with peer review, and potentially disrupt the entire scholarly communication system. Success for any such development relies on reaching a critical threshold of research community engagement with both the process and the platform, and therefore cannot be achieved without a significant change of incentives in research environments.

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…

Giving University Students Incentives to Do Homework Improves Their Performance

ERIC Educational Resources Information Center

Radhakrishnan, Phanikiran; Lam, Dianne; Ho, Geoffrey

2009-01-01

Past research has focused on either the positive influence of incentives on homework completion (Cullen, Cullen, Hayhow, & Plouffe, 1975) or the positive influence of homework completion on academic performance (Cooper, Robinson, & Patall, 2006). Our study is one of the first to integrate these two streams of research to examine whether higher…

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…

The Mixed Nature of Incentives for Community Health Workers: Lessons from a Qualitative Study in Two Districts in India.

PubMed

Sarin, Enisha; Lunsford, Sarah Smith; Sooden, Ankur; Rai, Sanjay; Livesley, Nigel

2016-01-01

Incentives play an important role in motivating community health workers (CHWs). In India, accredited social health activists (ASHAs) are female CHWs who provide a range of services, including those specific to reproductive, maternal, neonatal, child, and adolescent health. Qualitative interviews were conducted with 49 ASHAs and one of their family members (husband, mother-in-law, sister-in-law, or son) from Gurdaspur and Mewat districts to explore the role of family, community, and health system in supporting ASHAs in their work. Thematic analysis revealed that incentives were both empowering and a source of distress for ASHAs and their families. Earning income and contributing to the household's financial wellbeing inspired a sense of financial independence and self-confidence for ASHAs, especially with respect to relations with their husbands and parents-in-law. In spite of the empowering effects of the incentives, they were a cause of distress. Low incentive rates relative to the level of effort required to complete ASHA responsibilities, compounded by irregular and incomplete payment, put pressure on families. ASHAs dedicated much of their time and own resources to perform their duties, drawing them away from their household responsibilities. Communication around incentives from supervisors may have led ASHAs to prioritize and promote those services that yielded higher incentives, as opposed to focusing on the most appropriate services for the client. ASHAs and their families maintained hope that their positions would eventually bring in a regular salary, which contributed to retention of ASHAs. Incentives, therefore, are both motivating and inspiring as well as a cause dissatisfaction among ASHAs and their families. Recommendations include revising the incentive scheme to be responsive to the time and effort required to complete tasks and the out-of-pocket costs incurred while working as an ASHA; improve communication to ASHAs on incentives and responsibilities; and ensure timely and complete payment of incentives to ASHAs. The findings from this study contribute to the existing literature on incentivized CHW programs and help throw added light on the role incentives play in family dynamics which affects performance of CHW.

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.

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

Do rewards reinforce the growth mindset?: Joint effects of the growth mindset and incentive schemes in a field intervention.

PubMed

Chao, Melody Manchi; Visaria, Sujata; Mukhopadhyay, Anirban; Dehejia, Rajeev

2017-10-01

The current study draws on the motivational model of achievement which has been guiding research on the growth mindset intervention (Dweck & Leggett, 1988) and examines how this intervention interacts with incentive systems to differentially influence performance for high- and low-achieving students in Indian schools that serve low-SES communities. Although, as expected, the growth mindset intervention did interact with incentive systems and prior achievement to influence subsequent academic performance, the existing growth mindset framework cannot fully account for the observed effects. Specifically, we found that the growth mindset intervention did facilitate performance through persistence, but only when the incentive system imparted individuals with a sense of autonomy. Such a facilitation effect was only found among those students who had high prior achievement, but not among those who had underperformed. When the incentive did not impart a sense of autonomy, the growth mindset intervention undermined the performance of those who had high initial achievement. To reconcile these discrepancies and to advance understanding of the impacts of psychological interventions on achievement outcomes, we discuss how the existing theory can be extended and integrated with an identity-based motivation framework (Oyserman & Destin, 2010). We also discuss the implications of our work for future research and practice. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

The effect of task demand and incentive on neurophysiological and cardiovascular markers of effort.

PubMed

Fairclough, Stephen H; Ewing, Kate

2017-09-01

According to motivational intensity theory, effort is proportional to the level of task demand provided that success is possible and successful performance is deemed worthwhile. The current study represents a simultaneous manipulation of demand (working memory load) and success importance (financial incentive) to investigate neurophysiological (EEG) and cardiovascular measures of effort. A 2×2 repeated-measures study was conducted where 18 participants performed a n-back task under three conditions of demand: easy (1-back), hard (4-back) and very hard (7-back). In addition, participants performed these tasks in the presence of performance-contingent financial incentive or in a no-incentive (pilot trial) condition. Three bands of EEG activity were quantified: theta (4-7Hz), lower-alpha (7.5-10Hz) and upper-alpha (10.5-13Hz). Fronto-medial activity in the theta band and activity in the upper-alpha band at frontal, central and parietal sites were sensitive to demand and indicated greatest effort when the task was challenging and success was possible. Mean systolic blood pressure and activity in the lower-alpha band at parietal sites were also sensitive to demand but also increased in the incentive condition across all levels of task demand. The results of the study largely support the predictions of motivational intensity using neurophysiological markers of effort. Copyright © 2017. Published by Elsevier B.V.

Near-term deployment of carbon capture and sequestration from biorefineries in the United States.

PubMed

Sanchez, Daniel L; Johnson, Nils; McCoy, Sean T; Turner, Peter A; Mach, Katharine J

2018-05-08

Capture and permanent geologic sequestration of biogenic CO 2 emissions may provide critical flexibility in ambitious climate change mitigation. However, most bioenergy with carbon capture and sequestration (BECCS) technologies are technically immature or commercially unavailable. Here, we evaluate low-cost, commercially ready CO 2 capture opportunities for existing ethanol biorefineries in the United States. The analysis combines process engineering, spatial optimization, and lifecycle assessment to consider the technical, economic, and institutional feasibility of near-term carbon capture and sequestration (CCS). Our modeling framework evaluates least cost source-sink relationships and aggregation opportunities for pipeline transport, which can cost-effectively transport small CO 2 volumes to suitable sequestration sites; 216 existing US biorefineries emit 45 Mt CO 2 annually from fermentation, of which 60% could be captured and compressed for pipeline transport for under $25/tCO 2 A sequestration credit, analogous to existing CCS tax credits, of $60/tCO 2 could incent 30 Mt of sequestration and 6,900 km of pipeline infrastructure across the United States. Similarly, a carbon abatement credit, analogous to existing tradeable CO 2 credits, of $90/tCO 2 can incent 38 Mt of abatement. Aggregation of CO 2 sources enables cost-effective long-distance pipeline transport to distant sequestration sites. Financial incentives under the low-carbon fuel standard in California and recent revisions to existing federal tax credits suggest a substantial near-term opportunity to permanently sequester biogenic CO 2 This financial opportunity could catalyze the growth of carbon capture, transport, and sequestration; improve the lifecycle impacts of conventional biofuels; support development of carbon-negative fuels; and help fulfill the mandates of low-carbon fuel policies across the United States. Copyright © 2018 the Author(s). Published by PNAS.

Near-term deployment of carbon capture and sequestration from biorefineries in the United States

PubMed Central

Johnson, Nils; McCoy, Sean T.; Turner, Peter A.; Mach, Katharine J.

2018-01-01

Capture and permanent geologic sequestration of biogenic CO2 emissions may provide critical flexibility in ambitious climate change mitigation. However, most bioenergy with carbon capture and sequestration (BECCS) technologies are technically immature or commercially unavailable. Here, we evaluate low-cost, commercially ready CO2 capture opportunities for existing ethanol biorefineries in the United States. The analysis combines process engineering, spatial optimization, and lifecycle assessment to consider the technical, economic, and institutional feasibility of near-term carbon capture and sequestration (CCS). Our modeling framework evaluates least cost source–sink relationships and aggregation opportunities for pipeline transport, which can cost-effectively transport small CO2 volumes to suitable sequestration sites; 216 existing US biorefineries emit 45 Mt CO2 annually from fermentation, of which 60% could be captured and compressed for pipeline transport for under $25/tCO2. A sequestration credit, analogous to existing CCS tax credits, of $60/tCO2 could incent 30 Mt of sequestration and 6,900 km of pipeline infrastructure across the United States. Similarly, a carbon abatement credit, analogous to existing tradeable CO2 credits, of $90/tCO2 can incent 38 Mt of abatement. Aggregation of CO2 sources enables cost-effective long-distance pipeline transport to distant sequestration sites. Financial incentives under the low-carbon fuel standard in California and recent revisions to existing federal tax credits suggest a substantial near-term opportunity to permanently sequester biogenic CO2. This financial opportunity could catalyze the growth of carbon capture, transport, and sequestration; improve the lifecycle impacts of conventional biofuels; support development of carbon-negative fuels; and help fulfill the mandates of low-carbon fuel policies across the United States. PMID:29686063

The effect of environmental factors on technical and scale efficiency of primary health care providers in Greece.

PubMed

Kontodimopoulos, Nick; Moschovakis, Giorgos; Aletras, Vassilis H; Niakas, Dimitris

2007-11-17

The purpose of this study was to compare technical and scale efficiency of primary care centers from the two largest Greek providers, the National Health System (NHS) and the Social Security Foundation (IKA) and to determine if, and how, efficiency is affected by various exogenous factors such as catchment population and location. The sample comprised of 194 units (103 NHS and 91 IKA). Efficiency was measured with Data Envelopment Analysis (DEA) using three inputs, -medical staff, nursing/paramedical staff, administrative/other staff- and two outputs, which were the aggregated numbers of scheduled/emergency patient visits and imaging/laboratory diagnostic tests. Facilities were categorized as small, medium and large (<15,000, 15,000-30,000 and >30,000 respectively) to reflect catchment population and as urban/semi-urban or remote/island to reflect location. In a second stage analysis, technical and scale efficiency scores were regressed against facility type (NHS or IKA), size and location using multivariate Tobit regression. Regarding technical efficiency, IKA performed better than the NHS (84.9% vs. 70.1%, Mann-Whitney P < 0.001), smaller units better than medium-sized and larger ones (84.2% vs. 72.4% vs. 74.3%, Kruskal-Wallis P < 0.01) and remote/island units better than urban centers (81.1% vs. 75.7%, Mann-Whitney P = 0.103). As for scale efficiency, IKA again outperformed the NHS (89.7% vs. 85.9%, Mann-Whitney P = 0.080), but results were reversed in respect to facility size and location. Specifically, larger units performed better (96.3% vs. 90.9% vs. 75.9%, Kruskal-Wallis P < 0.001), and urban units showed higher scale efficiency than remote ones (91.9% vs. 75.3%, Mann-Whitney P < 0.001). Interestingly 75% of facilities appeared to be functioning under increasing returns to scale. Within-group comparisons revealed significant efficiency differences between the two primary care providers. Tobit regression models showed that facility type, size and location were significant explanatory variables of technical and scale efficiency. Variations appeared to exist in the productive performance of the NHS and IKA as the two main primary care providers in Greece. These variations reflect differences in primary care organization, economical incentives, financial constraints, sociodemographic and local peculiarities. In all technical efficiency comparisons, IKA facilities appeared to outperform NHS ones irrespective of facility size or location. In respect to scale efficiency, the results were to some extent inconclusive and observed differences were mostly insignificant, although again IKA appeared to perform better.

Gas-heat-pump development

NASA Astrophysics Data System (ADS)

Creswick, F. A.

Incentives for the development of gas heat pumps are discussed. Technical progress made on several promising technologies was reviewed. The status of development of gas-engine-driven heat pumps, the absorption cycle for the near- and long-term gas heat pump systems, the Stirling engine, the small Rankine-cycle engines, and gas-turbine-driven heat pump systems were briefly reviewed. Progress in the US, Japan, and Europe is noted.

Public attitudes toward programs designed to enhance forest related benefits on private lands

Treesearch

Donald F. Dennis; Mark J. Twery; Michael A. Rechlin; Bruce Hansen

2003-01-01

Public agencies may at times provide education, technical help, tax incentives, or other forms of aid to private landowners to help them enhance their land in ways that benefit the public. Since public funds are used to pay these expenses, it is important that program goals be correlated with underlying public values and concerns. We used a conjoint ranking survey to...

Individual Versus Team-Based Financial Incentives to Increase Physical Activity: A Randomized, Controlled Trial.

PubMed

Patel, Mitesh S; Asch, David A; Rosin, Roy; Small, Dylan S; Bellamy, Scarlett L; Eberbach, Kimberly; Walters, Karen J; Haff, Nancy; Lee, Samantha M; Wesby, Lisa; Hoffer, Karen; Shuttleworth, David; Taylor, Devon H; Hilbert, Victoria; Zhu, Jingsan; Yang, Lin; Wang, Xingmei; Volpp, Kevin G

2016-07-01

More than half of adults in the United States do not attain the minimum recommended level of physical activity to achieve health benefits. The optimal design of financial incentives to promote physical activity is unknown. To compare the effectiveness of individual versus team-based financial incentives to increase physical activity. Randomized, controlled trial comparing three interventions to control. Three hundred and four adult employees from an organization in Philadelphia formed 76 four-member teams. All participants received daily feedback on performance towards achieving a daily 7000 step goal during the intervention (weeks 1- 13) and follow-up (weeks 14- 26) periods. The control arm received no other intervention. In the three financial incentive arms, drawings were held in which one team was selected as the winner every other day during the 13-week intervention. A participant on a winning team was eligible as follows: $50 if he or she met the goal (individual incentive), $50 only if all four team members met the goal (team incentive), or $20 if he or she met the goal individually and $10 more for each of three teammates that also met the goal (combined incentive). Mean proportion of participant-days achieving the 7000 step goal during the intervention. Compared to the control group during the intervention period, the mean proportion achieving the 7000 step goal was significantly greater for the combined incentive (0.35 vs. 0.18, difference: 0.17, 95 % confidence interval [CI]: 0.07-0.28, p <0.001) but not for the individual incentive (0.25 vs 0.18, difference: 0.08, 95 % CI: -0.02-0.18, p = 0.13) or the team incentive (0.17 vs 0.18, difference: -0.003, 95 % CI: -0.11-0.10, p = 0.96). The combined incentive arm participants also achieved the goal at significantly greater rates than the team incentive (0.35 vs. 0.17, difference: 0.18, 95 % CI: 0.08-0.28, p < 0.001), but not the individual incentive (0.35 vs. 0.25, difference: 0.10, 95 % CI: -0.001-0.19, p = 0.05). Only the combined incentive had greater mean daily steps than control (difference: 1446, 95 % CI: 448-2444, p ≤ 0.005). There were no significant differences between arms during the follow-up period (weeks 14- 26). Financial incentives rewarded for a combination of individual and team performance were most effective for increasing physical activity. Clinicaltrials.gov identifier: NCT02001194.

42 CFR § 414.1365 - Subcategories for the improvement activities performance category.

Code of Federal Regulations, 2010 CFR

2017-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive...

Analysis of alternative strategies for energy conservation in new buildings

NASA Astrophysics Data System (ADS)

Fang, J. M.; Tawil, J.

1980-12-01

The policy instruments considered include: greater reliance on market forces; research and development; information, education and demonstration programs; tax incentives and sanctions; mortgage and finance programs; and regulations and standards. The analysis starts with an explanation of the barriers to energy conservation in the residential and commercial sectors. Individual policy instruments are described and evaluated with respect to energy conservation, economic efficiency, equity, political impacts, and implementation and other transitional impacts. Five possible strategies are identified: (1) increased reliance on the market place; (2) energy consumption tax and supply subsidies; (3) Building Energy Performance Standards (BEPS) with no sanctions and no incentives; (4) BEPS with sanctions and incentives (price control); and (5) BEPS with sanctions and incentives (no price controls). A comparative analysis is performed. Elements are proposed for inclusion in a comprehensive strategy for conservation in new buildings.

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…

Incentive-Based Primary Care: Cost and Utilization Analysis

PubMed Central

Hollander, Marcus J; Kadlec, Helena

2015-01-01

Context: In its fee-for-service funding model for primary care, British Columbia, Canada, introduced incentive payments to general practitioners as pay for performance for providing enhanced, guidelines-based care to patients with chronic conditions. Evaluation of the program was conducted at the health care system level. Objective: To examine the impact of the incentive payments on annual health care costs and hospital utilization patterns in British Columbia. Design: The study used Ministry of Health administrative data for Fiscal Year 2010–2011 for patients with diabetes, congestive heart failure, chronic obstructive pulmonary disease, and/or hypertension. In each disease group, cost and utilization were compared across patients who did, and did not, receive incentive-based care. Main Outcome Measures: Health care costs (eg, primary care, hospital) and utilization measures (eg, hospital days, readmissions). Results: After controlling for patients’ age, sex, service needs level, and continuity of care (defined as attachment to a general practice), the incentives reduced the net annual health care costs, in Canadian dollars, for patients with hypertension (by approximately Can$308 per patient), chronic obstructive pulmonary disease (by Can$496), and congestive heart failure (by Can$96), but not diabetes (incentives cost about Can$148 more per patient). The incentives were also associated with fewer hospital days, fewer admissions and readmissions, and shorter lengths of hospital stays for all 4 groups. Conclusion: Although the available literature on pay for performance shows mixed results, we showed that the funding model used in British Columbia using incentive payments for primary care might reduce health care costs and hospital utilization. PMID:26263389

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…

Augmenting the impact of technology adoption with financial incentive to improve radiology report signature times.

PubMed

Andriole, Katherine P; Prevedello, Luciano M; Dufault, Allen; Pezeshk, Parham; Bransfield, Robert; Hanson, Richard; Doubilet, Peter M; Seltzer, Steven E; Khorasani, Ramin

2010-03-01

Radiology report signature time (ST) can be a substantial component of total report turnaround time. Poor turnaround time resulting from lengthy ST can adversely affect patient care. The combination of technology adoption with financial incentive was evaluated to determine if ST improvement can be augmented and sustained. This prospective study was performed at a 751-bed, urban, tertiary care adult teaching hospital. Test-site imaging volume approximated 48,000 examinations per month. The radiology department has 100 trainees and 124 attending radiologists serving multiple institutions. Over a study period of 4 years and 4 months, three interventions focused on radiologist signature performance were implemented: 1) a notification paging application that alerted radiologists when reports were ready for signature, 2) a picture archiving and communications systems (PACS)-integrated speech recognition report generation system, and 3) a departmental financial incentive to reward radiologists semiannually for ST performance. Signature time was compared before and after the interventions. Wilcoxon and linear regression statistical analyses were used to assess the significance of trends. Technology adoption (paging plus speech recognition) reduced median ST from >5 to <1 hour (P < .001) and 80th-percentile ST from >24 to 15 to 18 hours (P < .001). Subsequent addition of a financial incentive further improved 80th-percentile ST to 4 to 8 hours (P < .001). The gains in median and 80th-percentile ST were sustained over the final 31 months of the study period. Technology interventions coupled with financial incentive can result in synergistic and sustainable improvement in radiologist report-signing behavior. The addition of a financial incentive leads to better performance than that achievable through technology alone.

System Advisor Model, SAM 2011.12.2: General Description

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

Gilman, P.; Dobos, A.

2012-02-01

This document describes the capabilities of the U.S. Department of Energy and National Renewable Energy Laboratory's System Advisor Model (SAM), Version 2011.12.2, released on December 2, 2011. SAM is software that models the cost and performance of renewable energy systems. Project developers, policy makers, equipment manufacturers, and researchers use graphs and tables of SAM results in the process of evaluating financial, technology, and incentive options for renewable energy projects. SAM simulates the performance of solar, wind, geothermal, biomass, and conventional power systems. The financial model can represent financing structures for projects that either buy and sell electricity at retail ratesmore » (residential and commercial) or sell electricity at a price determined in a power purchase agreement (utility). Advanced analysis options facilitate parametric, sensitivity, and statistical analyses, and allow for interfacing SAM with Microsoft Excel or with other computer programs. SAM is available as a free download at http://sam.nrel.gov. Technical support and more information about the software are available on the website.« less

A maternal health voucher scheme: what have we learned from the demand-side financing scheme in Bangladesh?

PubMed

Ahmed, Shakil; Khan, M Mahmud

2011-01-01

It is now more than 2 years since the Ministry of Health and Family Welfare of the Government of Bangladesh implemented the Maternal Health Voucher Scheme, a specialized form of demand-side financing programme. To analyse the early lessons from the scheme, information was obtained through semi-structured interviews with stakeholders at the sub-district level. The analysis identified a number of factors affecting the efficiency and performance of the scheme in the program area: delay in the release of voucher funds, selection criteria used for enrolling pregnant women in the programme, incentives created by the reimbursement system, etc. One of the objectives of the scheme was to encourage market competition among health care providers, but it failed to increase market competitiveness in the area. The resources made available through the scheme did not attract any new providers into the market and public facilities remained the only eligible provider both before and after scheme implementation. However, incentives provided through the voucher system did motivate public providers to offer a higher level of services. The beneficiaries expressed their overall satisfaction with the scheme as well. Since the local facility was not technically ready to provide all types of maternal health care services, providing vouchers may not improve access to care for many pregnant women. To improve the performance of the demand-side strategy, it has become important to adopt some supply-side interventions. In poor developing countries, a demand-side strategy may not be very effective without significant expansion of the service delivery capacity of health facilities at the sub-district level.

A Socio-Technical Analysis of Patient Accessible Electronic Health Records.

PubMed

Hägglund, Maria; Scandurra, Isabella

2017-01-01

In Sweden, and internationally, there is a movement towards increased transparency in healthcare including giving patients online access to their electronic health records (EHR). The purpose of this paper is to analyze the Swedish patient accessible EHR (PAEHR) service using a socio-technical framework, to increase the understanding of factors that influence the design, implementation, adoption and use of the service. Using the Sitting and Singh socio-technical framework as a basis for analyzing the Swedish PAEHR system and its context indicated that there are many stakeholders engaged in these types of services, with different driving forces and incentives that may influence the adoption and usefulness of PAEHR services. The analysis was useful in highlighting important areas that need to be further explored in evaluations of PAEHR services, and can act as a guide when planning evaluations of any PAEHR service.

42 CFR § 414.1335 - Data submission criteria for the quality performance category.

Code of Federal Regulations, 2010 CFR

2017-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive...

The role of behavioral economic incentive design and demographic characteristics in financial incentive-based approaches to changing health behaviors: a meta-analysis.

PubMed

Haff, Nancy; Patel, Mitesh S; Lim, Raymond; Zhu, Jingsan; Troxel, Andrea B; Asch, David A; Volpp, Kevin G

2015-01-01

To evaluate the use of behavioral economics to design financial incentives to promote health behavior change and to explore associations with demographic characteristics. Studies performed by the Center for Health Incentives and Behavioral Economics at the University of Pennsylvania published between January 2006 and March 2014. Randomized, controlled trials with available participant-level data. Studies that did not use financial incentives to promote health behavior change were excluded. Participant-level data from seven studies were pooled. Meta-analysis on the pooled sample using a random-effects model with interaction terms to examine treatment effects and whether they varied by incentive structure or demographic characteristics. The pooled study sample comprised 1403 participants, of whom 35% were female, 70% were white, 24% were black, and the mean age was 48 years (standard deviation 11.2 years). In the fully adjusted model, participants offered financial incentives had higher odds of behavior change (odds ratio [OR]: 3.96; p < .01) when compared to control. There were no significant interactions between financial incentives and gender, age, race, income, or education. When further adjusting for incentive structure, blacks had higher odds than whites of achieving behavior change (OR: 1.67; p < .05) with a conditional payment. Compared to lower-income participants, higher-income participants had lower odds of behavior change (OR: 0.46; p = .01) with a regret lottery. Financial incentives designed using concepts from behavioral economics were effective for promoting health behavior change. There were no large and consistent relationships between the effectiveness of financial incentives and observable demographic characteristics. Second-order examinations of incentive structure suggest potential relationships among the effectiveness of financial incentives, incentive structure, and the demographic characteristics of race and income.

A study of a nursing department performance measurement system: using the Balanced Scorecard and the Analytic Hierarchy Process.

PubMed

Chu, Hsuan-Lien; Wang, Chen-Chin; Dai, Yu-Tzu

2009-01-01

The health care industry is under pressure from government and private entities as well as from market conditions to contain costs. In an effort to respond to these pressures, the case hospital in this study implemented a Balanced Scorecard (BSC) in January 2003 and integrated it with the hospital's formal incentive plan for non-physicians in January 2005. The nursing department's performance improved in the 2 years following the introduction of the plan. This study contributes to the literature by demonstrating the performance improvement that results from integrating the BSC with an incentive plan in the nursing field. The results provide insight into the current BSC performance metrics applied by the case nursing department, and could be used as guidelines by other health care organizations that wish to implement BSC-based incentive plans.

Selfish play increases during high-stakes NBA games and is rewarded with more lucrative contracts.

PubMed

Uhlmann, Eric Luis; Barnes, Christopher M

2014-01-01

High-stakes team competitions can present a social dilemma in which participants must choose between concentrating on their personal performance and assisting teammates as a means of achieving group objectives. We find that despite the seemingly strong group incentive to win the NBA title, cooperative play actually diminishes during playoff games, negatively affecting team performance. Thus team cooperation decreases in the very high stakes contexts in which it is most important to perform well together. Highlighting the mixed incentives that underlie selfish play, personal scoring is rewarded with more lucrative future contracts, whereas assisting teammates to score is associated with reduced pay due to lost opportunities for personal scoring. A combination of misaligned incentives and psychological biases in performance evaluation bring out the "I" in "team" when cooperation is most critical.

Selfish Play Increases during High-Stakes NBA Games and Is Rewarded with More Lucrative Contracts

PubMed Central

Uhlmann, Eric Luis; Barnes, Christopher M.

2014-01-01

High-stakes team competitions can present a social dilemma in which participants must choose between concentrating on their personal performance and assisting teammates as a means of achieving group objectives. We find that despite the seemingly strong group incentive to win the NBA title, cooperative play actually diminishes during playoff games, negatively affecting team performance. Thus team cooperation decreases in the very high stakes contexts in which it is most important to perform well together. Highlighting the mixed incentives that underlie selfish play, personal scoring is rewarded with more lucrative future contracts, whereas assisting teammates to score is associated with reduced pay due to lost opportunities for personal scoring. A combination of misaligned incentives and psychological biases in performance evaluation bring out the “I” in “team” when cooperation is most critical. PMID:24763384

Reward Motivation Enhances Task Coding in Frontoparietal Cortex

PubMed Central

Etzel, Joset A.; Cole, Michael W.; Zacks, Jeffrey M.; Kay, Kendrick N.; Braver, Todd S.

2016-01-01

Reward motivation often enhances task performance, but the neural mechanisms underlying such cognitive enhancement remain unclear. Here, we used a multivariate pattern analysis (MVPA) approach to test the hypothesis that motivation-related enhancement of cognitive control results from improved encoding and representation of task set information. Participants underwent two fMRI sessions of cued task switching, the first under baseline conditions, and the second with randomly intermixed reward incentive and no-incentive trials. Information about the upcoming task could be successfully decoded from cue-related activation patterns in a set of frontoparietal regions typically associated with task control. More critically, MVPA classifiers trained on the baseline session had significantly higher decoding accuracy on incentive than non-incentive trials, with decoding improvement mediating reward-related enhancement of behavioral performance. These results strongly support the hypothesis that reward motivation enhances cognitive control, by improving the discriminability of task-relevant information coded and maintained in frontoparietal brain regions. PMID:25601237

Merit-Based Incentive Payment System (MIPS): Harsh Choices For Interventional Pain Management Physicians.

PubMed

Manchikanti, Laxmaiah; Helm Ii, Standiford; Benyamin, Ramsin M; Hirsch, Joshua A

2016-01-01

The Merit-based Incentive Payment System (MIPS) was created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to improve the health of all Americans by providing incentives and policies to improve patient health outcomes. MIPS combines 3 existing programs, Meaningful Use (MU), now called Advancing Care Information (ACI), contributing 25% of the composite score; Physician Quality Reporting System (PQRS), changed to Quality, contributing 50% of the composite score; and Value-based Payment (VBP) system to Resource Use or cost, contributing 10% of the composite score. Additionally, Clinical Practice Improvement Activities (CPIA), contributing 15% of the composite score, create multiple strategic goals to design incentives that drive movement toward delivery system reform principles with inclusion of Advanced Alternative Payment Models (APMs). Under the present proposal, the Centers for Medicare and Medicaid Services (CMS) has estimated approximately 30,000 to 90,000 providers from a total of over 761,000 providers will be exempt from MIPS. About 87% of solo practitioners and 70% of practitioners in groups of less than 10 will be subjected to negative payments or penalties ranging from 4% to 9%. In addition, MIPS also will affect a provider's reputation by making performance measures accessible to consumers and third-party physician rating Web sites.The MIPS composite performance scoring method, at least in theory, utilizes weights for each performance category, exceptional performance factors to earn bonuses, and incorporates the special circumstances of small practices.In conclusion, MIPS has the potential to affect practitioners negatively. Interventional Pain Medicine practitioners must understand the various MIPS measures and how they might participate in order to secure a brighter future. Medicare Access and CHIP Reauthorization Act of 2015, merit-based incentive payment system, quality performance measures, resource use, clinical practice improvement activities, advancing care information performance category.

Data-driven planning of distributed energy resources amidst socio-technical complexities

NASA Astrophysics Data System (ADS)

Jain, Rishee K.; Qin, Junjie; Rajagopal, Ram

2017-08-01

New distributed energy resources (DER) are rapidly replacing centralized power generation due to their environmental, economic and resiliency benefits. Previous analyses of DER systems have been limited in their ability to account for socio-technical complexities, such as intermittent supply, heterogeneous demand and balance-of-system cost dynamics. Here we develop ReMatch, an interdisciplinary modelling framework, spanning engineering, consumer behaviour and data science, and apply it to 10,000 consumers in California, USA. Our results show that deploying DER would yield nearly a 50% reduction in the levelized cost of electricity (LCOE) over the status quo even after accounting for socio-technical complexities. We abstract a detailed matching of consumers to DER infrastructure from our results and discuss how this matching can facilitate the development of smart and targeted renewable energy policies, programmes and incentives. Our findings point to the large-scale economic and technical feasibility of DER and underscore the pertinent role DER can play in achieving sustainable energy goals.

Why British GPs use computers and hospital doctors do not.

PubMed Central

Benson, T.

2001-01-01

Almost all general medical practitioners (GPs) in the UK use computers, compared with less than one in ten of hospital doctors. This paper explains how this unexpected situation came about over a thirty-year period, identifying some of the successes and failures of British medical computing along the way. Twelve separate factors are considered. The major determinants have not been technical, but rather a strong tide of political backing for general practice and leadership from the profession at the highest level, which have combined to build an appropriate regulatory framework and financial incentives that have encouraged GPs to embrace computers. Hospital computing has some difficulties not met by GPs, but the main factor preventing progress has been the lack of any real incentive positive (carrot) or negative (stick), for hospital doctors to use computers. PMID:11825153

Medicare program; end-stage renal disease prospective payment system, quality incentive program, and durable medical equipment, prosthetics, orthotics, and supplies.

PubMed

2013-12-02

This rule updates and makes revisions to the End-Stage Renal Disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2014. This rule also sets forth requirements for the ESRD quality incentive program (QIP), including for payment year (PY) 2016 and beyond. In addition, this rule clarifies the grandfathering provision related to the 3-year minimum lifetime requirement (MLR) for Durable Medical Equipment (DME), and provides clarification of the definition of routinely purchased DME. This rule also implements budget-neutral fee schedules for splints and casts, and intraocular lenses (IOLs) inserted in a physician's office. Finally, this rule makes a few technical amendments and corrections to existing regulations related to payment for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) items and services.

Why British GPs use computers and hospital doctors do not.

PubMed

Benson, T

2001-01-01

Almost all general medical practitioners (GPs) in the UK use computers, compared with less than one in ten of hospital doctors. This paper explains how this unexpected situation came about over a thirty-year period, identifying some of the successes and failures of British medical computing along the way. Twelve separate factors are considered. The major determinants have not been technical, but rather a strong tide of political backing for general practice and leadership from the profession at the highest level, which have combined to build an appropriate regulatory framework and financial incentives that have encouraged GPs to embrace computers. Hospital computing has some difficulties not met by GPs, but the main factor preventing progress has been the lack of any real incentive positive (carrot) or negative (stick), for hospital doctors to use computers.

78 FR 40835 - Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-08

...This rule proposes to update and make revisions to the End- Stage Renal Disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2014. This rule also proposes to set forth requirements for the ESRD quality incentive program (QIP), including for payment year (PY) 2016 and beyond. In addition, this rule proposes to clarify the grandfathering provision related to the 3-year minimum lifetime requirement (MLR) for Durable Medical Equipment (DME). In addition, it provides clarification of the definition of routinely purchased DME. This rule also proposes the implementation of budget- neutral fee schedules for splints and casts, and intraocular lenses (IOLs) inserted in a physician's office. Finally, this rule would make a few technical amendments and corrections to existing regulations related to payment for DMEPOS items and services.

Effects of an Incentive Based Budgeting System on Institutional Performance Indicators: An Exploratory Longitudinal Case Study of a Public University

ERIC Educational Resources Information Center

Willett, Michael S.

2013-01-01

The purpose of this exploratory longitudinal case study was to examine how the implementation of an Incentive Based Budgeting (IBB) system (i.e., Responsibility-Centered Management [RCM]) affected selected institutional performance indicators at the campus level and two comparable schools at a large Mid-Western public University. The value of…

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…

Holding Accountability to Account: How Scholarship and Experience in Other Fields Inform Exploration of Performance Incentives in Education. Working Paper 2008-04

ERIC Educational Resources Information Center

Rothstein, Richard

2008-01-01

Accountability and performance incentive plans in education are compromised by goal distortion, gaming, and corruption. Education policy makers who design such plans have paid insufficient attention to similar experiences in other fields. This paper describes institutions in health care, job training and welfare administration, and in the private…

Practice and Incentive Effects on Learner Performance: Aircraft Instrument Comprehension Task.

ERIC Educational Resources Information Center

Tenpas, Barbara G.; Higgins, Norman C.

To study the effects of practice and incentive on learner performance on the aircraft instrument comprehension task, 48 third-year Air Force cadets were chosen as subjects. The subjects were expected to be able to identify which one of four pictures of aircraft in flight most nearly corresponded to the position indicated on a panel of attitude and…

Crossing the Barriers: An Analysis of Market Barriers to Geothermal Development and Potential Improvement Scenarios

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

Young, Katherine R; Levine, Aaron L; Cook, Jeffrey J

Developers have identified many non-technical barriers to geothermal power development, including market barriers. Understanding the challenges to market deployment of geothermal power is important since obtaining power purchase agreements is often cited as one of the largest barriers to geothermal development. This paper discusses the impacts to deployment caused by market challenges, including market demand, price of electricity, policies and incentives.

USSR Report, Science and Technology Policy, No. 12.

DTIC Science & Technology

1983-05-09

deciduous wood instead of the scarce coniferous. 45 State Prize were awarded to four textbooks for VUZes and professional-technical schools: "Osnovy...upon the size of the material incentive fund, the social-cultural mea- sures fund, the housing contruction fund, and the fund for the develop- ment...and unification, patent and legal aspects, ecological and safety are used. Each of these determine some aspect of the utility of the manufactured

Consistent Criteria are Needed to Assess Small-Business Innovation Initiatives.

DTIC Science & Technology

1981-07-07

Federal programs designed to provide funding or technical and management assistance directly to small busi - nesses (such as the National Science...activities to support small businesses as innovators 33 Efforts to influence economy-wide factors 35 Programs that provide funding or management and... Management : A Guide to Entrepreneurship (Boston: Houghton Mifflin, 1977), p. 61. 2/H. Stoll and J. Walter, Tax Incentives for Small Businesses (Chicago

Defending Against Advanced Persistent Threats Using Game-Theory

PubMed Central

König, Sandra; Schauer, Stefan

2017-01-01

Advanced persistent threats (APT) combine a variety of different attack forms ranging from social engineering to technical exploits. The diversity and usual stealthiness of APT turns them into a central problem of contemporary practical system security, since information on attacks, the current system status or the attacker’s incentives is often vague, uncertain and in many cases even unavailable. Game theory is a natural approach to model the conflict between the attacker and the defender, and this work investigates a generalized class of matrix games as a risk mitigation tool for an advanced persistent threat (APT) defense. Unlike standard game and decision theory, our model is tailored to capture and handle the full uncertainty that is immanent to APTs, such as disagreement among qualitative expert risk assessments, unknown adversarial incentives and uncertainty about the current system state (in terms of how deeply the attacker may have penetrated into the system’s protective shells already). Practically, game-theoretic APT models can be derived straightforwardly from topological vulnerability analysis, together with risk assessments as they are done in common risk management standards like the ISO 31000 family. Theoretically, these models come with different properties than classical game theoretic models, whose technical solution presented in this work may be of independent interest. PMID:28045922

Dissemination of Technology to Evaluate Healthy Food Incentive Programs.

PubMed

Freedman, Darcy A; Hunt, Alan R; Merritt, Katie; Shon, En-Jung; Pike, Stephanie N

2017-03-01

Federal policy supports increased implementation of monetary incentive interventions for chronic disease prevention among low-income populations. This study describes how a Prevention Research Center, working with a dissemination partner, developed and distributed technology to support nationwide implementation and evaluation of healthy food incentive programming focused on Supplemental Nutrition Assistance Program recipients. FM Tracks, an iOS-based application and website, was developed to standardize evaluation methods for healthy food incentive program implementation at direct-to-consumer markets. This evaluation examined diffusion and adoption of the technology over 9 months (July 2015-March 2016). Data were analyzed in 2016. FM Tracks was disseminated to 273 markets affiliated with 37 regional networks in 18 states and Washington, DC. All markets adopted the sales transaction data collection feature, with nearly all recording at least one Supplemental Nutrition Assistance Program (99.3%) and healthy food incentive (97.1%) transaction. A total of 43,493 sales transactions were recorded. By the ninth month of technology dissemination, markets were entering individual sales transactions using the application (34.5%) and website (29.9%) and aggregated transactions via website (35.6%) at similar rates. Use of optional evaluation features like recording a customer ID with individual transactions increased successively with a low of 22.2% during the first month to a high of 69.2% in the ninth month. Systematic and widely used evaluation technology creates possibilities for pragmatic research embedded within ongoing, real-world implementation of food access interventions. Technology dissemination requires supportive technical assistance and continuous refinement that can be advanced through academic-practitioner partnerships. Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Measuring client satisfaction and the quality of family planning services: A comparative analysis of public and private health facilities in Tanzania, Kenya and Ghana

PubMed Central

2011-01-01

Background Public and private family planning providers face different incentive structures, which may affect overall quality and ultimately the acceptability of family planning for their intended clients. This analysis seeks to quantify differences in the quality of family planning (FP) services at public and private providers in three representative sub-Saharan African countries (Tanzania, Kenya and Ghana), to assess how these quality differentials impact upon FP clients' satisfaction, and to suggest how quality improvements can improve contraceptive continuation rates. Methods Indices of technical, structural and process measures of quality are constructed from Service Provision Assessments (SPAs) conducted in Tanzania (2006), Kenya (2004) and Ghana (2002) using direct observation of facility attributes and client-provider interactions. Marginal effects from multivariate regressions controlling for client characteristics and the multi-stage cluster sample design assess the relative importance of different measures of structural and process quality at public and private facilities on client satisfaction. Results Private health facilities appear to be of higher (interpersonal) process quality than public facilities but not necessarily higher technical quality in the three countries, though these differentials are considerably larger at lower level facilities (clinics, health centers, dispensaries) than at hospitals. Family planning client satisfaction, however, appears considerably higher at private facilities - both hospitals and clinics - most likely attributable to both process and structural factors such as shorter waiting times and fewer stockouts of methods and supplies. Conclusions Because the public sector represents the major source of family planning services in developing countries, governments and Ministries of Health should continue to implement and to encourage incentives, perhaps performance-based, to improve quality at public sector health facilities, as well as to strengthen regulatory and monitoring structures to ensure quality at both public and private facilities. In the meantime, private providers appear to be fulfilling an important gap in the provision of FP services in these countries. PMID:21864335

Measuring client satisfaction and the quality of family planning services: a comparative analysis of public and private health facilities in Tanzania, Kenya and Ghana.

PubMed

Hutchinson, Paul L; Do, Mai; Agha, Sohail

2011-08-24

Public and private family planning providers face different incentive structures, which may affect overall quality and ultimately the acceptability of family planning for their intended clients. This analysis seeks to quantify differences in the quality of family planning (FP) services at public and private providers in three representative sub-Saharan African countries (Tanzania, Kenya and Ghana), to assess how these quality differentials impact upon FP clients' satisfaction, and to suggest how quality improvements can improve contraceptive continuation rates. Indices of technical, structural and process measures of quality are constructed from Service Provision Assessments (SPAs) conducted in Tanzania (2006), Kenya (2004) and Ghana (2002) using direct observation of facility attributes and client-provider interactions. Marginal effects from multivariate regressions controlling for client characteristics and the multi-stage cluster sample design assess the relative importance of different measures of structural and process quality at public and private facilities on client satisfaction. Private health facilities appear to be of higher (interpersonal) process quality than public facilities but not necessarily higher technical quality in the three countries, though these differentials are considerably larger at lower level facilities (clinics, health centers, dispensaries) than at hospitals. Family planning client satisfaction, however, appears considerably higher at private facilities - both hospitals and clinics - most likely attributable to both process and structural factors such as shorter waiting times and fewer stockouts of methods and supplies. Because the public sector represents the major source of family planning services in developing countries, governments and Ministries of Health should continue to implement and to encourage incentives, perhaps performance-based, to improve quality at public sector health facilities, as well as to strengthen regulatory and monitoring structures to ensure quality at both public and private facilities. In the meantime, private providers appear to be fulfilling an important gap in the provision of FP services in these countries.

Use of monetary and nonmonetary incentives to increase response rates among African Americans in the Wisconsin Pregnancy Risk Assessment Monitoring System.

PubMed

Dykema, Jennifer; Stevenson, John; Kniss, Chad; Kvale, Katherine; González, Kim; Cautley, Eleanor

2012-05-01

From 2009 to 2010, an experiment was conducted to increase response rates among African American mothers in the Wisconsin Pregnancy Risk Assessment Monitoring System (PRAMS). Sample members were randomly assigned to groups that received a prepaid, cash incentive of $5 (n = 219); a coupon for diapers valued at $6 (n = 210); or no incentive (n = 209). Incentives were included with the questionnaire, which was mailed to respondents. We examined the effects of the incentives on several outcomes, including response rates, cost effectiveness, survey response distributions, and item nonresponse. Response rates were significantly higher for the cash group than for the coupon (42.5 vs. 32.4%, P < .05) or no incentive group (42.5 vs. 30.1%, P < .01); the coupon and no incentive groups performed similarly. While absolute costs were the highest for the cash group, the cost per completed survey was the lowest. The incentives had limited effects on response distributions for specific survey questions. Although respondents completing the survey by mail in the cash and coupon groups exhibited a trend toward being less likely to have missing data, the effect was not significant. Compared to a coupon or no incentive, a small cash incentive significantly improved response rates and was cost effective among African American respondents in Wisconsin PRAMS. Incentives had only limited effects, however, on survey response distributions, and no significant effects on item nonresponse.

Role of contingency in striatal response to incentive in adolescents with anxiety.

PubMed

Benson, Brenda E; Guyer, Amanda E; Nelson, Eric E; Pine, Daniel S; Ernst, Monique

2015-03-01

This study examines the effect of contingency on reward function in anxiety. We define contingency as the aspect of a situation in which the outcome is determined by one's action-that is, when there is a direct link between one's action and the outcome of the action. Past findings in adolescents with anxiety or at risk for anxiety have revealed hypersensitive behavioral and neural responses to higher value rewards with correct performance. This hypersensitivity to highly valued (salient) actions suggests that the value of actions is determined not only by outcome magnitude, but also by the degree to which the outcome is contingent on correct performance. Thus, contingency and incentive value might each modulate reward responses in unique ways in anxiety. Using fMRI with a monetary reward task, striatal response to cue anticipation is compared in 18 clinically anxious and 20 healthy adolescents. This task manipulates orthogonally reward contingency and incentive value. Findings suggest that contingency modulates the neural response to incentive magnitude differently in the two groups. Specifically, during the contingent condition, right-striatal response tracks incentive value in anxious, but not healthy, adolescents. During the noncontingent condition, striatal response is bilaterally stronger to low than to high incentive in anxious adolescents, while healthy adolescents exhibit the expected opposite pattern. Both contingency and reward magnitude differentiate striatal activation in anxious versus healthy adolescents. These findings may reflect exaggerated concern about performance and/or alterations of striatal coding of reward value in anxious adolescents. Abnormalities in reward function in anxiety may have treatment implications.

Diaphragmatic mobility in healthy subjects during incentive spirometry with a flow-oriented device and with a volume-oriented device.

PubMed

Yamaguti, Wellington Pereira dos Santos; Sakamoto, Eliana Takahama; Panazzolo, Danilo; Peixoto, Corina da Cunha; Cerri, Giovanni Guido; Albuquerque, André Luis Pereira

2010-01-01

To compare the diaphragmatic mobility of healthy subjects during incentive spirometry with a volume-oriented device, during incentive spirometry with a flow-oriented device, and during diaphragmatic breathing. To compare men and women in terms of diaphragmatic mobility during these three types of breathing exercises. We evaluated the pulmonary function and diaphragmatic mobility of 17 adult healthy volunteers (9 women and 8 men). Diaphragmatic mobility was measured via ultrasound during diaphragmatic breathing and during the use of the two types of incentive spirometers. Diaphragmatic mobility was significantly greater during the use of the volume-oriented incentive spirometer than during the use of the flow-oriented incentive spirometer (70.16 ± 12.83 mm vs. 63.66 ± 10.82 mm; p = 0.02). Diaphragmatic breathing led to a greater diaphragmatic mobility than did the use of the flow-oriented incentive spirometer (69.62 ± 11.83 mm vs. 63.66 ± 10.82 mm; p = 0.02). During all three types of breathing exercises, the women showed a higher mobility/FVC ratio than did the men. Incentive spirometry with a volume-oriented device and diaphragmatic breathing promoted greater diaphragmatic mobility than did incentive spirometry with a flow-oriented device. Women performed better on the three types of breathing exercises than did men.

Financial incentives and maternal health: where do we go from here?

PubMed

Morgan, Lindsay; Stanton, Mary Ellen; Higgs, Elizabeth S; Balster, Robert L; Bellows, Ben W; Brandes, Neal; Comfort, Alison B; Eichler, Rena; Glassman, Amanda; Hatt, Laurel E; Conlon, Claudia M; Koblinsky, Marge

2013-12-01

Health financing strategies that incorporate financial incentives are being applied in many low- and middle-income countries, and improving maternal and neonatal health is often a central goal. As yet, there have been few reviews of such programmes and their impact on maternal health. The US Government Evidence Summit on Enhancing Provision and use of Maternal Health Services through Financial Incentives was convened on 24-25 April 2012 to address this gap. This article, the final in a series assessing the effects of financial incentives--performance-based incentives (PBIs), insurance, user fee exemption programmes, conditional cash transfers, and vouchers--summarizes the evidence and discusses issues of context, programme design and implementation, cost-effectiveness, and sustainability. We suggest key areas to consider when designing and implementing financial incentive programmes for enhancing maternal health and highlight gaps in evidence that could benefit from additional research. Although the methodological rigor of studies varies, the evidence, overall, suggests that financial incentives can enhance demand for and improve the supply of maternal health services. Definitive evidence demonstrating a link between incentives and improved health outcomes is lacking; however, the evidence suggests that financial incentives can increase the quantity and quality of maternal health services and address health systems and financial barriers that prevent women from accessing and providers from delivering quality, lifesaving maternal healthcare.

49 CFR 350.317 - What are Incentive Funds and how may they be used?

Code of Federal Regulations, 2013 CFR

2013-10-01

... States that achieve reduction in CMV-involved fatal accidents, CMV fatal accident rate, or that meet specified CMV safety performance criteria. Incentive Funds may be used for any eligible activity or item...

49 CFR 350.317 - What are Incentive Funds and how may they be used?

Code of Federal Regulations, 2011 CFR

2011-10-01

... States that achieve reduction in CMV-involved fatal accidents, CMV fatal accident rate, or that meet specified CMV safety performance criteria. Incentive Funds may be used for any eligible activity or item...

49 CFR 350.317 - What are Incentive Funds and how may they be used?

Code of Federal Regulations, 2014 CFR

2014-10-01

... States that achieve reduction in CMV-involved fatal accidents, CMV fatal accident rate, or that meet specified CMV safety performance criteria. Incentive Funds may be used for any eligible activity or item...

49 CFR 350.317 - What are Incentive Funds and how may they be used?

Code of Federal Regulations, 2010 CFR

2010-10-01

... States that achieve reduction in CMV-involved fatal accidents, CMV fatal accident rate, or that meet specified CMV safety performance criteria. Incentive Funds may be used for any eligible activity or item...

49 CFR 350.317 - What are Incentive Funds and how may they be used?

Code of Federal Regulations, 2012 CFR

2012-10-01

... States that achieve reduction in CMV-involved fatal accidents, CMV fatal accident rate, or that meet specified CMV safety performance criteria. Incentive Funds may be used for any eligible activity or item...

Medicare and Medicaid: Conflicting Incentives for Long-Term Care

PubMed Central

Grabowski, David C

2007-01-01

The structure of Medicare and Medicaid creates conflicting incentives regarding dually eligible beneficiaries without coordinating their care. Both Medicare and Medicaid have an interest in limiting their costs, and neither has an incentive to take responsibility for the management or quality of care. Examples of misaligned incentives are Medicare's cost-sharing rules, cost shifting within home health care and nursing homes, and cost shifting across chronic and acute care settings. Several policy initiatives—capitation, pay-for-performance, and the shift of the dually eligible population's Medicaid costs to the federal government—may address these conflicting incentives, but all have strengths and weaknesses. With the aging baby boom generation and projected federal and state budget shortfalls, this issue will be a continuing focus of policymakers in the coming decades. PMID:18070331

Improving Working Memory in Children with Attention-Deficit/Hyperactivity Disorder: The Separate and Combined Effects of Incentives and Stimulant Medication

ERIC Educational Resources Information Center

Strand, Michael T.; Hawk, Larry W., Jr.; Bubnik, Michelle; Shiels, Keri; Pelham, William E., Jr.; Waxmonsky, James G.

2012-01-01

Working memory (WM) is considered a core deficit in Attention-Deficit/Hyperactivity Disorder (ADHD), with numerous studies demonstrating impaired WM among children with ADHD. We tested the degree to which WM in children with ADHD was improved by performance-based incentives, an analog of behavioral intervention. In two studies, WM performance was…

Bonus Awards for Teachers in Texas' Performance Pay Program: Findings from the First Round of TEEG Schools. Research Brief

ERIC Educational Resources Information Center

National Center on Performance Incentives, 2009

2009-01-01

A recent report published by the National Center on Performance Incentives (NCPI) presents findings from the second-year of a multi-year evaluation of the Texas Educator Excellence Grant (TEEG) program, a statewide educator incentive program that operated in Texas. As part of this evaluation report, researchers examined how first-year TEEG schools…

Michigan's Physician Group Incentive Program offers a regional model for incremental 'fee for value' payment reform.

PubMed

Share, David A; Mason, Margaret H

2012-09-01

Blue Cross Blue Shield of Michigan partnered with providers across the state to create an innovative, "fee for value" physician incentive program that would deliver high-quality, efficient care. The Physician Group Incentive Program rewards physician organizations-formal groups of physicians and practices that can accept incentive payments on behalf of their members-based on the number of quality and utilization measures they adopt, such as generic drug dispensing rates, and on their performance on these measures across their patient populations. Physicians also receive payments for implementing a range of patient-centered medical home capabilities, such as patient registries, and they receive higher fees for office visits for incorporating these capabilities into routine practice while also improving performance. Taken together, the incentive dollars, fee increases, and care management payments amount to a potential increase in reimbursement of 40 percent or more from Blue Cross Blue Shield of Michigan for practices designated as high-performing patient-centered medical homes. At the same time, we estimate that implementing the patient-centered medical home capabilities was associated with $155 million in lower medical costs in program year 2011 for Blue Cross Blue Shield of Michigan members. We intend to devote a higher percentage of reimbursement over time to communities of caregivers that offer high-value, system-based care, and a lower percentage of reimbursement to individual physicians on a service-specific basis.

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.

Aligning incentives in supply chains.

PubMed

Narayanan, V G; Raman, Ananth

2004-11-01

Most companies don't worry about the behavior of their supply chain partners. Instead, they expect the supply chain to work efficiently without interference, as if guided by Adam Smith's famed invisible hand. In their study of more than 50 supply networks, V.G. Narayanan and Ananth Raman found that companies often looked out for their own interests and ignored those of their network partners. Consequently, supply chains performed poorly. Those results aren't shocking when you consider that supply chains extend across several functions and many companies, each with its own priorities and goals. Yet all those functions and firms must pull in the same direction for a chain to deliver goods and services to consumers quickly and cost-effectively. According to the authors, a supply chain works well only if the risks, costs, and rewards of doing business are distributed fairly across the network. In fact, misaligned incentives are often the cause of excess inventory, stock-outs, incorrect forecasts, inadequate sales efforts, and even poor customer service. The fates of all supply chain partners are interlinked: If the firms work together to serve consumers, they will all win. However, they can do that only if incentives are aligned. Companies must acknowledge that the problem of incentive misalignment exists and then determine its root cause and align or redesign incentives. They can improve alignment by, for instance, adopting revenue-sharing contracts, using technology to track previously hidden information, or working with intermediaries to build trust among network partners. It's also important to periodically reassess incentives, because even top-performing networks find that changes in technology or business conditions alter the alignment of incentives.

Automated Visibility Measurements with a Horizon Scanning Imager. Volume 1. Technical Discussion

DTIC Science & Technology

1990-12-01

environment, if one difficult. In the case of many relatively simplistic "rule assumes that the measured values of Cr are consistently following...report unless contractual obligations or notices on a specific document requires that it be returned. REPORT DOCUMENTATION PAGE Approved OMB No. 0704-0188...control computer from the original Zenith Z-248 incentive being that the sooner one identifies the class desktop to the Texas Micro Systems (TMI) design

Making of the New Man

DTIC Science & Technology

1960-02-24

The aspiration to be a healthy society, to create for it all new material and cultural values — exactly that incentive, and not the corroding of...people of our generation. And everyone who is acquainted with the materials and resolutions of the.XXI CPSÜ Congress must feel a surge of pride, of...full.of deep meaning are now spreading: "the material -technical base of communism,’» "the decisive stage in competition with the capitalist world

Evaluating the financial cost and impact on long-term pavement performance of expediting Michigan's road construction work.

DOT National Transportation Integrated Search

2014-02-01

The Michigan Department of Transportation (MDOT) has been using monetary incentive payments for many : years to accelerate highway construction work, resulting in reduced delays to the traveling public. It was : envisioned that incentive/disincentive...

Effect of pay-for-performance incentives on quality of care in small practices with electronic health records: a randomized trial.

PubMed

Bardach, Naomi S; Wang, Jason J; De Leon, Samantha F; Shih, Sarah C; Boscardin, W John; Goldman, L Elizabeth; Dudley, R Adams

2013-09-11

Most evaluations of pay-for-performance (P4P) incentives have focused on large-group practices. Thus, the effect of P4P in small practices, where many US residents receive care, is largely unknown. Furthermore, whether electronic health records (EHRs) with chronic disease management capabilities support small-practice response to P4P has not been studied. To assess the effect of P4P incentives on quality in EHR-enabled small practices in the context of an established quality improvement initiative. A cluster-randomized trial of small (<10 clinicians) primary care clinics in New York City from April 2009 through March 2010. A city program provided all participating clinics with the same EHR software with decision support and patient registry functionalities and quality improvement specialists offering technical assistance. Incentivized clinics were paid for each patient whose care met the performance criteria, but they received higher payments for patients with comorbidities, who had Medicaid insurance, or who were uninsured (maximum payments: $200/patient; $100,000/clinic). Quality reports were given quarterly to both the intervention and control groups. Comparison of differences in performance improvement, from the beginning to the end of the study, between control and intervention clinics for aspirin or antithrombotic prescription, blood pressure control, cholesterol control, and smoking cessation interventions. Mixed-effects logistic regression was used to account for clustering of patients within clinics, with a treatment by time interaction term assessing the statistical significance of the effect of the intervention. Participating clinics (n = 42 for each group) had similar baseline characteristics, with a mean of 4592 (median, 2500) patients at the intervention group clinics and 3042 (median, 2000) at the control group clinics. Intervention clinics had greater adjusted absolute improvement in rates of appropriate antithrombotic prescription (12.0% vs 6.1%, difference: 6.0% [95% CI, 2.2% to 9.7%], P = .001 for interaction term), blood pressure control (no comorbidities: 9.7% vs 4.3%, difference: 5.5% [95% CI, 1.6% to 9.3%], P = .01 for interaction term; with diabetes mellitus: 9.0% vs 1.2%, difference: 7.8% [95% CI, 3.2% to 12.4%], P = .007 for interaction term; with diabetes mellitus or ischemic vascular disease: 9.5% vs 1.7%, difference: 7.8% [95% CI, 3.0% to 12.6%], P = .01 for interaction term), and in smoking cessation interventions (12.4% vs 7.7%, difference: 4.7% [95% CI, -0.3% to 9.6%], P = .02 for interaction term). Intervention clinics performed better on all measures for Medicaid and uninsured patients except cholesterol control, but no differences were statistically significant. Among small EHR-enabled clinics, a P4P incentive program compared with usual care resulted in modest improvements in cardiovascular care processes and outcomes. Because most proposed P4P programs are intended to remain in place more than a year, further research is needed to determine whether this effect increases or decreases over time. clinicaltrials.gov Identifier: NCT00884013.

Effect of provider and patient reminders, deployment of nurse practitioners, and financial incentives on cervical and breast cancer screening rates.

PubMed

Kaczorowski, Janusz; Hearps, Stephen J C; Lohfeld, Lynne; Goeree, Ron; Donald, Faith; Burgess, Ken; Sebaldt, Rolf J

2013-06-01

To evaluate the effect of the Provider and Patient Reminders in Ontario: Multi-Strategy Prevention Tools (P-PROMPT) reminder and recall system and pay-for-performance incentives on the delivery rates of cervical and breast cancer screening in primary care practices in Ontario, with or without deployment of nurse practitioners (NPs). Before-and-after comparisons of the time-appropriate delivery rates of cervical and breast cancer screening using the automated and NP-augmented strategies of the P-PROMPT reminder and recall system. Southwestern Ontario. A total of 232 physicians from 24 primary care network or family health network groups across 110 different sites eligible for pay-for-performance incentives. The P-PROMPT project combined pay-for-performance incentives with provider and patient reminders and deployment of NPs to enhance the delivery of preventive care services. The mean delivery rates at the practice level of time-appropriate mammograms and Papanicolaou tests completed within the previous 30 months. Before-and-after comparisons of time-appropriate delivery rates (< 30 months) of cancer screening showed the rates of Pap tests and mammograms for eligible women significantly increased over a 1-year period by 6.3% (P < .001) and 5.3% (P < .001), respectively. The NP-augmented strategy achieved comparable rate increases to the automated strategy alone in the delivery rates of both services. The use of provider and patient reminders and pay-for-performance incentives resulted in increases in the uptake of Pap tests and mammograms among eligible primary care patients over a 1-year period in family practices in Ontario.

Incentives in Rheumatology: the Potential Contribution of Physician Responses to Financial Incentives, Public Reporting, and Treatment Guidelines to Health Care Sustainability.

PubMed

Harrison, Mark; Milbers, Katherine; Mihic, Tamara; Anis, Aslam H

2016-07-01

Concerns about the sustainability of current health care expenditure are focusing attention on the cost, quality and value of health care provision. Financial incentives, for example pay-for-performance (P4P), seek to reward quality and value in health care provision. There has long been an expectation that P4P schemes are coming to rheumatology. We review the available evidence about the use of incentives in this setting and provide two emerging examples of P4P schemes which may shape the future of service provision in rheumatology. Currently, there is limited and equivocal evidence in rheumatology about the impact of incentive schemes. However, reporting variation in the quality and provision of rheumatology services has highlighted examples of inefficiencies in the delivery of care. If financial incentives can improve the delivery of timely and appropriate care for rheumatology patients, then they may have an important role to play in the sustainability of health care provision.

Investigating financial incentives for maternal health: an introduction.

PubMed

Stanton, Mary Ellen; Higgs, Elizabeth S; Koblinsky, Marge

2013-12-01

Projection of current trends in maternal and neonatal mortality reduction shows that many countries will fall short of the UN Millennium Development Goal 4 and 5. Underutilization of maternal health services contributes to this poor progress toward reducing maternal and neonatal morbidity and mortality. Moreover, the quality of services continues to lag in many countries, with a negative effect on the health of women and their babies, including deterring women from seeking care. To enhance the use and provision of quality maternal care, countries and donors are increasingly using financial incentives. This paper introduces the JHPN Supplement, in which each paper reviews the evidence of the effectiveness of a specific financial incentive instrument with the aim of improving the use and quality of maternal healthcare and impact. The US Agency for International Development and the US National Institutes of Health convened a US Government Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives on 24-25 April 2012 in Washington, DC. The Summit brought together leading global experts in finance, maternal health, and health systems from governments, academia, development organizations, and foundations to assess the evidence on whether financial incentives significantly and substantially increase provision, use and quality of maternal health services, and the contextual factors that impact the effectiveness of these incentives. Evidence review teams evaluated the multidisciplinary evidence of various financial mechanisms, including supply-side incentives (e.g. performance-based financing, user fees, and various insurance mechanisms) and demand-side incentives (e.g. conditional cash transfers, vouchers, user fee exemptions, and subsidies for care-seeking). At the Summit, the teams presented a synthesis of evidence and initial recommendations on practice, policy, and research for discussion. The Summit enabled structured feedback on recommendations which the teams included in their final papers appearing in this Supplement. Papers in this Supplement review the evidence for a specific financial incentive mechanism (e.g. pay for performance, conditional cash transfer) to improve the use and quality of maternal healthcare and makes recommendations for programmes and future research. While data on programmes using financial incentives for improved use and indications of the quality of maternal health services support specific conclusions and recommendations, including those for future research, data linking the use of financial incentives with improved health outcomes are minimal.

Transitioning the California Energy Commission Eligible Equipment List to a National Platform

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

Truitt, Sarah; Nobler, Erin; Krasko, Vitaliy

The Energy Commission called on the National Renewable Energy Laboratory's (NREL)'s Solar Technical Assistance Team to explore various pathways for supporting continued evolution of the list. NREL staff utilized the Database of State Incentives for Renewables and Efficiency (DSIRE), California Solar Initiative (CSI) data, and information from in-depth interviews to better understand the impact of a lack of an updated list and suggest potential solutions. A total of 18 people from state energy offices, rebate program administrators, utilities, national testing laboratories, private companies, nonprofit organizations, and the federal government were interviewed between July and September 2013. CSI data were analyzedmore » to illustrate the monetary benefits of the algorithm behind calculating performance of PV modules included on the list. The primary objectives of this study are to: 1) Determine the impact of not maintaining the list, and 2) Explore alternatives to the State of California's maintenance of the list.« less

Army Incentives for the PCMH

DTIC Science & Technology

2011-01-24

Performance Metrics Community Based Medical Homes Slide 8 of 10 2011 MHS Conference  Increase our primary care market share Net increase in primary... Sharing Knowledge: Achieving Breakthrough Performance 2011 Military Health System Conference Army Incentives for the PCMH 24 January 2011 Mr. Ken...enroll as soon as fully staffed  Operate at economic advantage to DoD Improve ER/ UCC usage rates Improve utilization rates Business Rules Army

Accidental versus operational oil spills from shipping in the Baltic Sea: risk governance and management strategies.

PubMed

Hassler, Björn

2011-03-01

Marine governance of oil transportation is complex. Due to difficulties in effectively monitoring procedures on vessels en voyage, incentives to save costs by not following established regulations on issues such as cleaning of tanks, crew size, and safe navigation may be substantial. The issue of problem structure is placed in focus, that is, to what degree the specific characteristics and complexity of intentional versus accidental oil spill risks affect institutional responses. It is shown that whereas the risk of accidental oil spills primarily has been met by technical requirements on the vessels in combination with Port State control, attempts have been made to curb intentional pollution by for example increased surveillance and smart governance mechanisms such as the No-Special-Fee system. It is suggested that environmental safety could be improved by increased use of smart governance mechanisms tightly adapted to key actors' incentives to alter behavior in preferable directions.

Calculations of financial incentives for providers in a pay-for-performance program: Manual review versus data from structured fields in electronic health records

PubMed Central

Urech, Tracy H.; Woodard, LeChauncy D.; Virani, Salim S.; Dudley, R. Adams; Lutschg, Meghan Z.; Petersen, Laura A.

2015-01-01

Background Hospital report cards and financial incentives linked to performance require clinical data that are reliable, appropriate, timely, and cost-effective to process. Pay-for-performance plans are transitioning to automated electronic health record (EHR) data as an efficient method to generate data needed for these programs. Objective To determine how well data from automated processing of structured EHR fields (AP-EHR) reflect data from manual chart review and the impact of these data on performance rewards. Research Design Cross-sectional analysis of performance measures used in a cluster randomized trial assessing the impact of financial incentives on guideline-recommended care for hypertension. Subjects A total of 2,840 patients with hypertension assigned to participating physicians at 12 Veterans Affairs hospital-based outpatient clinics. Fifty-two physicians and 33 primary care personnel received incentive payments. Measures Overall, positive and negative agreement indices and Cohen's kappa were calculated for assessments of guideline-recommended antihypertensive medication use, blood pressure (BP) control, and appropriate response to uncontrolled BP. Pearson's correlation coefficient was used to assess how similar participants’ calculated earnings were between the data sources. Results By manual chart review data, 72.3% of patients were considered to have received guideline-recommended antihypertensive medications compared to 65.0% by AP-EHR review (k=0.51). Manual review indicated 69.5% of patients had controlled BP compared to 66.8% by AP-EHR review (k=0.87). Compared to 52.2% of patients per the manual review, 39.8% received an appropriate response by AP-EHR review (k=0.28). Participants’ incentive payments calculated using the two methods were highly correlated (r≥0.98). Using the AP-EHR data to calculate earnings, participants’ payment changes ranged from a decrease of $91.00 (−30.3%) to an increase of $18.20 (+7.4%) for medication use (IQR, −14.4% to 0%) and a decrease of $100.10 (−31.4%) to an increase of $36.40 (+15.4%) for BP control or appropriate response to uncontrolled BP (IQR, −11.9% to −6.1%). Conclusions Pay-for-performance plans that use only EHR data should carefully consider the measures and the structure of the EHR before data collection and financial incentive disbursement. For this study, we feel that a 10% difference in the total amount of incentive earnings disbursed based on AP-EHR data compared to manual review is acceptable given the time and resources required to abstract data from medical records. PMID:26340661

[Effects of breathing exercises on breathing pattern and thoracoabdominal motion after gastroplasty].

PubMed

Tomich, Georgia Miranda; França, Danielle Corrêa; Diniz, Marco Túlio Costa; Britto, Raquel Rodrigues; Sampaio, Rosana Ferreira; Parreira, Verônica Franco

2010-01-01

To evaluate breathing pattern and thoracoabdominal motion during breathing exercises. Twenty-four patients with class II or III obesity (18 women; 6 men) were studied on the second postoperative day after gastroplasty. The mean age was 37 +/- 11 years, and the mean BMI was 44 +/- 3 kg/m(2). Diaphragmatic breathing, incentive spirometry with a flow-oriented device and incentive spirometry with a volume-oriented device were performed in random order. Respiratory inductive plethysmography was used in order to measure respiratory variables and thoracoabdominal motion. Comparisons among the three exercises showed significant differences: tidal volume was higher during incentive spirometry (with the flow-oriented device or with the volume-oriented device) than during diaphragmatic breathing; the respiratory rate was lower during incentive spirometry with the volume-oriented device than during incentive spirometry with the flow-oriented device; and minute ventilation was higher during incentive spirometry (with the flow-oriented device or with the volume-oriented device) than during diaphragmatic breathing. Rib cage motion did not vary during breathing exercises, although there was an increase in thoracoabdominal asynchrony, especially during incentive spirometry with the flow-oriented device. Among the breathing exercises evaluated, incentive spirometry with the volume-oriented device provided the best results, because it allowed slower, deeper inhalation.

Financial Incentives and Maternal Health: Where Do We Go from Here?

PubMed Central

Stanton, Mary Ellen; Higgs, Elizabeth S.; Balster, Robert L.; Bellows, Ben W.; Brandes, Neal; Comfort, Alison B.; Eichler, Rena; Glassman, Amanda; Hatt, Laurel E.; Conlon, Claudia M.; Koblinsky, Marge

2013-01-01

Health financing strategies that incorporate financial incentives are being applied in many low- and middle-income countries, and improving maternal and neonatal health is often a central goal. As yet, there have been few reviews of such programmes and their impact on maternal health. The US Government Evidence Summit on Enhancing Provision and use of Maternal Health Services through Financial Incentives was convened on 24-25 April 2012 to address this gap. This article, the final in a series assessing the effects of financial incentives—performance-based incentives (PBIs), insurance, user fee exemption programmes, conditional cash transfers, and vouchers—summarizes the evidence and discusses issues of context, programme design and implementation, cost-effectiveness, and sustainability. We suggest key areas to consider when designing and implementing financial incentive programmes for enhancing maternal health and highlight gaps in evidence that could benefit from additional research. Although the methodological rigor of studies varies, the evidence, overall, suggests that financial incentives can enhance demand for and improve the supply of maternal health services. Definitive evidence demonstrating a link between incentives and improved health outcomes is lacking; however, the evidence suggests that financial incentives can increase the quantity and quality of maternal health services and address health systems and financial barriers that prevent women from accessing and providers from delivering quality, lifesaving maternal healthcare.

77 FR 35795 - Applications for New Awards; Teacher Incentive Fund

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-14

... personnel may include, for example, school counselors, media specialists, or para-educators. Performance... by the State as a priority school pursuant to the State's approved request for Elementary and... Incentive Fund AGENCY: Office of Elementary and Secondary Education, Department of Education. ACTION: Notice...

Cost-effectiveness of hospital pay-for-performance incentives.

PubMed

Nahra, Tammie A; Reiter, Kristin L; Hirth, Richard A; Shermer, Janet E; Wheeler, John R C

2006-02-01

One increasingly popular mechanism for stimulating quality improvements is pay-for-performance, or incentive, programs. This article examines the cost-effectiveness of a hospital incentive system for heart-related care, using a principal-agent model, where the insurer is the principal and hospitals are the agents. Four-year incentive system costsfor the payer were dollar 22,059,383, composed primarily of payments to the participating hospitals, with approximately 5 percent in administrative costs. Effectiveness is measured in stages, beginning with improvements in the processes of heart care. Care process improvements are converted into quality-adjusted life years (QALYs) gained, with reference to literatures on clinical effectiveness and survival. An estimated 24,418 patients received improved care, resulting in a range of QALYs from 733 to 1,701, depending on assumptions about clinical effectiveness. Cost per QALY was found to be between dollar 12,967 and dollar 30,081, a level well under consensus measures of the value of a QALY.

Financial versus Non-Financial Incentives for Improving Patient Experience.

PubMed

Lee, Thomas H

2015-05-01

Delivering compassionate and coordinated care is a goal for all health care providers. Humans are not always consistent, though, both individually and collectively, and this is why everyone needs incentives to be at their best and to try to always be improving. The endlessly interesting question in patient experience is, what should those incentives look like? Should they be financial or nonfinancial? Dr. Thomas H. Lee explores what is most effective in regard to engaging and motivating physicians. While different approaches will work in different organizational cultures, financial incentives have their role in performance improvement. Compassionate coordinated care should be a social norm and be pursued by all health care organizations.

Incentives and provider payment methods.

PubMed

Barnum, H; Kutzin, J; Saxenian, H

1995-01-01

The mode of payment creates powerful incentives affecting provider behavior and the efficiency, equity and quality outcomes of health finance reforms. This article examines provider incentives as well as administrative costs, and institutional conditions for successful implementation associated with provider payment alternatives. The alternatives considered are budget reforms, capitation, fee-for-service, and case-based reimbursement. We conclude that competition, whether through a regulated private sector or within a public system, has the potential to improve the performance of any payment method. All methods generate both adverse and beneficial incentives. Systems with mixed forms of provider payment can provide tradeoffs to offset the disadvantages of individual modes. Low-income countries should avoid complex payment systems requiring higher levels of institutional development.

Beyond Measurement and Reward: Methods of Motivating Quality Improvement and Accountability.

PubMed

Berenson, Robert A; Rice, Thomas

2015-12-01

The article examines public policies designed to improve quality and accountability that do not rely on financial incentives and public reporting of provider performance. Payment policy should help temper the current "more is better" attitude of physicians and provider organizations. Incentive neutrality would better support health professionals' intrinsic motivation to act in their patients' best interests to improve overall quality than would pay-for-performance plans targeted to specific areas of clinical care. Public policy can support clinicians' intrinsic motivation through approaches that support systematic feedback to clinicians and provide concrete opportunities to collaborate to improve care. Some programs administered by the Centers for Medicare & Medicaid Services, including Partnership for Patients and Conditions of Participation, deserve more attention; they represent available, but largely ignored, approaches to support providers to improve quality and protect beneficiaries against substandard care. Public policies related to quality improvement should focus more on methods of enhancing professional intrinsic motivation, while recognizing the potential role of organizations to actively promote and facilitate that motivation. Actually achieving improvement, however, will require a reexamination of the role played by financial incentives embedded in payments and the unrealistic expectations placed on marginal incentives in pay-for-performance schemes. © Health Research and Educational Trust.

Grids: The Top Ten Questions

DOE PAGES

Schopf, Jennifer M.; Nitzberg, Bill

2002-01-01

The design and implementation of a national computing system and data grid has become a reachable goal from both the computer science and computational science point of view. A distributed infrastructure capable of sophisticated computational functions can bring many benefits to scientific work, but poses many challenges, both technical and socio-political. Technical challenges include having basic software tools, higher-level services, functioning and pervasive security, and standards, while socio-political issues include building a user community, adding incentives for sites to be part of a user-centric environment, and educating funding sources about the needs of this community. This paper details the areasmore » relating to Grid research that we feel still need to be addressed to fully leverage the advantages of the Grid.« less

Strategies for Improving Vaccine Delivery: A Cluster-Randomized Trial.

PubMed

Fu, Linda Y; Zook, Kathleen; Gingold, Janet A; Gillespie, Catherine W; Briccetti, Christine; Cora-Bramble, Denice; Joseph, Jill G; Haimowitz, Rachel; Moon, Rachel Y

2016-06-01

New emphasis on and requirements for demonstrating health care quality have increased the need for evidence-based methods to disseminate practice guidelines. With regard to impact on pediatric immunization coverage, we aimed to compare a financial incentive program (pay-for-performance [P4P]) and a virtual quality improvement technical support (QITS) learning collaborative. This single-blinded (to outcomes assessor), cluster-randomized trial was conducted among unaffiliated pediatric practices across the United States from June 2013 to June 2014. Practices received either the P4P or QITS intervention. All practices received a Vaccinator Toolkit. P4P practices participated in a tiered financial incentives program for immunization coverage improvement. QITS practices participated in a virtual learning collaborative. Primary outcome was percentage of all needed vaccines received (PANVR). We also assessed immunization up-to-date (UTD) status. Data were analyzed from 3,147 patient records from 32 practices. Practices in the study arms reported similar QI activities (∼6 to 7 activities). We found no difference in PANVR between P4P and QITS (mean ± SE, 90.7% ± 1.1% vs 86.1% ± 1.3%, P = 0.46). Likewise, there was no difference in odds of being UTD between study arms (adjusted odds ratio 1.02, 95% confidence interval 0.68 to 1.52, P = .93). In within-group analysis, patients in both arms experienced nonsignificant increases in PANVR. Similarly, the change in adjusted odds of UTD over time was modest and nonsignificant for P4P but reached significance in the QITS arm (adjusted odds ratio 1.28, 95% confidence interval 1.02 to 1.60, P = .03). Participation in either a financial incentives program or a virtual learning collaborative led to self-reported improvements in immunization practices but minimal change in objectively measured immunization coverage. Copyright © 2016 by the American Academy of Pediatrics.

42 CFR § 414.1330 - Quality performance category.

Code of Federal Regulations, 2010 CFR

2017-10-01

... SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1330 Quality... comprise: (1) 60 percent of a MIPS eligible clinician's final score for MIPS payment year 2019. (2) 50...

Rewarding safe behavior: strategies for change.

PubMed

Fell-Carlson, Deborah

2004-12-01

Effective, sustainable safety incentives are integrated into a performance management system designed to encourage long term behavior change. Effective incentive program design integrates the fundamental considerations of compensation (i.e., valence, instrumentality, expectancy, equity) with behavior change theory in the context of a strong merit based performance management system. Clear expectations are established and communicated from the time applicants apply for the position. Feedback and social recognition are leveraged and used as rewards, in addition to financial incentives built into the compensation system and offered periodically as short term incentives. Rewards are tied to specific objectives intended to influence specific behaviors. Objectives are designed to challenge employees, providing opportunities to grow and enhance their sense of belonging. Safety contests and other awareness activities are most effective when used to focus safety improvement efforts on specific behaviors or processes, for a predetermined period of time, in the context of a comprehensive safety system. Safety incentive programs designed around injury outcomes can result in unintended, and undesirable, consequences. Safety performance can be leveraged by integrating safety into corporate cultural indicators. Symbols of safety remind employees of corporate safety goals and objectives (e.g., posted safety goals and integrating safety into corporate mission and vision). Rites and ceremonies provide opportunities for social recognition and feedback and demonstrate safety is a corporate value. Feedback opportunities, rewards, and social recognition all provide content for corporate legends, those stories embellished over time, that punctuate the overall system of organizational norms, and provide examples of the organizational safety culture in action.

Quality Measures for Dialysis: Time for a Balanced Scorecard

PubMed Central

2016-01-01

Recent federal legislation establishes a merit-based incentive payment system for physicians, with a scorecard for each professional. The Centers for Medicare and Medicaid Services evaluate quality of care with clinical performance measures and have used these metrics for public reporting and payment to dialysis facilities. Similar metrics may be used for the future merit-based incentive payment system. In nephrology, most clinical performance measures measure processes and intermediate outcomes of care. These metrics were developed from population studies of best practice and do not identify opportunities for individualizing care on the basis of patient characteristics and individual goals of treatment. The In-Center Hemodialysis (ICH) Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey examines patients' perception of care and has entered the arena to evaluate quality of care. A balanced scorecard of quality performance should include three elements: population-based best clinical practice, patient perceptions, and individually crafted patient goals of care. PMID:26316622

Active Choice and Financial Incentives to Increase Rates of Screening Colonoscopy-A Randomized Controlled Trial.

PubMed

Mehta, Shivan J; Feingold, Jordyn; Vandertuyn, Matthew; Niewood, Tess; Cox, Catherine; Doubeni, Chyke A; Volpp, Kevin G; Asch, David A

2017-11-01

Behavioral economic approaches could increase uptake for colorectal cancer screening. We performed a randomized controlled trial of 2245 employees to determine whether an email containing a phone number for scheduling (control), an email with the active choice to opt in or opt out (active choice), or the active choice email plus a $100 incentive (financial incentive) increased colonoscopy completion within 3 months. Higher proportions of participants in the financial incentive group underwent screening (3.7%) than in the control (1.6%) or active choice groups (1.5%) (P = .01 and P < .01). We found no difference in uptake of screening between the active choice and control groups (P = .88). The $100 conditional incentive modestly but significantly increased colonoscopy use. ClinicalTrials.gov no: NCT02660671. Copyright © 2017 AGA Institute. Published by Elsevier Inc. All rights reserved.

[Exploratory analysis of work engagement: use of the Utrecht scale in Benin].

PubMed

Ahanhanzo, Yolaine Glèlè; Kittel, France; Paraïso, Noël Moussiliou; Godin, Isabelle; Wilmet-Dramaix, Michèle; Makoutodé, Michel

2014-01-01

Work engagement, an emerging concept in the field of positive psychology in the workplace is not well known in developing countries. Defined as a positive and and fulfilling mindset related to work, it recalls a positive attitude incentive of performance and need to be investigated. In the context of the socioeconomic crisis of health workers, and with the chronic issue of poor quality of data, this study was designed to identify the factors associated with work engagement among health workers. in charge of data collection in the Benin Routine Health Information System. This study was a cross-sectional and analytical study targeting health workers in charge of data collection in public and private health centres. The dependent variable was work engagement and independent variables were sociodemographic and professional features, personal and professional resources and perception of technical factors. Logistic regression was used. The adequacy of the model was tested with the Hosmer-Lemeshow goodness of fit test. The results indicate that the level of work engagement is similar with that observed in previous studies. Predictors identified in logistic regression are perception of technical factors, location of the job, and personal resources, such as level of effort and overcommitment. This study identified factors associated with work engagement in a developing country, and adds to the knowledge concerning this new concept in Benin. The findings can contribute to research for improvement of human resources management in the health sector to achieve real performance and development.

EHRs in primary care practices: benefits, challenges, and successful strategies.

PubMed

Goetz Goldberg, Debora; Kuzel, Anton J; Feng, Lisa Bo; DeShazo, Jonathan P; Love, Linda E

2012-02-01

To understand the current use of electronic health records (EHRs) in small primary care practices and to explore experiences and perceptions of physicians and staff toward the benefits, challenges, and successful strategies for implementation and meaningful use of advanced EHR functions. Qualitative case study of 6 primary care practices in Virginia. We performed surveys and in-depth interviews with clinicians and administrative staff (N = 38) and observed interpersonal relations and use of EHR functions over a 16-month period. Practices with an established EHR were selected based on a maximum variation of quality activities, location, and ownership. Physicians and staff report increased efficiency in retrieving medical records, storing patient information, coordination of care, and office operations. Costs, lack of knowledge of EHR functions, and problems transforming office operations were barriers reported for meaningful use of EHRs. Major disruption to patient care during upgrades and difficulty utilizing performance tracking and quality functions were also reported. Facilitators for adopting and using advanced EHR functions include team-based care, adequate technical support, communication and training for employees and physicians, alternative strategies for patient care during transition, and development of new processes and work flow procedures. Small practices experience difficulty with implementation and utilization of advanced EHR functions. Federal and state policies should continue to support practices by providing technical assistance and financial incentives, grants, and/or loans. Small practices should consider using regional extension center services and reaching out to colleagues and other healthcare organizations with similar EHR systems for advice and guidance.

Combining Theory-Driven Evaluation and Causal Loop Diagramming for Opening the 'Black Box' of an Intervention in the Health Sector: A Case of Performance-Based Financing in Western Uganda.

PubMed

Renmans, Dimitri; Holvoet, Nathalie; Criel, Bart

2017-09-03

Increased attention on "complexity" in health systems evaluation has resulted in many different methodological responses. Theory-driven evaluations and systems thinking are two such responses that aim for better understanding of the mechanisms underlying given outcomes. Here, we studied the implementation of a performance-based financing intervention by the Belgian Technical Cooperation in Western Uganda to illustrate a methodological strategy of combining these two approaches. We utilized a systems dynamics tool called causal loop diagramming (CLD) to generate hypotheses feeding into a theory-driven evaluation. Semi-structured interviews were conducted with 30 health workers from two districts (Kasese and Kyenjojo) and with 16 key informants. After CLD, we identified three relevant hypotheses: "success to the successful", "growth and underinvestment", and "supervision conundrum". The first hypothesis leads to increasing improvements in performance, as better performance leads to more incentives, which in turn leads to better performance. The latter two hypotheses point to potential bottlenecks. Thus, the proposed methodological strategy was a useful tool for identifying hypotheses that can inform a theory-driven evaluation. The hypotheses are represented in a comprehensible way while highlighting the underlying assumptions, and are more easily falsifiable than hypotheses identified without using CLD.

Incentive spirometry following thoracic surgery: what should we be doing?

PubMed

Agostini, Paula; Singh, Sally

2009-06-01

Thoracic surgery may cause reduced respiratory function and pulmonary complications, with associated increased risk of mortality. Postoperative physiotherapy aims to reverse atelectasis and secretion retention, and may include incentive spirometry. To review the evidence for incentive spirometry, examining the physiological basis, equipment and its use following thoracic surgery. MEDLINE was searched from 1950 to January 2008, EMBASE was searched from 1980 to January 2008, and CINAHL was searched from 1982 to January 2008, all using the OVID interface. The search term was: '[incentive spirometry.mp]'. The Cochrane Library was searched using the terms 'incentive spirometry' and 'postoperative physiotherapy'. The Chartered Society of Physiotherapy Resource Centre was also searched, and a hand search was performed to follow-up references from the retrieved studies. Non-scientific papers were excluded, as were papers that did not relate to thoracic surgery or the postoperative treatment of patients with incentive spirometry. Initially, 106 studies were found in MEDLINE, 99 in EMBASE and 42 in CINAHL. Eight references were found in the Cochrane Library and one paper in the Chartered Society of Physiotherapy Resource Centre. Four studies and one systematic review investigating the effects of postoperative physiotherapy and incentive spirometry in thoracic surgery patients were selected and reviewed. Physiological evidence suggests that incentive spirometry may be appropriate for lung re-expansion following major thoracic surgery. Based on sparse literature, postoperative physiotherapy regimes with, or without, the use of incentive spirometry appear to be effective following thoracic surgery compared with no physiotherapy input.

Differential dependence of Pavlovian incentive motivation and instrumental incentive learning processes on dopamine signaling

PubMed Central

Wassum, Kate M.; Ostlund, Sean B.; Balleine, Bernard W.; Maidment, Nigel T.

2011-01-01

Here we attempted to clarify the role of dopamine signaling in reward seeking. In Experiment 1, we assessed the effects of the dopamine D1/D2 receptor antagonist flupenthixol (0.5 mg/kg i.p.) on Pavlovian incentive motivation and found that flupenthixol blocked the ability of a conditioned stimulus to enhance both goal approach and instrumental performance (Pavlovian-to-instrumental transfer). In Experiment 2 we assessed the effects of flupenthixol on reward palatability during post-training noncontingent re-exposure to the sucrose reward in either a control 3-h or novel 23-h food-deprived state. Flupenthixol, although effective in blocking the Pavlovian goal approach, was without effect on palatability or the increase in reward palatability induced by the upshift in motivational state. This noncontingent re-exposure provided an opportunity for instrumental incentive learning, the process by which rats encode the value of a reward for use in updating reward-seeking actions. Flupenthixol administered prior to the instrumental incentive learning opportunity did not affect the increase in subsequent off-drug reward-seeking actions induced by that experience. These data suggest that although dopamine signaling is necessary for Pavlovian incentive motivation, it is not necessary for changes in reward experience, or for the instrumental incentive learning process that translates this experience into the incentive value used to drive reward-seeking actions, and provide further evidence that Pavlovian and instrumental incentive learning processes are dissociable. PMID:21693635

48 CFR 1552.216-78 - Award term incentive plan.

Code of Federal Regulations, 2010 CFR

2010-10-01

... evaluation of performance, and, together with Agency need and availability of funding, serves as the basis... the acceptable quality levels (AQL) for the evaluated tasks, both individual and aggregate, for that... incentive period. [identify the most significant tasks. Describe the AQL for each task as well as an overall...

Incentives Alone Not Enough to Prod Teacher Effectiveness

ERIC Educational Resources Information Center

Sawchuk, Stephen

2009-01-01

Policy experts are renewing questions about the role of school culture and leadership in the drive to improve teaching effectiveness in the most-challenging school environments. As states and districts increasingly explore tactics like performance-based pay, incentive programs, and bonuses to attract the best teachers to troubled schools, experts…

42 CFR § 414.1445 - Identification of other payer advanced APMs.

Code of Federal Regulations, 2010 CFR

2017-10-01

... AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1445... determination prior to the QP Performance Period to identify Medicaid Medical Home Models and Medicaid APMs. (b...

42 CFR § 414.1375 - Advancing care information performance category.

Code of Federal Regulations, 2010 CFR

2017-10-01

... HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1375... final score for MIPS payment year 2019 and each MIPS payment year thereafter. (b) Reporting for the...

42 CFR § 414.1355 - Improvement activities performance category.

Code of Federal Regulations, 2010 CFR

2017-10-01

... AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive § 414.1355... comprises: (1) 15 percent of a MIPS eligible clinician's final score for MIPS payment year 2019 and for each...

42 CFR § 414.1340 - Data completeness criteria for the quality performance category.

Code of Federal Regulations, 2010 CFR

2017-10-01

..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM (CONTINUED) PAYMENT FOR PART B MEDICAL AND OTHER HEALTH SERVICES Merit-Based Incentive Payment System and Alternative Payment Model Incentive... that meet the measure's denominator criteria, regardless of payer for MIPS payment year 2019. (2) At...

48 CFR 970.5215-3 - Conditional payment of fee, profit, and other incentives-facility management contracts

Code of Federal Regulations, 2010 CFR

2010-10-01

... Acquisition Regulations System DEPARTMENT OF ENERGY AGENCY SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND.... Financial incentives for timely mission accomplishment or cost effectiveness shall never compromise or..., undue risk to the common defense and security. In addition, this category includes performance failures...

48 CFR 970.5215-3 - Conditional payment of fee, profit, and other incentives-facility management contracts

Code of Federal Regulations, 2011 CFR

2011-10-01

... Acquisition Regulations System DEPARTMENT OF ENERGY AGENCY SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND.... Financial incentives for timely mission accomplishment or cost effectiveness shall never compromise or..., undue risk to the common defense and security. In addition, this category includes performance failures...

48 CFR 970.5215-3 - Conditional payment of fee, profit, and other incentives-facility management contracts

Code of Federal Regulations, 2014 CFR

2014-10-01

... Acquisition Regulations System DEPARTMENT OF ENERGY AGENCY SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND.... Financial incentives for timely mission accomplishment or cost effectiveness shall never compromise or..., undue risk to the common defense and security. In addition, this category includes performance failures...

Framing Financial Incentives to Increase Physical Activity Among Overweight and Obese Adults: A Randomized, Controlled Trial.

PubMed

Patel, Mitesh S; Asch, David A; Rosin, Roy; Small, Dylan S; Bellamy, Scarlett L; Heuer, Jack; Sproat, Susan; Hyson, Chris; Haff, Nancy; Lee, Samantha M; Wesby, Lisa; Hoffer, Karen; Shuttleworth, David; Taylor, Devon H; Hilbert, Victoria; Zhu, Jingsan; Yang, Lin; Wang, Xingmei; Volpp, Kevin G

2016-03-15

Financial incentive designs to increase physical activity have not been well-examined. To test the effectiveness of 3 methods to frame financial incentives to increase physical activity among overweight and obese adults. Randomized, controlled trial. (ClinicalTrials.gov: NCT 02030119). University of Pennsylvania. 281 adult employees (body mass index ≥27 kg/m2). 13-week intervention. Participants had a goal of 7000 steps per day and were randomly assigned to a control group with daily feedback or 1 of 3 financial incentive programs with daily feedback: a gain incentive ($1.40 given each day the goal was achieved), lottery incentive (daily eligibility [expected value approximately $1.40] if goal was achieved), or loss incentive ($42 allocated monthly upfront and $1.40 removed each day the goal was not achieved). Participants were followed for another 13 weeks with daily performance feedback but no incentives. Primary outcome was the mean proportion of participant-days that the 7000-step goal was achieved during the intervention. Secondary outcomes included the mean proportion of participant-days achieving the goal during follow-up and the mean daily steps during intervention and follow-up. The mean proportion of participant-days achieving the goal was 0.30 (95% CI, 0.22 to 0.37) in the control group, 0.35 (CI, 0.28 to 0.42) in the gain-incentive group, 0.36 (CI, 0.29 to 0.43) in the lottery-incentive group, and 0.45 (CI, 0.38 to 0.52) in the loss-incentive group. In adjusted analyses, only the loss-incentive group had a significantly greater mean proportion of participant-days achieving the goal than control (adjusted difference, 0.16 [CI, 0.06 to 0.26]; P = 0.001), but the adjusted difference in mean daily steps was not significant (861 [CI, 24 to 1746]; P = 0.056). During follow-up, daily steps decreased for all incentive groups and were not different from control. Single employer. Financial incentives framed as a loss were most effective for achieving physical activity goals. National Institute on Aging.

Effects of Incentive Spirometry on Respiratory Motion in Healthy Subjects Using Cine Breathing Magnetic Resonance Imaging.

PubMed

Kotani, Toshiaki; Akazawa, Tsutomu; Sakuma, Tsuyoshi; Nagaya, Shigeyuki; Sonoda, Masaru; Tanaka, Yuji; Katogi, Takehide; Nemoto, Tetsuharu; Minami, Shohei

2015-06-01

To investigate the effectiveness of incentive spirometry on respiratory motion in healthy subjects using cine breathing magnetic resonance imaging (MRI). Ten non-smoking healthy subjects without any history of respiratory disease were studied. Subjects were asked to perform pulmonary training using incentive spirometry every day for two weeks. To assess the effectiveness of this training, pulmonary function tests and cine breathing MRI were performed before starting pulmonary training and two weeks after its completion. After training, there were significant improvements in vital capacity (VC) from 3.58±0.8 L to 3.74±0.8 L and in %VC from 107.4±10.8 to 112.1±8.2. Significant changes were observed in the right diaphragm motion, right chest wall motion, and left chest wall motion, which were increased from 55.7±9.6 mm to 63.4±10.2 mm, from 15.6±6.1 mm to 23.4±10.4 mm, and from 16.3±7.6 mm to 22.0±9.8 mm, respectively. Two weeks of training using incentive spirometry provided improvements in pulmonary function and respiratory motion, which suggested that incentive spirometry may be a useful preoperative modality for improving pulmonary function during the perioperative period.

Decentralization strategies and provider incentives in healthcare: evidence from the english national health service.

PubMed

Mannion, Russell; Goddard, Maria; Kuhn, Michael; Bate, Angela

2005-01-01

This article examines the incentive effects of delegating operational and financial decision making from central government to local healthcare providers. It addresses the economic consequences of a contemporary policy initiative in the English National Health Service (NHS)-earned autonomy. This policy entails awarding operational autonomy to 'front-line' organisations that are assessed to be meeting national performance targets. In doing so, it introduces new types of incentives into the healthcare system, changes the nature of established agency relationships and represents a novel approach to performance management. Theoretical elements of a principal-agent model are used to examine the impact of decentralization in the context of the results of an empirical study that elicited the perceptions of senior hospital managers regarding the incentive effects of earned autonomy. A multi-method approach was adopted. In order to capture the breadth of policy impact, we conducted a national postal questionnaire survey of all Chief Executives in acute-care hospital Trusts in England (n = 173). To provide added depth and richness to our understanding of the impact and incentive effects of earned autonomy at an organisational level, we interviewed senior managers in a purposeful sample of eight acute-care hospital Trusts. This theoretical framework and our empirical work suggest that some aspects of the earned autonomy as currently implemented in the NHS serve to weaken the potential incentive effect of decentralization. In particular, the nature of the freedoms is such that many senior managers do not view autonomy as a particularly valuable prize. This suggests that incentives associated with the policy will be insufficiently powerful to motivate providers to deliver better performance. We also found that principal commitment may be a problem in the NHS. Some hospital managers reported that they already enjoyed a large degree of autonomy, regardless of their current performance ratings. We also found evidence that the objectives of providers may differ from those of both the central government and local purchasers. There is, therefore, a risk that granting greater autonomy will allow providers to pursue their own objectives which, whilst not self-serving, may still jeopardize the achievement of strategic goals. It is apparent that the design and implementation features of decentralizing policies such as earned autonomy require careful attention if an optimal balance is to be struck between central oversight and local autonomy in the delivery of healthcare.

Accelerated Adoption of Advanced Health Information Technology in Beacon Community Health Centers.

PubMed

Jones, Emily; Wittie, Michael

2015-01-01

To complement national and state-level HITECH Act programs, 17 Beacon communities were funded to fuel community-wide use of health information technology to improve quality. Health centers in Beacon communities received supplemental funding. This article explores the association between participation in the Beacon program and the adoption of electronic health records. Using the 2010-2012 Uniform Data System, trends in health information technology adoption among health centers located within and outside of Beacon communities were explored using differences in mean t tests and multivariate logistic regression. Electronic health record adoption was widespread and rapidly growing in all health centers, especially quality improvement functionalities: structured data capture, order and results management, and clinical decision support. Adoption lagged for functionalities supporting patient engagement, performance measurement, care coordination, and public health. The use of advanced functionalities such as care coordination grew faster in Beacon health centers, and Beacon health centers had 1.7 times higher odds of adopting health records with basic safety and quality functionalities in 2010-2012. Three factors likely underlie these findings: technical assistance, community-wide activation supporting health information exchange, and the layering of financial incentives. Additional technical assistance and community-wide activation is needed to support the use of functionalities that are currently lagging. © Copyright 2015 by the American Board of Family Medicine.

Neural substrates of social facilitation effects on incentive-based performance

PubMed Central

Chib, Vikram S; Adachi, Ryo; O’Doherty, John P

2018-01-01

Abstract Throughout our lives we must perform tasks while being observed by others. Previous studies have shown that the presence of an audience can cause increases in an individual’s performance as compared to when they are not being observed—a phenomenon called ‘social facilitation’. However, the neural mechanisms underlying this effect, in the context of skilled-task performance for monetary incentives, are not well understood. We used functional magnetic resonance imaging to monitor brain activity while healthy human participants performed a skilled-task during conditions in which they were paid based on their performance and observed and not observed by an audience. We found that during social facilitation, social signals represented in the dorsomedial prefrontal cortex (dmPFC) enhanced reward value computations in ventromedial prefrontal cortex (vmPFC). We also found that functional connectivity between dmPFC and ventral striatum was enhanced when participants exhibited social facilitation effects, indicative of a means by which social signals serve to modulate brain regions involved in regulating behavioral motivation. These findings illustrate how neural processing of social judgments gives rise to the enhanced motivational state that results in social facilitation of incentive-based performance. PMID:29648653

A randomized trial of blood donor recruitment strategies.

PubMed

Reich, Pascale; Roberts, Paula; Laabs, Nancy; Chinn, Artina; McEvoy, Patrick; Hirschler, Nora; Murphy, Edward L

2006-07-01

Improvement in donor return rates, especially among first-time donors, may significantly improve the blood supply. There are few rigorous studies of the effectiveness of various approaches to donor recruitment, however. By use of a single-blind, randomized trial design, 6919 post-September 11, 2001, first-time donors were randomly assigned into the following intervention arms: T-shirt incentive versus none, recruitment scripts with a patient story (Script A) versus a complimentary message including the donor's blood type (Script B), and telephone versus e-mail recruitment. Our primary outcome was a second donation within 6 months. Rate ratios (RRs) and 95 percent confidence intervals (95% CIs) were calculated with Taylor series methods. A total of 1421 (20.5%) first-time donors returned within the 6 months, including 1252 with a second and 169 with both second and third donations. The T-shirt incentive was not effective in increasing returns compared to no incentive (20.5% vs. 20.6%; RR, 0.99; 95% CI, 0.91-1.09). Script A was significantly more effective than Script B (22.2% vs. 18.9%; RR, 1.18; 95% CI, 1.07-1.29). E-mail was substantially less effective than telephone recruitment (13.2% vs. 27.8%; RR, 0.48; 95% CI, 0.40-0.57). A T-shirt incentive had no apparent effect, but an empathetic message significantly improved the return donation rate. E-mail recruitment was substantially less effective than telephone recruitment, perhaps due to technical problems. The study illustrates the utility of the randomized clinical trial study design for testing donor recruitment strategies.

Assessment of practices, capacities and incentives of poultry chain actors in implementation of highly pathogenic avian influenza mitigation measures in Ghana.

PubMed

Turkson, Paa Kobina; Okike, Iheanacho

2016-02-01

The animal health services-seeking behaviour of animal owners related to prevention and control of animal diseases may influence their decisions as to whether or not to use services provided by the public or private sectors. The specific objective of this paper was to assess the practices, capacities and incentives of actors involved in highly pathogenic avian influenza (HPAI) control to provide information for prevention and control in Ghana. Questionnaires were designed based on specific practices, incentives and capacities associated with each mitigation measure that was being assessed. Two peacetime preventive mitigation measures (biosecurity and reporting) and two outbreak containment measures (culling with compensation and movement control) were selected for evaluation. Supply chain actors were characterised based on baseline information. Tables were generated showing proportions of respondents in the various response categories in Likert-scale type itemised questionnaire. Mean scores (and their standard deviations) for the various actors with regard to mitigation measures were calculated. Pair-wise comparisons were done using t -ratio statistic and significance of differences were determined at a Bonferroni adjusted P -value of 0.0024. The study found statistically significant differences between certain actors for practices (biosecurity, reporting, culling and compensation and movement controls), incentives (reporting and movement control) and capacities (reporting and movement control). The findings provide lessons to help improve education and messages on HPAI and to help provide technical assistance targeted at specific actors to prevent and control future HPAI H5N1 outbreaks in Ghana.

The impact of changes in incentives and governance on the motivation of dental practitioners.

PubMed

Harris, Rebecca V; Dancer, Joanna M; Montasem, Alexander

2011-01-01

Recent changes to the system of remuneration and contracting arrangements with Primary Care Trusts (PCTs) has meant that dental practitioners in the UK have experienced several types of incentive and governance arrangements. This paper uses data from a qualitative study of 20 dental practitioners to examine the influence of different systems of incentives and governance on their motivational system. Results show that a perceived reduction in autonomy was the least acceptable aspect of the health reforms. The study also suggests that conflict between self-interested and altruistic motives may occur where medical professionals operate as independent contractors in a small business environment. Whilst dentists appeared to show altruistic motives towards their patients, priorities towards running an autonomous business enterprise meant that PCT managerial requirements, for example, to widen access were not welcomed, because of their impact on managerial autonomy. Moreover, whilst dentists' professional ethos appeared geared towards achieving technically high quality standards of work, this produced tensions against a background of cost containment in a fee-per-item system of remuneration. The paper raises issues such as the person-system interaction associated with professional and individual autonomy and the importance of reciprocity and fair payment. Copyright © 2010 John Wiley & Sons, Ltd.

Financial Incentives Differentially Regulate Neural Processing of Positive and Negative Emotions during Value-Based Decision-Making

PubMed Central

Farrell, Anne M.; Goh, Joshua O. S.; White, Brian J.

2018-01-01

Emotional and economic incentives often conflict in decision environments. To make economically desirable decisions then, deliberative neural processes must be engaged to regulate automatic emotional reactions. In this functional magnetic resonance imaging (fMRI) study, we evaluated how fixed wage (FW) incentives and performance-based (PB) financial incentives, in which pay is proportional to outcome, differentially regulate positive and negative emotional reactions to hypothetical colleagues that conflicted with the economics of available alternatives. Neural activity from FW to PB incentive contexts decreased for positive emotional stimuli but increased for negative stimuli in middle temporal, insula, and medial prefrontal regions. In addition, PB incentives further induced greater responses to negative than positive emotional decisions in the frontal and anterior cingulate regions involved in emotion regulation. Greater response to positive than negative emotional features in these regions also correlated with lower frequencies of economically desirable choices. Our findings suggest that whereas positive emotion regulation involves a reduction of responses in valence representation regions, negative emotion regulation additionally engages brain regions for deliberative processing and signaling of incongruous events. PMID:29487519

Financial Incentives Differentially Regulate Neural Processing of Positive and Negative Emotions during Value-Based Decision-Making.

PubMed

Farrell, Anne M; Goh, Joshua O S; White, Brian J

2018-01-01

Emotional and economic incentives often conflict in decision environments. To make economically desirable decisions then, deliberative neural processes must be engaged to regulate automatic emotional reactions. In this functional magnetic resonance imaging (fMRI) study, we evaluated how fixed wage (FW) incentives and performance-based (PB) financial incentives, in which pay is proportional to outcome, differentially regulate positive and negative emotional reactions to hypothetical colleagues that conflicted with the economics of available alternatives. Neural activity from FW to PB incentive contexts decreased for positive emotional stimuli but increased for negative stimuli in middle temporal, insula, and medial prefrontal regions. In addition, PB incentives further induced greater responses to negative than positive emotional decisions in the frontal and anterior cingulate regions involved in emotion regulation. Greater response to positive than negative emotional features in these regions also correlated with lower frequencies of economically desirable choices. Our findings suggest that whereas positive emotion regulation involves a reduction of responses in valence representation regions, negative emotion regulation additionally engages brain regions for deliberative processing and signaling of incongruous events.

Work attendance among healthcare workers: prevalence, incentives, and long-term consequences for health and performance.

PubMed

Dellve, Lotta; Hadzibajramovic, Emina; Ahlborg, Gunnar

2011-09-01

This paper is a report of a cohort study of healthcare workers' work attendance, and its long-term consequences' on health, burnout, work ability and performance. Concepts and measures of work attendance have varied in the scientific literature. Attending work in spite of being sick can have serious consequences on health. There is little knowledge on which individual and work-related conditions that increase work attendance and the long-term impact on health and performance. Prospective analyses of three measures of work attendance i.e. sickness attendance, uninterrupted long-term attendance and balanced attendance (≤7 days of sick leave per year and no sickness attendance) were done using questionnaire data from a 2-year cohort study (2004-2006) of randomly selected healthcare workers (n = 2624). Incentives (e.g. effort-reward balance, social support, meaningfulness) and requirements (e.g. time-pressure, dutifulness, high responsibility) to attend work as well as general health, burnout, sick leave, work ability and performance were assessed. There was a positive relation between balanced work attendance and incentives, whereas high sickness attendance was associated with requirements. Follow up after 2 years showed that balanced attendance was associated with sustained health and performance while sickness attendance was associated with poor health, burnout, sick-leave and decreased performance. It is important to distinguish between measures of work attendance as they differ in relation to incentives, and health- and performance-related consequences. Sickness attendance seems to be an important risk indicator. A balanced work attendance should be promoted for sustained health and performance in healthcare organisations. © 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

Impact of a Pay-for-Performance Program on Care for Black Patients with Hypertension: Important Answers in the Era of the Affordable Care Act.

PubMed

Petersen, Laura A; Ramos, Kate Simpson; Pietz, Kenneth; Woodard, LeChauncy D

2017-06-01

Evaluate the effect of a pay-for-performance intervention on the quality of hypertension care provided to black patients and determine whether it produced risk selection. Primary data collected between 2007 and 2009 from Veterans Affairs physicians and their primary care panels. Nested study within a cluster randomized controlled trial of three types of financial incentives and no incentives (control). We compared the proportion of physicians' black patients meeting hypertension performance measures for baseline and final performance periods. We measured risk selection by comparing the proportion of patients who switched providers, patient visit frequency, and panel turnover. Due to limited power, we prespecified in the analysis plan combining the three incentive groups and oversampling black patients. Data collected electronically and by chart review. The proportion of black patients who achieved blood pressure control or received an appropriate response to uncontrolled blood pressure in the final period was 6.3 percent (95 percent confidence interval, 0.8-11.7 percent) greater for physicians who received an incentive than for controls. There was no difference between intervention and controls in the proportion of patients who switched providers, visit frequency, or panel turnover. A pay-for-performance intervention improved blood pressure control or appropriate response to uncontrolled blood pressure in black patients and did not produce risk selection. © Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Investigating Group Contingencies to Promote Brief Abstinence from Cigarette Smoking

PubMed Central

Meredith, Steven E.; Dallery, Jesse

2013-01-01

In contingency management (CM), monetary incentives are contingent on evidence of drug abstinence. Typically, incentives (e.g., “vouchers” exchangeable for goods or services) are contingent on individual performance. We programmed vouchers contingent on group performance to investigate whether these contingencies would promote brief abstinence from cigarette smoking. Thirty-two participants were divided into small teams (n = 3 per team). During three 5-day within-subject experimental conditions, participants submitted video recordings of breath carbon monoxide (CO) measures twice daily via Mōtiv8 Systems™, an Internet-based remote monitoring application. During the interdependent contingency condition, participants earned vouchers each time they and their teammates submitted breath CO samples indicative of abstinence (i.e., negative samples). During the independent contingency condition, participants earned vouchers each time they submitted negative samples, regardless of their teammates' performance. During the no vouchers condition, no monetary incentives were contingent on abstinence. In addition, half of the participants (n = 16) could communicate with their teammates through an online peer support forum. Although forum access did not appear to promote smoking abstinence, monetary incentives did promote brief abstinence. Significantly more negative samples were submitted when vouchers were contingent on individual performance (56%) or team performance (53%) relative to when no vouchers were available (35%; F = 6.9, p = 0.002). The results show that interdependent contingencies can promote brief abstinence from cigarette smoking. Moreover, the results suggest that these contingencies may help lower treatment costs and promote social support. PMID:23421358

Modulation of working memory function by motivation through loss-aversion.

PubMed

Krawczyk, Daniel C; D'Esposito, Mark

2013-04-01

Cognitive performance is affected by motivation. Few studies, however, have investigated the neural mechanisms of the influence of motivation through potential monetary punishment on working memory. We employed functional MRI during a delayed recognition task that manipulated top-down control demands with added monetary incentives to some trials in the form of potential losses of bonus money. Behavioral performance on the task was influenced by loss-threatening incentives in the form of faster and more accurate performance. As shown previously, we found enhancement of activity for relevant stimuli occurs throughout all task periods (e.g., stimulus encoding, maintenance, and response) in both prefrontal and visual association cortex. Further, these activation patterns were enhanced for trials with possible monetary loss relative to nonincentive trials. During the incentive cue, the amygdala and striatum showed significantly greater activation when money was at a possible loss on the trial. We also evaluated patterns of functional connectivity between regions responsive to monetary consequences and prefrontal areas responsive to the task. This analysis revealed greater delay period connectivity between and the left insula and prefrontal cortex with possible monetary loss relative to nonincentive trials. Overall, these results reveal that incentive motivation can modulate performance on working memory tasks through top-down signals via amplification of activity within prefrontal and visual association regions selective to processing the perceptual inputs of the stimuli to be remembered. Copyright © 2011 Wiley Periodicals, Inc.

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.

Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions.

PubMed

Bärnighausen, Till; Bloom, David E

2009-06-26

In many countries worldwide, health worker shortages are one of the main constraints in achieving population health goals. Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload. We draw on studies of financial-incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial-incentive programmes: financing (programmes may benefit from innovative donor financing schemes, such as endowment funds, international financing facilities or compensation payments); promotion (programmes should use tested communication channels in order to reach secondary school graduates and health workers); selection (programmes may use selection criteria to ensure programme success and to achieve supplementary policy goals); placement (programmes should match participants to areas in order to maximize participant satisfaction and retention); support (programmes should prepare participants for the time in an underserved area, stay in close contact with participants throughout the different phases of enrolment and help participants by assigning them mentors, establishing peer support systems or financing education courses relevant to work in underserved areas); enforcement (programmes may use community-based monitoring or outsource enforcement to existing institutions); and evaluation (in order to broaden the evidence on the effectiveness of financial incentives in increasing the health workforce in underserved areas, programmes in developing countries should evaluate their performance; in order to improve the strength of the evidence on the effectiveness of financial incentives, controlled experiments should be conducted where feasible). In comparison to other interventions to increase the supply of health workers to medically underserved areas, financial-incentive programmes have advantages--unlike initiatives using non-financial incentives, they establish legally enforceable commitments to work in underserved areas and, unlike compulsory service policies, they will not be opposed by health workers--as well as disadvantages--unlike initiatives using non-financial incentives, they may not improve the working and living conditions in underserved areas (which are important determinants of health workers' long-term retention) and, unlike compulsory service policies, they cannot guarantee that they will supply health workers to underserved areas who would not have worked in such areas without financial incentives. Financial incentives, non-financial incentives, and compulsory service are not mutually exclusive and may positively affect each other's performance.

Designing financial-incentive programmes for return of medical service in underserved areas: seven management functions

PubMed Central

Bärnighausen, Till; Bloom, David E

2009-01-01

In many countries worldwide, health worker shortages are one of the main constraints in achieving population health goals. Financial-incentive programmes for return of service, whereby participants receive payments in return for a commitment to practise for a period of time in a medically underserved area, can alleviate local and regional health worker shortages through a number of mechanisms. First, they can redirect the flow of those health workers who would have been educated without financial incentives from well-served to underserved areas. Second, they can add health workers to the pool of workers who would have been educated without financial incentives and place them in underserved areas. Third, financial-incentive programmes may improve the retention in underserved areas of those health workers who participate in a programme, but who would have worked in an underserved area without any financial incentives. Fourth, the programmes may increase the retention of all health workers in underserved areas by reducing the strength of some of the reasons why health workers leave such areas, including social isolation, lack of contact with colleagues, lack of support from medical specialists and heavy workload. We draw on studies of financial-incentive programmes and other initiatives with similar objectives to discuss seven management functions that are essential for the long-term success of financial-incentive programmes: financing (programmes may benefit from innovative donor financing schemes, such as endowment funds, international financing facilities or compensation payments); promotion (programmes should use tested communication channels in order to reach secondary school graduates and health workers); selection (programmes may use selection criteria to ensure programme success and to achieve supplementary policy goals); placement (programmes should match participants to areas in order to maximize participant satisfaction and retention); support (programmes should prepare participants for the time in an underserved area, stay in close contact with participants throughout the different phases of enrolment and help participants by assigning them mentors, establishing peer support systems or financing education courses relevant to work in underserved areas); enforcement (programmes may use community-based monitoring or outsource enforcement to existing institutions); and evaluation (in order to broaden the evidence on the effectiveness of financial incentives in increasing the health workforce in underserved areas, programmes in developing countries should evaluate their performance; in order to improve the strength of the evidence on the effectiveness of financial incentives, controlled experiments should be conducted where feasible). In comparison to other interventions to increase the supply of health workers to medically underserved areas, financial-incentive programmes have advantages – unlike initiatives using non-financial incentives, they establish legally enforceable commitments to work in underserved areas and, unlike compulsory service policies, they will not be opposed by health workers – as well as disadvantages – unlike initiatives using non-financial incentives, they may not improve the working and living conditions in underserved areas (which are important determinants of health workers' long-term retention) and, unlike compulsory service policies, they cannot guarantee that they will supply health workers to underserved areas who would not have worked in such areas without financial incentives. Financial incentives, non-financial incentives, and compulsory service are not mutually exclusive and may positively affect each other's performance. PMID:19558682

Using financial incentives to improve value in orthopaedics.

PubMed

Lansky, David; Nwachukwu, Benedict U; Bozic, Kevin J

2012-04-01

A variety of reforms to traditional approaches to provider payment and benefit design are being implemented in the United States. There is increasing interest in applying these financial incentives to orthopaedics, although it is unclear whether and to what extent they have been implemented and whether they increase quality or reduce costs. We reviewed and discussed physician- and patient-oriented financial incentives being implemented in orthopaedics, key challenges, and prerequisites to payment reform and value-driven payment policy in orthopaedics. We searched the MEDLINE database using as search terms various provider payment and consumer incentive models. We retrieved a total of 169 articles; none of these studies met the inclusion criteria. For incentive models known to the authors to be in use in orthopaedics but for which no peer-reviewed literature was found, we searched Google for further information. Provider financial incentives reviewed include payments for reporting, performance, and patient safety and episode payment. Patient incentives include tiered networks, value-based benefit design, reference pricing, and value-based purchasing. Reform of financial incentives for orthopaedic surgery is challenged by (1) lack of a payment/incentive model that has demonstrated reductions in cost trends and (2) the complex interrelation of current pay schemes in today's fragmented environment. Prerequisites to reform include (1) a reliable and complete data infrastructure; (2) new business structures to support cost sharing; and (3) a retooling of patient expectations. There is insufficient literature reporting the effects of various financial incentive models under implementation in orthopaedics to know whether they increase quality or reduce costs. National concerns about cost will continue to drive experimentation, and all anticipated innovations will require improved collaboration and data collection and reporting.

Impact of a pay-for-performance incentive on support for smoking cessation and on smoking prevalence among people with diabetes.

PubMed

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

2007-06-05

Many people with diabetes continue to smoke despite being at high risk of cardiovascular disease. We examined the impact of a pay-for-performance incentive in the United Kingdom introduced in 2004 as part of the new general practitioner contract to improve support for smoking cessation and to reduce the prevalence of smoking among people with chronic diseases such as diabetes. We performed a population-based longitudinal study of the recorded delivery of cessation advice and the prevalence of smoking using electronic records of patients with diabetes obtained from participating general practices. The survey was carried out in an ethnically diverse part of southwest London before (June-October 2003) and after (November 2005-January 2006) the introduction of a pay-for-performance incentive. Significantly more patients with diabetes had their smoking status ever recorded in 2005 than in 2003 (98.8% v. 90.0%, p <0.001). The proportion of patients with documented smoking cessation advice also increased significantly over this period, from 48.0% to 83.5% (p < 0.001). The prevalence of smoking decreased significantly from 20.0% to 16.2% (p < 0.001). The reduction over the study period was lower among women (adjusted odds ratio 0.71, 95% confidence interval 0.53-0.95) but was not significantly different in the most and least affluent groups. In 2005, smoking rates continued to differ significantly with age (10.6%-25.1%), sex (women, 11.5%; men, 20.6%) and ethnic background (4.9%-24.9%). The introduction of a pay-for-performance incentive in the United Kingdom increased the provision of support for smoking cessation and was associated with a reduction in smoking prevalence among patients with diabetes in primary health care settings. Health care planners in other countries may wish to consider introducing similar incentive schemes for primary care physicians.

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

Focus on Teacher Pay and Incentives: Recent Legislative Actions and Update on Salary Averages

ERIC Educational Resources Information Center

Gaines, Gale F.

2004-01-01

One indicator of progress in the Challenge to Lead goals refers to teacher compensation: Salaries, benefits and incentives are competitive in the marketplace. They are aimed at recognized expertise, student performance, state needs and taking on additional or different roles to improve curriculum and instruction." Most Southern Regional Education…

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…

Clark's Triangle and Fiscal Incentives: Implications for Colleges'

ERIC Educational Resources Information Center

Lang, Dan

2015-01-01

For nearly 35 year's Burton Clark's triangle has been used as a paradigm for describing, assessing, and comparing systems of postsecondary education (Clark, 1998, 2004). Two major developments in the fiscal management of post-secondary education occurred more or less contemporaneously: incentive or performance funding on the part of the state and…

Time-bound promotions in Indian medical institutes: a mirage?

PubMed

Sukhlecha, Anupama

2016-01-01

Incentives, pay hikes and timely promotions enhance the job performance of an employee. In medical institutes, too, satisfied teachers would train students in a better way leading to better equipped doctors and ultimately, greater patient satisfaction. A study in Malaysia links high levels of satisfaction of employees with good salary, promotions, and incentives.

Motivational Incentives and Methylphenidate Enhance Electrophysiological Correlates of Error Monitoring in Children with Attention Deficit/Hyperactivity Disorder

ERIC Educational Resources Information Center

Groom, Madeleine J.; Liddle, Elizabeth B.; Scerif, Gaia; Liddle, Peter F.; Batty, Martin J.; Liotti, Mario; Hollis, Chris P.

2013-01-01

Background: Children with attention deficit hyperactivity disorder (ADHD) are characterised by developmentally inappropriate levels of hyperactivity, impulsivity and/or inattention and are particularly impaired when performing tasks that require a high level of cognitive control. Methylphenidate (MPH) and motivational incentives may help improve…

Evaluating Student-Teacher Linkage Data in Teacher Incentive Fund (TIF) Sites: Acquisition, Verification, and System Development. The Harvesting Project

ERIC Educational Resources Information Center

Watson, Jeffery; Witham, Peter; St. Louis, Timothy

2010-01-01

The U.S. Department of Education Teacher Incentive Fund (TIF) seeks to transform education compensation systems so that principal and teacher performance (measured through classroom productivity measures) connects to compensation. Classroom-level productivity measures require robust student-teacher linkage data. Organizations such as the…

Increasing Educator Effectiveness: Lessons Learned from Teacher Incentive Fund Sites

ERIC Educational Resources Information Center

Eckert, Jonathan

2013-01-01

Created by the U.S. Congress in 2006, the Teacher Incentive Fund (TIF) represents the first federal initiative targeted directly at state and district efforts to introduce performance measures into educator compensation. TIF responds to a growing body of evidence that existing pay structures do not respond to labor force realities or adequately…

Reward Motivation Enhances Task Coding in Frontoparietal Cortex.

PubMed

Etzel, Joset A; Cole, Michael W; Zacks, Jeffrey M; Kay, Kendrick N; Braver, Todd S

2016-04-01

Reward motivation often enhances task performance, but the neural mechanisms underlying such cognitive enhancement remain unclear. Here, we used a multivariate pattern analysis (MVPA) approach to test the hypothesis that motivation-related enhancement of cognitive control results from improved encoding and representation of task set information. Participants underwent two fMRI sessions of cued task switching, the first under baseline conditions, and the second with randomly intermixed reward incentive and no-incentive trials. Information about the upcoming task could be successfully decoded from cue-related activation patterns in a set of frontoparietal regions typically associated with task control. More critically, MVPA classifiers trained on the baseline session had significantly higher decoding accuracy on incentive than non-incentive trials, with decoding improvement mediating reward-related enhancement of behavioral performance. These results strongly support the hypothesis that reward motivation enhances cognitive control, by improving the discriminability of task-relevant information coded and maintained in frontoparietal brain regions. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

Avoiding unintended incentives in ACO payment models.

PubMed

Douven, Rudy; McGuire, Thomas G; McWilliams, J Michael

2015-01-01

One goal of the Medicare Shared Savings Program for accountable care organizations (ACOs) is to reduce Medicare spending for ACOs' patients relative to the organizations' spending history. However, we found that current rules for setting ACO spending targets (or benchmarks) diminish ACOs' incentives to generate savings and may even encourage higher instead of lower Medicare spending. Spending in the three years before ACOs enter or renew a contract is weighted unequally in the benchmark calculation, with a high weight of 0.6 given to the year just before a new contract starts. Thus, ACOs have incentives to increase spending in that year to inflate their benchmark for future years and thereby make it easier to obtain shared savings from Medicare in the new contract period. We suggest strategies to improve incentives for ACOs, including changes to the weights used to determine benchmarks and new payment models that base an ACO's spending target not only on its own past performance but also on the performance of other ACOs or Medicare providers. Project HOPE—The People-to-People Health Foundation, Inc.

Maine PACE Program Final Technical Report

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

Fischer, Dana; Adamson, Joy M

The ARRA EECBG BetterBuilding helped augment the existing Home Energy Savings Programs (HESP) and incentives with financing through a subordinate lien PACE and HUD PowerSaver programs. The program was designed to document innovative techniques to dramatically increase the number of homes participating in weatherization programs in participating towns. Maine will support new energy efficiency retrofit pilots throughout the state, designed to motivate a large number of homeowners to invest in comprehensive home energy efficiency upgrades to bring real solutions to market.

Quarterly Technical Progress Report

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

Mary K. Banken

This project has identified all FDD oil reservoirs in Oklahoma; grouped those reservoirs into plays that have similar depositional origins; collected, organized, and analyzed all available data; conducted characterization and simulation studies on selected reservoirs in each plays; and implemented a technology transfer program targeted to the operators of FDD reservoirs. By fulfilling these objectives, the FDD project has had the goal of helping to sustain the life expectancy of existing wells and provide incentive for development and exploratory wells with the ultimate objective of increasing oil recovery.

Effect of volume-oriented versus flow-oriented incentive spirometry on chest wall volumes, inspiratory muscle activity, and thoracoabdominal synchrony in the elderly.

PubMed

Lunardi, Adriana C; Porras, Desiderio C; Barbosa, Renata Cc; Paisani, Denise M; Marques da Silva, Cibele C B; Tanaka, Clarice; Carvalho, Celso R F

2014-03-01

Aging causes physiological and functional changes that impair pulmonary function. Incentive spirometry is widely used for lung expansion, but the effects of volume-oriented incentive spirometry (VIS) versus flow-oriented incentive spirometry (FIS) on chest wall volumes, inspiratory muscle activity, and thoracoabdominal synchrony in the elderly are poorly understood. We compared VIS and FIS in elderly subjects and healthy adult subjects. Sixteen elderly subjects (9 women, mean ± SD age 70.6 ± 3.9 y, mean ± SD body mass index 23.8 ± 2.5 kg/m(2)) and 16 healthy adults (8 women, mean ± age 25.9 ± 4.3 y, mean ± body mass index 23.6 ± 2.4 kg/m(2)) performed quiet breathing, VIS, and FIS in randomized sequence. Chest wall kinematics (via optoelectronic plethysmography) and inspiratory muscle activity (via surface electromyography) were assessed simultaneously. Synchrony between the superior thorax and abdominal motion was calculated (phase angle). In the elderly subjects both types of incentive spirometry increased chest wall volumes similarly, whereas in the healthy adult subjects VIS increased the chest wall volume more than did FIS. FIS and VIS triggered similar lower thoracoabdominal synchrony in the elderly subjects, whereas in the healthy adults FIS induced lower synchrony than did VIS. FIS required more muscle activity in the elderly subjects to create an increase in chest wall volume. Incentive spirometry performance is influenced by age, and the differences between elderly and healthy adults response should be considered in clinical practice.

Capacity market design and renewable energy: Performance incentives, qualifying capacity, and demand curves

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

Byers, Conleigh; Levin, Todd; Botterud, Audun

A review of capacity markets in the United States in the context of increasing levels of variable renewable energy finds substantial differences with respect to incentives for operational performance, methods to calculate qualifying capacity for variable renewable energy and energy storage, and demand curves for capacity. The review also reveals large differences in historical capacity market clearing prices. The authors conclude that electricity market design must continue to evolve to achieve cost-effective policies for resource adequacy.

Institutional obstacles to expansion of world food production.

PubMed

Crosson, P R

1975-05-09

It was argued that over the near-to-medium term-roughly to the mid-1980's-there is enough potential for growth in existing Green Revolution technology and in technical capacity of farmers that institutions affecting these two sources of increased food production probably will not be seriously constraining. The principal bottlenecks likely will be found among those institutions affecting farmers' incentives to innovate. There is impressive evidence that when other conditions for innovation are favorable the supply of marketing services, for both inputs and outputs, is quite elastic. This seems to include the supply of funds from rural saving and informal credit sources, although the evidence is less clear in this respect. The situation concerning price relations and availability of inputs appears mixed. If national income growth targets are achieved, then the growth in total demand for food in the LDC's should be fast enough to support incentive prices for farmers. This advantage could be lost, however, if governments adopt policies to suppress food prices to keep down the cost of living. The price of fertilizers is expected to fall from the high levels of 1974, the amount of the fall depending in good measure on the success of the LDC's in increasing fertilizer production. Historically, their efforts to expand capacity have been relatively inefficient. Moreover, many countries still lack adequate capacity to produce the HYV's and pesticides. Even with good progress in expanding domestic production of inputs, imports will continue to be an important source of supply. Maintenance of present high prices of petroleum products could be a major obstacle to financing these imports on the necessary scale because of the drain it would place on available foreign exchange. I conclude, on balance, that prices and availability of fertilizers, pesticides, and seeds could have important negative effects on farmers' incentives to adopt Green Revolution technology. Rigidities in water management institutions may be even more limiting, for reasons noted in the previous section. The role of existing land tenure institutions is not clear. The tentative conclusion, however, is that over the near-to-medium term the maintenance will not be a major obstacle to further spread of the Green Revolution. Over the longer term, it could become more seriously limiting. The reason is that continued expansion of food production will eventually require the invention and adoption of new technologies and a higher level of technical and managerial skill than most farmers in the LDC's now possess. To do this will require substantial investments in domestic research and extension institutions and in rural education. In countries where a small class of large landowners wield substantial political power, these investments may not occur on the necessary scale because the large farmers have their own means of acquiring the technology and little perceived interest in supporting the upgrading of the skills of small farmers. This review of institutional obstacles to expansion of food production in the LDC's must end on a tentative note. The review does suggest some observations about the process of institutional change, however. There is impressive evidence of strong latent potential in the private sector of the LDC's for mobilizing the resources and effort needed for agricultural progress when the private economic rewards for doing so are high. Under these circumstances, needed changes in the institutions required to mobilize the resources and direct the effort seem relatively easy to achieve. Institutional resistance is stronger in situations where influential interests perceive change as a threat or where there is no direct personal economic reward to change, as in the typical public institution. The latter point is particularly important because the performance of public institutions is critical. Development of new technology, the fundamental condition for continued longterm growth, is basically a public responsibility because the gains from adoption usually cannot be sufficiently captured by private institutions to justify their assuming the cost. Although private firms often have incentives to impart technical knowledge to farmers as a way of widening the market for their products, the broadening and strengthening of the institutional structures concerned with both the general and technical education of farmers is a public responsibility. This is true also of the development of large irrigation systems, both because of the scale of the needed investments and the potential for social conflict in water management. The lack of a well-defined mechanism that would link responses of public institutions to the large social payoffs to increased public investment in irrigation, new technology, and technical abilities of farmers may prove in the long run to be the most important single obstacle to adequate growth of food production in the LDC's.

The Short-Term Effect of Breathing Tasks Via an Incentive Spirometer on Lung Function Compared With Autogenic Drainage in Subjects With Cystic Fibrosis.

PubMed

Sokol, Gil; Vilozni, Daphna; Hakimi, Ran; Lavie, Moran; Sarouk, Ifat; Bat-El Bar; Dagan, Adi; Ofek, Miryam; Efrati, Ori

2015-12-01

Forced expiration may assist secretion movement by manipulating airway dynamics in patients with cystic fibrosis (CF). Expiratory resistive breathing via a handheld incentive spirometer has the potential to control the expiratory flow via chosen resistances (1-8 mm) and thereby mobilize secretions and improve lung function. Our objective was to explore the short-term effect of using a resistive-breathing incentive spirometer on lung function in subjects with CF compared with the autogenic drainage technique. This was a retrospective study. Subjects with CF performed 30-45 min of either the resistive-breathing incentive spirometer (n = 40) or autogenic drainage (n = 32) technique on separate days. The spirometer encourages the patient to exhale as long as possible while maintaining a low lung volume. The autogenic drainage technique includes repetitive inspiratory and expiratory maneuvers at various tidal breathing magnitudes while exhalation is performed in a sighing manner. Spirometry was performed before and 20-30 min after the therapy. Use of a resistive-breathing incentive spirometer improved FVC and FEV1 by 5-42% in 26 subjects. The forced expiratory flow during the middle half of the FVC maneuver (FEF25-75%) improved by >20% in 9 (22%) subjects. FVC improved the most in subjects with an FEV1 of 40-60% of predicted. Improvements negatively correlated with baseline percent-of-predicted FVC values provided improvements were above 10% (r(2) = 0.28). Values improved in a single subjects using the autogenic drainage technique. These 2 techniques may allow lower thoracic pressures and assist in the prevention of central airway collapse. The resistive-breathing incentive spirometer is a self-administered simple method that may aid airway clearance and has the potential to improve lung function as measured by FVC, FEV1, and FEF25-75% in patients with CF. Copyright © 2015 by Daedalus Enterprises.

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.

The Relationship between Incentives to Learn and Maslow's Hierarchy of Needs

NASA Astrophysics Data System (ADS)

Wu, Wenling

This paper empirically explores lots of students in college for their hierarchy of needs and incentives to learn, and finds the linear relationship between them. With the survey, it's be found that there are some kinds of factors influence the students needs order. The paper gives several diagrams to show these important factors which affect the college students' hierarchy of needs most. The paper also finds the change of the student' hierarchy of needs will affect the variety of incentives to learn. Then the paper develops a model for qualitative analyze this relationship. Numerical examples are used to demonstrate the performance of the model. With this model the correct and useful methods can be easily selected for students to incentive according to their types of hierarchy of needs.

ISO 50001 for Commercial Buildings: Lessons Learned From U.S. DOE Pilot Project: Preprint

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

Deru, M.; Field, K.; Punjabi, S.

In the U.S., the ISO 50001 Standard, which establishes energy management systems (EnMSs) and processes, has shown uptake primarily in the industrial sector. The U.S. Department of Energy (DOE) undertook a pilot program to explore ISO 50001 implementation in commercial buildings. Eight organizations participated as pilots, with technical assistance provided by DOE, the National Renewable Energy Laboratory (NREL), the Lawrence Berkeley National Laboratory (LBNL), and the Georgia Institute of Technology (Georgia Tech). This paper shares important lessons learned from the pilot. Staff time was the most critical resource required to establish effective EnMSs in commercial buildings. The pilot also revealedmore » that technical support and template/example materials were essential inputs. Crucial activities included evaluating performance, identifying goals, making connections, communicating operational controls, and tracking/reviewing progress. Benefits realized included enhanced intra-organizational connections, greater energy awareness, increased process efficiencies, and improved ability to make business cases. Incremental benefits for ISO 50001 certification were greater accountability, assurance of best practices, public relations opportunities, and potential to unlock verified savings credits or incentive money. Incremental certification costs included more staff/consultant time, money for certification, and a tendency to limit EnMS scope in order to ensure favorable audit results. Five best practices were identified - utilizing expert technical assistance, training, and other resources; focusing on implementation over documentation; keeping top management involved; considering organizational structure when selecting EnMS scope; and matching the implementation level to an EnMS's scope and scale. The last two practices are particularly relevant to the commercial buildings sector.« less

Provider and Patient Directed Financial Incentives to Improve Care and Outcomes for Patients with Diabetes

PubMed Central

Lorincz, Ilona S.; Lawson, Brittany C. T.

2012-01-01

Incentive programs directed at both providers and patients have become increasingly widespread. Pay-for-performance (P4P) where providers receive financial incentives to carry out specific care or improve clinical outcomes has been widely implemented. The existing literature indicates they probably spur initial gains which then level off or partially revert if incentives are withdrawn. The literature also indicates that process measures are easier to influence through P4P programs but that intermediate outcomes such as glucose, blood pressure, and cholesterol control are harder to influence, and the long term impact of P4P programs on health is largely unknown. Programs directed at patients show greater promise as a means to influence patient behavior and intermediate outcomes such as weight loss; however, the evidence for long term effects are lacking. In combination, both patient and provider incentives are potentially powerful tools but whether they are cost-effective has yet to be determined. PMID:23225214

Financial incentives and measurement improved physicians' quality of care in the Philippines.

PubMed

Peabody, John; Shimkhada, Riti; Quimbo, Stella; Florentino, Jhiedon; Bacate, Marife; McCulloch, Charles E; Solon, Orville

2011-04-01

The merits of using financial incentives to improve clinical quality have much appeal, yet few studies have rigorously assessed the potential benefits. The uncertainty surrounding assessments of quality can lead to poor policy decisions, possibly resulting in increased cost with little or no quality improvement, or missed opportunities to improve care. We conducted an experiment involving physicians in thirty Philippine hospitals that overcomes many of the limitations of previous studies. We measured clinical performance and then examined whether modest bonuses equal to about 5 percent of a physician's salary, as well as system-level incentives that increased compensation to hospitals and across groups of physicians, led to improvements in the quality of care. We found that both the bonus and system-level incentives improved scores in a quality measurement system used in our study by ten percentage points. Our findings suggest that when careful measurement is combined with the types of incentives we studied, there may be a larger impact on quality than previously recognized.

Use of incentive spirometry in portable chest radiography.

PubMed

McEntee, Mark F; Houssein, Nariman; Al-azawi, Dhafir

2014-01-01

The degree of lung inflation seen on a chest radiograph is dependent on the point during the patient's respiratory cycle at which the radiographer exposes the image receptor. Exposing the image receptor at the exact peak of inflation can be difficult because of the limited time available in which to capture the inspiratory pause. An incentive spirometer can indicate the moment of peak inhalation. This study tested whether images taken with and without an incentive spirometer display different levels of image quality. This is a paired, prospective, single-blinded study of 30 patients undergoing portable chest radiography. The radiographs were acquired with and without the use of an incentive spirometer. Visual grading analysis was performed using the 1996 European Guidelines on Quality Criteria for Diagnostic Radiographic Images. The mean patient age was 53 years. Sixty images were acquired, 30 with the use of incentive spirometry and 30 without. The most common indication for portable chest radiography was "postlung lobectomy." Scoring on the radiologist's ability to see the sixth rib, spine, trachea, and cardiac border was not affected significantly by the use of incentive spirometry. Use of an incentive spirometer was associated with significant improvement in ability to see the 10th rib (P ≤ .004), vascular pattern (P ≤ .001), retrocardiac lung (P ≤ .013), and the costophrenic angles (P ≤ .005). This study introduces a technique to improve the quality of portable chest radiographs. The use of incentive spirometry improved inspiratory depth and image quality for portable chest radiographs.

Effects of Incentive Spirometry on Respiratory Motion in Healthy Subjects Using Cine Breathing Magnetic Resonance Imaging

PubMed Central

Akazawa, Tsutomu; Sakuma, Tsuyoshi; Nagaya, Shigeyuki; Sonoda, Masaru; Tanaka, Yuji; Katogi, Takehide; Nemoto, Tetsuharu; Minami, Shohei

2015-01-01

Objective To investigate the effectiveness of incentive spirometry on respiratory motion in healthy subjects using cine breathing magnetic resonance imaging (MRI). Methods Ten non-smoking healthy subjects without any history of respiratory disease were studied. Subjects were asked to perform pulmonary training using incentive spirometry every day for two weeks. To assess the effectiveness of this training, pulmonary function tests and cine breathing MRI were performed before starting pulmonary training and two weeks after its completion. Results After training, there were significant improvements in vital capacity (VC) from 3.58±0.8 L to 3.74±0.8 L and in %VC from 107.4±10.8 to 112.1±8.2. Significant changes were observed in the right diaphragm motion, right chest wall motion, and left chest wall motion, which were increased from 55.7±9.6 mm to 63.4±10.2 mm, from 15.6±6.1 mm to 23.4±10.4 mm, and from 16.3±7.6 mm to 22.0±9.8 mm, respectively. Conclusion Two weeks of training using incentive spirometry provided improvements in pulmonary function and respiratory motion, which suggested that incentive spirometry may be a useful preoperative modality for improving pulmonary function during the perioperative period. PMID:26161341

Incentive spirometry for the tracheostomy patient.

PubMed

Goldstein, Gregg H; Iloreta, Alfred Marc; Ojo, Bukola; Malkin, Benjamin D

2012-12-01

To determine the feasibility of developing and using a customized incentive spirometer device for patients who have undergone a tracheostomy procedure. The authors performed a prospective case series approved by the institutional review board. Academic medical center. Patients were eligible for participation if they were older than 18 years and had a new tracheostomy. Spirometry exercises were performed using a protocol adapted from the American Academy of Respiratory Care guidelines. Patient data were recorded, including age, sex, tobacco use, surgical procedure, time under general anesthesia, length of hospital stay, and time until ambulation. The details of the spirometry exercises were also recorded along with any complications that occurred. An incentive spirometer was adapted for use with tracheostomy patients and received an investigational device exemption from the Food and Drug Administration. A total of 10 patients were enrolled (mean age 60 years). Sixty percent were current or former tobacco users, the mean anesthesia time was 9 hours, and 70% underwent a microvascular free flap reconstruction. Patients used the incentive spirometer for a mean of 1.6 days during the postoperative period, averaging 3.3 sessions per day and 6.8 breaths per session. The device was well tolerated by patients, and there were no complications associated with its use. This study supports the feasibility of using a customized incentive spirometer for tracheostomy patients and establishes a safety profile for the device to be used in future studies.

Independent effects of reward expectation and spatial orientation on the processing of emotional facial expressions.

PubMed

Kang, Guanlan; Zhou, Xiaolin; Wei, Ping

2015-09-01

The present study investigated the effect of reward expectation and spatial orientation on the processing of emotional facial expressions, using a spatial cue-target paradigm. A colored cue was presented at the left or right side of the central fixation point, with its color indicating the monetary reward stakes of a given trial (incentive vs. non-incentive), followed by the presentation of an emotional facial target (angry vs. neutral) at a cued or un-cued location. Participants were asked to discriminate the emotional expression of the target, with the cue-target stimulus onset asynchrony being 200-300 ms in Experiment 1 and 950-1250 ms in Experiment 2a (without a fixation cue) and Experiment 2b (with a fixation cue), producing a spatial facilitation effect and an inhibition of return effect, respectively. The results of all the experiments revealed faster reaction times in the monetary incentive condition than in the non-incentive condition, demonstrating the effect of reward to facilitate task performance. An interaction between reward expectation and the emotion of the target was evident in all the three experiments, with larger reward effects for angry faces than for neutral faces. This interaction was not affected by spatial orientation. These findings demonstrate that incentive motivation improves task performance and increases sensitivity to angry faces, irrespective of spatial orienting and reorienting processes.

Quality Measures for Dialysis: Time for a Balanced Scorecard.

PubMed

Kliger, Alan S

2016-02-05

Recent federal legislation establishes a merit-based incentive payment system for physicians, with a scorecard for each professional. The Centers for Medicare and Medicaid Services evaluate quality of care with clinical performance measures and have used these metrics for public reporting and payment to dialysis facilities. Similar metrics may be used for the future merit-based incentive payment system. In nephrology, most clinical performance measures measure processes and intermediate outcomes of care. These metrics were developed from population studies of best practice and do not identify opportunities for individualizing care on the basis of patient characteristics and individual goals of treatment. The In-Center Hemodialysis (ICH) Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey examines patients' perception of care and has entered the arena to evaluate quality of care. A balanced scorecard of quality performance should include three elements: population-based best clinical practice, patient perceptions, and individually crafted patient goals of care. Copyright © 2016 by the American Society of Nephrology.

Do Monetary Incentives Matter in Classroom Experiments? Effects on Course Performance

ERIC Educational Resources Information Center

Rousu, Matthew C.; Corrigan, Jay R.; Harris, David; Hayter, Jill K.; Houser, Scott; Lafrancois, Becky A.; Onafowora, Olugbenga; Colson, Gregory; Hoffer, Adam

2015-01-01

Using 641 principles of economics students across four universities, the authors examine whether providing monetary incentives in a prisoner's dilemma game enhances student learning as measured by a set of common exam questions. Subjects either play a two-player prisoner's dilemma game for real money, play the same game with no money at stake…

Reading Incentives that Work: No-Cost Strategies to Motivate Kids to Read and Love It!

ERIC Educational Resources Information Center

Small, Ruth V.

2009-01-01

In education, it is possible to find dozens of examples of "forced" reading incentive programs that categorize student reading levels, provide limited reading lists coordinated with those reading levels, assess student reading through computer-based tests, and award tangible prizes when they pass the test. Those who perform best get the most…

Moving Teachers: Implementation of Transfer Incentives in Seven Districts. Executive Summary. NCEE 2012-4052

ERIC Educational Resources Information Center

Glazerman, Steven; Protik, Ali; Teh, Bing-ru; Bruch, Julie; Seftor, Neil

2012-01-01

This report describes the implementation and intermediate impacts of an intervention designed to provide incentives for a school district's highest-performing teachers to work in its lowest-achieving schools. The report is part of a larger study in which random assignment was used to form two equivalent groups of classrooms organized into teacher…

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…

Teacher Pay for Performance: Experimental Evidence from the Project on Incentives in Teaching. [Executive Summary

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.

2013-01-01

The Project on Incentives in Teaching (POINT) was a three-year study conducted in the Metropolitan Nashville School System from 2006-07 through 2008-09, in which middle school mathematics teachers voluntarily participated in a controlled experiment to assess the effect of financial rewards for teachers whose students showed unusually large gains…

Incentive Matters!--The Benefit of Reminding Students about Their Academic Standing in Introductory Economics Courses

ERIC Educational Resources Information Center

Chen, Qihui; Okediji, Tade O.

2014-01-01

In this article, the authors illustrate how incentives can improve student performance in introductory economics courses. They implemented a policy experiment in a large introductory economics class in which they reminded students who scored below an announced cutoff score on the midterm exam about the risk of failing the course. The authors…

The Development of an Incentive Pay System for Use at Sue Bennett College.

ERIC Educational Resources Information Center

McLendon, Sandra F.

This paper reports on a study designed to assist in the development of an incentive pay system at Kentucky's Sue Bennett College that would be utilized to recognize merit and performance through increases in faculty salaries. Study procedures to determine the system's elements involved a literature search, a solicitation of input from the Faculty…

The Persistent Problems and Confounding Challenges of Educator Incentives: The Case of TIF in Prince George's County, Maryland

ERIC Educational Resources Information Center

Rice, Jennifer King; Malen, Betty; Baumann, Paul; Chen, Elke; Dougherty, Amy; Hyde, Laura; Jackson, Cara; Jacobson, Reuben; McKithen, Clarissa

2012-01-01

While education accountability systems emphasize teacher quality as a prerequisite for student learning, education administrators have struggled to staff low-performing schools with effective teachers. Fueled in part by the federal Teacher Incentive Fund, compensation reforms have gained center stage status among strategies aimed at improving…

Paying to Learn: The Effect of Financial Incentives on Elementary School Test Scores. NBER Working Paper No. 16333

ERIC Educational Resources Information Center

Bettinger, Eric P.

2010-01-01

Policymakers and academics are increasingly interested in applying financial incentives to individuals in education. This paper presents evidence from a pay for performance program taking place in Coshocton, Ohio. Since 2004, Coshocton has provided cash payments to students in grades three through six for successful completion of their…

Does the Effort of Processing Potential Incentives Influence the Adaption of Context Updating in Older Adults?

PubMed Central

Schmitt, Hannah; Kray, Jutta; Ferdinand, Nicola K.

2017-01-01

A number of aging studies suggest that older adults process positive and negative information differently. For instance, the socioemotional selectivity theory postulates that older adults preferably process positive information in service of emotional well-being (Reed and Carstensen, 2012). Moreover, recent research has started to investigate whether incentives like gains or losses can influence cognitive control in an ongoing task. In an earlier study (Schmitt et al., 2015), we examined whether incentive cues, indicating potential monetary gains, losses, or neutral outcomes for good performance in the following trial, would influence older adults’ ability to exert cognitive control. Cognitive control was measured in an AX-Continuous-Performance-Task (AX-CPT) in which participants had to select their responses to probe stimuli depending on a preceding context cue. In this study, we did not find support for a positivity effect in older adults, but both gains and losses led to enhanced context processing. As the trial-wise presentation mode may be too demanding on cognitive resources for such a bias to occur, the main goal of the present study was to examine whether motivational mindsets, induced by block-wise presentation of incentives, would result in a positivity effect. For this reason, we examined 17 older participants (65–76 years) in the AX-CPT using a block-wise presentation of incentive cues and compared them to 18 older adults (69–78 years) with the trial-wise presentation mode from our earlier study (Schmitt et al., 2015). Event-related potentials were recorded to the onset of the motivational cue and during the AX-CPT. Our results show that (a) older adults initially process cues signaling potential losses more strongly, but later during the AX-CPT invest more cognitive resources in preparatory processes like context updating in conditions with potential gains, and (b) block-wise and trial-wise presentation of incentive cues differentially influenced cognitive control. When incentives were presented block-wise, the above described valence effects were consistently found. In contrast, when incentives were presented trial-wise, the effects were mixed and salience as well as valence effects can be obtained. Hence, how positive and negative incentive cues influence cognitive control in older adults is dependent on demands of cue processing. PMID:29170649

Does the Effort of Processing Potential Incentives Influence the Adaption of Context Updating in Older Adults?

PubMed

Schmitt, Hannah; Kray, Jutta; Ferdinand, Nicola K

2017-01-01

A number of aging studies suggest that older adults process positive and negative information differently. For instance, the socioemotional selectivity theory postulates that older adults preferably process positive information in service of emotional well-being (Reed and Carstensen, 2012). Moreover, recent research has started to investigate whether incentives like gains or losses can influence cognitive control in an ongoing task. In an earlier study (Schmitt et al., 2015), we examined whether incentive cues, indicating potential monetary gains, losses, or neutral outcomes for good performance in the following trial, would influence older adults' ability to exert cognitive control. Cognitive control was measured in an AX-Continuous-Performance-Task (AX-CPT) in which participants had to select their responses to probe stimuli depending on a preceding context cue. In this study, we did not find support for a positivity effect in older adults, but both gains and losses led to enhanced context processing. As the trial-wise presentation mode may be too demanding on cognitive resources for such a bias to occur, the main goal of the present study was to examine whether motivational mindsets, induced by block-wise presentation of incentives, would result in a positivity effect. For this reason, we examined 17 older participants (65-76 years) in the AX-CPT using a block-wise presentation of incentive cues and compared them to 18 older adults (69-78 years) with the trial-wise presentation mode from our earlier study (Schmitt et al., 2015). Event-related potentials were recorded to the onset of the motivational cue and during the AX-CPT. Our results show that (a) older adults initially process cues signaling potential losses more strongly, but later during the AX-CPT invest more cognitive resources in preparatory processes like context updating in conditions with potential gains, and (b) block-wise and trial-wise presentation of incentive cues differentially influenced cognitive control. When incentives were presented block-wise, the above described valence effects were consistently found. In contrast, when incentives were presented trial-wise, the effects were mixed and salience as well as valence effects can be obtained. Hence, how positive and negative incentive cues influence cognitive control in older adults is dependent on demands of cue processing.

Energy Efficiency Appliance Standards: Where do we stand, how far can we go and how do we get there? An analysis across several economies

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

Letschert, Virginie E.; de la Rue du Can, Stephane; McNeil, Michael A.

This paper analyses several potential savings scenarios for minimum energy performance standard (MEPS) and comparable programs for governments participating i n the Super-efficient Equipment and Appliance Deployment (SEAD) Initiative, of the Clean Energy Ministerial, which represent over 60% of primary energy consumption in the world. We compare projected energy savings from the main end uses in the residential sector using three energy efficiency scenarios: (1) recent achievements, (2) cost-effective saving potential, and (3) energy efficiency technical potential. The recent achievement scenario (1) evaluates the future impact of MEPS enacted or under development between 2010 and 2012. The cost-effective potential scenariomore » (2) identifies the maximum potential for energy efficiency that results in net benefits to the consumer. The best available technology scenario (3) re presents the full potential of energy efficiency considering best available technologies as candidates for MEPS and incentive programs. We use the Bottom Up Energy Analysis System (BUENAS), developed by Lawrence Berkeley National Laboratory in collaboration with the Collaborative Labelling and Appliances Standards Program (CLASP), to provide a consistent methodology to com pare the different scenarios. This paper focuses on the main end uses in the residential sector. The comparison of the three scenarios for each economy provides possible opportunities for scaling up current policies or implementing additional policies. This comparison across economies reveals country best practices as well as end uses that present the greatest additional potential savings. The paper describes areas where methodologies and additional policy instruments can increase penetration of energy efficient technologies. First , we summarize the barriers and provide remedial policy tools/best practices, such as techno-economic analysis, in response to each barriers that prevent economies from capturing the full cost-effective potentials of MEPS (Scenario 1 to 2). Then, we consider the possible complementary policy options, such as incentive pro grams, to reach the full technical potential of energy efficiency in the residential sector (Scenario 2 to 3).« less

Legal and financial methods for reducing low emission sources: Options for incentives

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

Samitowski, W.

1995-12-31

There are two types of the so-called low emission sources in Cracow: over 1,000 local boiler houses and several thousand solid fuel-fired stoves. The accomplishment of each of 5 sub-projects offered under the American-Polish program entails solving the technical, financial, legal and public relations-related problems. The elimination of the low emission source requires, therefore, a joint effort of the following pairs: (a) local authorities, (b) investors, (c) owners and users of low emission sources, and (d) inhabitants involved in particular projects. The results of the studies developed by POLINVEST indicate that the accomplishment of the projects for the elimination ofmore » low emission sources will require financial incentives. Bearing in mind the today`s resources available from the community budget, this process may last as long as a dozen or so years. The task of the authorities of Cracow City is making a long-range operational strategy enabling reduction of low emission sources in Cracow.« less

Technology, Incentives, or Both? Factors Related to Level of Hospital Health Information Exchange.

PubMed

Lin, Sunny C; Everson, Jordan; Adler-Milstein, Julia

2018-02-28

To assess whether the level of health information exchange (HIE) in U.S. hospitals is related to technology capabilities, incentives to exchange, or both. A total of 1,812 hospitals attesting to stage 2 of Medicare's Meaningful Use Incentive Program through April 2016. Hospital-level, multivariate OLS regression with state fixed effects was used to analyze the relationship between technology capability and incentives measures, and percent of care transitions with summary of care records (SCRs) sent electronically to subsequent providers. Stage 2 hospitals reported sending SCRs electronically for an average of 41 percent (median = 33 percent) of transitions. HIE level is related to four capability measures, one incentive measure, and one measure that is related to both capability and incentive. Percent of transitions with SCRs sent electronically was 3 percentage points higher (95 percent CI: 0.1-5.1) for hospitals with a third-party HIE vendor, 3 percentage points higher (95 percent CI: 0.5-5.4) for hospitals with an EHR vendor as their HIE vendor, and 3 percentage points higher (95 percent CI: 0.4-5.4) for hospitals that automatically alert primary care providers. The direction and statistical significance of the relationships between specific EHR vendor and electronic SCR transmission level varied by vendor. Nonprofits and government hospitals performed 5 percentage points higher (95 percent CI: 1.5-9.1) and 8 percentage points higher (95 percent CI: 3.4-12.3) than for-profits. Hospitals in systems performed 3 percentage points higher (95 percent CI: 0.8-6.1). The overall level of HIE is low, with hospitals sending an SCR electronically for less than half of patient transitions. Specific hospital characteristics related to both technology capabilities and incentives were associated with higher levels of HIE. © Health Research and Educational Trust.

Effects of Individual Physician-Level and Practice-Level Financial Incentives on Hypertension Care: A Cluster Randomized Trial

PubMed Central

Petersen, Laura A.; Simpson, Kate; Pietz, Kenneth; Urech, Tracy H.; Hysong, Sylvia J.; Profit, Jochen; Conrad, Douglas A.; Dudley, R. Adams; Woodard, LeChauncy D.

2014-01-01

Importance Pay for performance is intended to align incentives to promote high quality care, but results have been contradictory. Objective To test the effect of explicit financial incentives to reward guideline-recommended hypertension care. Design, Setting, and Participants Cluster randomized controlled trial of 12 Veterans Affairs hospital-based outpatient clinics with five performance periods and a 12-month washout. We enrolled 83 primary care physicians and 42 non-physician personnel (e.g., nurses, pharmacists) working with physicians to deliver hypertension care. Interventions Clinics randomized to one of four groups: physician-level (individual) incentives; practice-level incentives; individual- plus practice-level incentives (combined); or none. Intervention participants received up to five payments every four months; all participants could access feedback reports. Main outcome measures For each four-month period, the number of hypertensive patients among a random sample who achieved guideline-recommended blood pressure thresholds or received an appropriate response to uncontrolled blood pressure; and/or been prescribed guideline-recommended medications and the number who developed hypotension. Results Mean (standard deviation) total payments over the study were $4,270 ($459), $2,672 ($153), and $1,648 ($248) for the combined, individual, and practice-level interventions, respectively. The adjusted change over the study in patients meeting the combined blood pressure/appropriate response measure was 8.84 percentage points (95% confidence interval [CI], 4.20–11.80) for the individual-level, 3.70 (95% CI, 0.24–7.68) for the practice-level, 5.54 (95% CI, 1.92–9.52) for the combined, and 0.47 (95% CI, −3.12–4.04) for the control groups. For medications, the change was 9.07 (95% CI, 4.52–13.44), 4.98 (95% CI, 0.64–10.08), 7.26 (95% CI, 2.92–12.48), and 4.35 (95% CI, −0.28–9.28) percentage points, respectively. The adjusted estimated difference in the change between the proportion of patients with blood pressure control/appropriate response for individual incentive and control groups was 8.36 percentage points (95% CI, 2.40–13.00; P=.005). Use of guideline-recommended medications did not significantly change compared to controls, nor did the incidence of hypotension. The effect of the incentive was not sustained after a washout. Conclusions and Relevance Individual financial incentives, but not practice-level or combined incentives, resulted in greater blood pressure control or appropriate response to uncontrolled blood pressure; none of the incentives resulted in greater use of guideline-recommended medications or increased incidence of hypotension compared to controls. Further research is needed to understand the factors that contributed to our findings. Trial registration NCT00302718; www.clinicaltrials.gov PMID:24026599

Incentive Processing in Persistent Disruptive Behavior and Psychopathic Traits: A Functional Magnetic Resonance Imaging Study in Adolescents.

PubMed

Cohn, Moran D; Veltman, Dick J; Pape, Louise E; van Lith, Koen; Vermeiren, Robert R J M; van den Brink, Wim; Doreleijers, Theo A H; Popma, Arne

2015-11-01

Children with early-onset disruptive behavior disorder (DBD), especially those with callous-unemotional traits, are at risk of developing persistent and severe adult antisocial behavior. One possible underlying mechanism for persistence is deficient reward and loss sensitivity, i.e., deficient incentive processing. However, little is known about the relation between deficient incentive processing and persistence of antisocial behavior into adulthood or its relation with callous-unemotional and other psychopathic traits. In this study, we investigate the relationship between the neural correlates of incentive processing and both DBD persistence and psychopathic traits. In a sample of 128 adolescents (mean age 17.7) with a history of criminal offending before age 12, functional magnetic resonance imaging was performed during a monetary incentive delay task designed to assess neural responses during incentive processing. Neural activation during incentive processing was then associated with DBD persistence and psychopathic traits, measured with the Youth Psychopathic Traits Inventory. Compared with both healthy control subjects and youths who had desisted from DBD, persistent DBD subjects showed lower neural responses in the ventral striatum during reward outcomes and higher neural responses in the amygdala during loss outcomes. Callous-unemotional traits were related to lower neural responses in the amygdala during reward outcomes, while other psychopathic traits were not related to incentive processing. In the current study, aberrant incentive processing is related to persistence of childhood antisocial behavior into late adolescence and to callous-unemotional traits. This mechanism may underlie treatment resistance in a subgroup of antisocial youth and provide a target for intervention. Copyright © 2015 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.

Putting out the welcome mat-targeting outreach efforts under the Affordable Care Act: Evidence from the Minnesota Community Application Agent Program.

PubMed

Dybdal, Kristin; Blewett, Lynn A; Pintor, Jessie Kemmick; Johnson, Kelli

2015-01-01

An evaluation of the Minnesota Community Application Agent (MNCAA) Program was conducted for the MN Minnesota Department of Human Services and funded by the Health Resources and Services Administration's State Health Access Program grant. The MNCAA evaluation assessed effectiveness in reaching disparate populations, explored overall program value, and sought lessons applicable to the Navigator programs required under the Affordable Care Act. Mixed-methods approach using quantitative analysis of tracking and payment data and interviews with key informants to elicit "lessons learned" about the MNCAA program. The MNCAA program offers incentive payments and technical assistance to community partner organizations that assist individuals in applying for public health care coverage. A total of 140 unique community organizations participated in the MNCAA program in 2008 to 2012. Outreach staff and directors from participating MNCAAs and state/local government officials were interviewed. The article highlights a strategy for targeting outreach to individuals eligible for Medicaid coverage or subsidies under the Affordable Care Act by presenting evaluation findings from a unique outreach program to increase access to care for vulnerable populations in Minnesota. Almost two-thirds of applicants were successfully enrolled but lengthy waiting periods persisted. Seventy percent of applications came from health care organizations. Only 13% of applicants assisted by MNCAAs were new to public health care programs. Most MNCAAs believed that the incentive payment-$25 per successful enrollee-was insufficient. Significant expertise in enrolling individuals in public health care programs exists within a core group of community organizations. Incentives to leverage the capacity of community organizations must be accompanied by recruiting and training. Outreach providers and navigators also need timely access to client information. More investment in financial incentives will be required.

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

Barbose, Galen; Wiser, Ryan; Bolinger, Mark

Some stakeholders continue to voice concerns about the performance of customer-sited photovoltaic (PV) systems, particularly because these systems typically receive financial support through ratepayer- or publicly-funded programs. Although much remains to be understood about the extent and specific causes of poor PV system performance, several studies of the larger programs and markets have shed some light on the issue. An evaluation of the California Energy Commission (CEC)'s Emerging Renewables Program, for example, found that 7% of systems, in a sample of 95, had lower-than-expected power output due to shading or soiling (KEMA 2005). About 3% of a larger sample ofmore » 140 systems were not operating at all or were operating well below expected output, due to failed equipment, faulty installation workmanship, and/or a lack of basic maintenance. In a recent evaluation of the other statewide PV incentive program in California, the Self-Generation Incentive Program, 9 of 52 projects sampled were found to have annual capacity factors less than 14.5%, although reasons for these low capacity factors generally were not identified (Itron 2005). Studies of PV systems in Germany and Japan, the two largest PV markets worldwide, have also revealed some performance problems associated with issues such as shading, equipment and installation defects, inverter failure, and deviations from module manufacturers' specifications (Otani et al. 2004, Jahn & Nasse 2004). Although owners of PV systems have an inherent incentive to ensure that their systems perform well, many homeowners and building operators may lack the necessary information and expertise to carry out this task effectively. Given this barrier, and the responsibility of PV incentive programs to ensure that public funds are prudently spent, these programs should (and often do) play a critical role in promoting PV system performance. Performance-based incentives (PBIs), which are based on actual energy production rather than the rated capacity of the modules or system, are often suggested as one possible strategy. Somewhat less recognized are the many other program design options also available, each with its particular advantages and disadvantages. To provide a point of reference for assessing the current state of the art, and to inform program design efforts going forward, we examine the approaches to encouraging PV system performance - including, but not limited to, PBIs - used by 32 prominent PV incentive programs in the U.S. (see Table 1).1 We focus specifically on programs that offer an explicit subsidy payment for customer-sited PV installations. PV support programs that offer other forms of financial support or that function primarily as a mechanism for purchasing renewable energy credits (RECs) through energy production-based payments are outside the scope of our review.2 The information presented herein is derived primarily from publicly available sources, including program websites and guidebooks, programs evaluations, and conference papers, as well as from a limited number of personal communications with program staff. The remainder of this report is organized as follows. The next section presents a simple conceptual framework for understanding the issues that affect PV system performance and provides an overview of the eight general strategies to encourage performance used among the programs reviewed in this report. The subsequent eight sections discuss in greater detail each of these program design strategies and describe how they have been implemented among the programs surveyed. Based on this review, we then offer a series of recommendations for how PV incentive programs can effectively promote PV system performance.« less

Synthetic fuels: an industry struggles to be born amidst the perils of techno-econo-politics

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

Heyman, M.

1976-04-01

Despite active planning for a variety of large-scale synthetic fuels projects and some encouraging technical achievements, most proposals have become bogged down, and disheartened supporters are reluctant to proceed further until the economic, environmental, and political atmosphere clears up. The top-level study group urged a variety of federal financial incentives be provided to spur construction and operation of twelve to 15 synthetic fuel first-of-a-kind ''commercial demonstration'' projects. While hopefully contributing a daily 350,000 barrels of oil equivalent by the middle of the next decade, a prime justification for embarking on the commercialization program would be to provide specific environmental, economic,more » and technical information that is currently lacking. The task force specifically pushed for: loan guarantees of up to 75 percent of project cost for high-Btu pipeline gas from coal, loan guarantees for as much as 50 percent of project cost for shale oil, syncrude, and unregulated electric utility or industrial fuels along with price supports; construction grants of up to 50 percent of project costs for regulated utility and industrial fuels; and a maximum of 75 percent in loan guarantees for production of liquids and gases from biomass. Direct combustion of solid wastes for energy recovery was considered inappropriate for inclusion in the program. That particular industry was viewed by the task force as already on its way in response to urban needs. Industry and congressional responses to the incentives are reviewed. (MCW)« less

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

Neill, Robert H.

Since all efforts to date to dispose of HLW in the US have been unsuccessful, the following specific actions need to be taken if we are serious about such disposal: - The requirement in the EPA environmental radiation protection standards to predict the behavior of these unwanted residuals for one million years is meaningless. The Standards must be revisited. - Characterize two sites. There are myriad ways a site can be found to be unacceptable. Additionally, the existing HLW inventory requires a second repository. - Congress should specify incentives to states under consideration for a site. Perhaps 5% of totalmore » cost would be appropriate. - An independent technical review group should be established in such states to evaluate a proposed repository similar to the New Mexico Environmental Evaluation Group (EEG) for the WIPP Project because the state's interests are not necessarily the same as DOE's. - Acceptance or rejection of a proposed site should be based on technical issues, not social ones. Professionals in this field should present papers identifying the merits of HLW disposal in their own state. The scarcity of such research suggests Not In My Back Yard (NIMBY) syndrome. - Medical diagnostic ionizing radiation exposure to the US public is now 8,000 times greater than radiation exposure from nuclear energy. People accept this believing the benefits outweigh any risks. A major effort needs to focus on both benefits as well as risks of radioactive waste disposal. - DOE needs to announce preferences of host rock formations, incentives for states, and potential consequences should we fail to act. (author)« less

Value-Based Payment Reform and the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015: A Primer for Plastic Surgeons.

PubMed

Squitieri, Lee; Chung, Kevin C

2017-07-01

In 2015, the U.S. Congress passed the Medicare Access and Children's Health Insurance Program Reauthorization Act, which effectively repealed the Centers for Medicare and Medicaid Services sustainable growth rate formula and established the Centers for Medicare and Medicaid Services Quality Payment Program. The Medicare Access and Children's Health Insurance Program Reauthorization Act represents an unparalleled acceleration toward value-based payment models and a departure from traditional volume-driven fee-for-service reimbursement. The Quality Payment Program includes two paths for provider participation: the Merit-Based Incentive Payment System and Advanced Alternative Payment Models. The Merit-Based Incentive Payment System pathway replaces existing quality reporting programs and adds several new measures to create a composite performance score for each provider (or provider group) that will be used to adjust reimbursed payment. The advanced alternative payment model pathway is available to providers who participate in qualifying Advanced Alternative Payment Models and is associated with an initial 5 percent payment incentive. The first performance period for the Merit-Based Incentive Payment System opens January 1, 2017, and closes on December 31, 2017, and is associated with payment adjustments in January of 2019. The Centers for Medicare and Medicaid Services estimates that the majority of providers will begin participation in 2017 through the Merit-Based Incentive Payment System pathway, but aims to have 50 percent of payments tied to quality or value through Advanced Alternative Payment Models by 2018. In this article, the authors describe key components of the Medicare Access and Children's Health Insurance Program Reauthorization Act to providers navigating through the Quality Payment Program and discuss how plastic surgeons may optimize their performance in this new value-based payment program.

Small physician practices in new york needed sustained help to realize gains in quality from use of electronic health records.

PubMed

Ryan, Andrew M; Bishop, Tara F; Shih, Sarah; Casalino, Lawrence P

2013-01-01

The 2009 American Recovery and Reinvestment Act spurred adoption of electronic health records (EHRs) in the United States, through such measures as financial incentives to providers through Medicare and Medicaid and regional extension centers, which provide ongoing technical assistance to practices. Yet the relationship between EHR adoption and quality of care remains poorly understood. We evaluated the early effects on quality of the Primary Care Information Project, which provides subsidized EHRs and technical assistance to primary care practices in underserved neighborhoods in New York City, using the regional extension center model. We found that just general participation in, or exposure to, the project was not enough to improve quality of care. It took sustained exposure on the part of these practices and technical assistance to them before they demonstrated improvement on measures of care most likely to be affected by the use of electronic health records, such as cancer screenings and care for patients with diabetes. Participating in the Primary Care Information Project for nine or more months was associated with significantly improved quality, but only for this limited group of quality measures and only for physicians receiving extensive technical assistance.

Horses or unicorns: can paying for performance make quality competition routine?

PubMed

Sage, William M; Kalyan, Dev N

2006-06-01

The competitive benefits of pay-for-performance (P4P) financial incentives are widely assumed. These incentives can affect health care through several mechanisms, however, not all of which involve competition. This insight has three implications. First, federal antitrust enforcement should continue to scrutinize P4P arrangements. Second, government needs to play a larger role in P4P than through antitrust oversight. Third, widespread enthusiasm for a particular health policy reform does not relieve policy makers of the obligation to understand its theoretical basis.

Using Patient-Reported Information to Improve Clinical Practice.

PubMed

Schlesinger, Mark; Grob, Rachel; Shaller, Dale

2015-12-01

To assess what is known about the relationship between patient experience measures and incentives designed to improve care, and to identify how public policy and medical practices can promote patient-valued outcomes in health systems with strong financial incentives. Existing literature (gray and peer-reviewed) on measuring patient experience and patient-reported outcomes, identified from Medline and Cochrane databases; evaluations of pay-for-performance programs in the United States, Europe, and the Commonwealth countries. We analyzed (1) studies of pay-for-performance, to identify those including metrics for patient experience, and (2) studies of patient experience and of patient-reported outcomes to identify evidence of influence on clinical practice, whether through public reporting or private reporting to clinicians. First, we identify four forms of "patient-reported information" (PRI), each with distinctive roles shaping clinical practice: (1) patient-reported outcomes measuring self-assessed physical and mental well-being, (2) surveys of patient experience with clinicians and staff, (3) narrative accounts describing encounters with clinicians in patients' own words, and (4) complaints/grievances signaling patients' distress when treatment or outcomes fall short of expectations. Because these forms vary in crucial ways, each must be distinctively measured, deployed, and linked with financial incentives. Second, although the literature linking incentives to patients experience is limited, implementing pay-for-performance systems appears to threaten certain patient-valued aspects of health care. But incentives can be made compatible with the outcomes patients value if: (a) a sufficient portion of incentives is tied to patient-reported outcomes and experiences, (b) incentivized forms of PRI are complemented by other forms of patient feedback, and (c) health care organizations assist clinicians to interpret and respond to PRI. Finally, we identify roles for the public and private sectors in financing PRI and orchestrating an appropriate balance among its four forms. Unless public policies are attentive to patients' perspectives, stronger financial incentives for clinicians can threaten aspects of care that patients most value. Certain policy parameters are already clear, but additional research is required to clarify how best to collect patient narratives in varied settings, how to report narratives to consumers in conjunction with quantified metrics, and how to promote a "culture of learning" at the practice level that incorporates patient feedback. © Health Research and Educational Trust.

Focus on Teacher Pay and Incentives: Recent Legislative Actions and Update on Salary Averages. Challenge to Lead

ERIC Educational Resources Information Center

Gaines, Gale F.

2004-01-01

Is your state making progress toward having a high-quality teacher in every classroom? How will you know? One indicator of progress in the Challenge to Lead goals refers to teacher compensation: "Salaries, benefits and incentives are competitive in the marketplace. They are aimed at recognized expertise, student performance, state needs and taking…

No Evidence That Incentive Pay for Teacher Teams Improves Student Outcomes: Results from a Randomized Trial. Research Brief

ERIC Educational Resources Information Center

Adamson, David M.

2012-01-01

Researchers examined whether rewarding teams of teachers for student performance had an effect on student achievement or teacher practices or attitudes in a demonstration project in Round Rock, Texas. They found that the intervention had no effect in any of these areas. Students taught by teacher teams who were offered incentives scored slightly…

Making Teacher Incentives Work: Lessons from North Carolina's Teacher Bonus Program. Education Outlook. No. 5

ERIC Educational Resources Information Center

Ahn, Thomas; Vigdor, Jacob L.

2011-01-01

North Carolina has operated one of the country's largest pay-for-performance teacher-bonus programs since the late 1990s. New research shows that a North Carolina-style incentive-pay program has the potential to improve student learning by encouraging teachers to exert more effort on the job. The North Carolina model avoids three pitfalls…

WWC Quick Review of the Report "Teacher Pay for Performance: Experimental Evidence from the Project on Incentives in Teaching"

ERIC Educational Resources Information Center

What Works Clearinghouse, 2011

2011-01-01

The study examined whether offering financial incentives to teachers of fifth- through eighth-grade math students improved their students' achievement on the math section of the Tennessee Comprehensive Assessment Program. The study took place in the Metropolitan Nashville Public School District during the 2006-07 through 2008-09 school years. It…

Green Carrots: A Survey of State Use of Fiscal Incentives for Academic Quality. ASHE Annual Meeting Paper.

ERIC Educational Resources Information Center

Holland, Barbara A.; Berdahl, Robert O.

This paper presents data from a 1989 survey of 48 state higher education executive officers regarding the use of fiscal enhancement programs as a strategy to influence higher education performance. The paper reports on the purposes and objectives most often funded through specific incentives, and on the key advantages and disadvantages of this…

The Impact of Changing Financial Work Incentives on the Earnings of Social Security Disability Insurance (SSDI) Beneficiaries

ERIC Educational Resources Information Center

Weathers, Robert R., II; Hemmeter, Jeffrey

2011-01-01

SSDI beneficiaries lose their entire cash benefit if they perform work that is substantial gainful activity (SGA) after using Social Security work incentive programs. The complete loss of benefits might be a work disincentive for beneficiaries. We report results from a pilot project that replaces the complete loss of benefits with a gradual…

Michigan's fee-for-value physician incentive program reduces spending and improves quality in primary care.

PubMed

Lemak, Christy Harris; Nahra, Tammie A; Cohen, Genna R; Erb, Natalie D; Paustian, Michael L; Share, David; Hirth, Richard A

2015-04-01

As policy makers and others seek to reduce health care cost growth while improving health care quality, one approach gaining momentum is fee-for-value reimbursement. This payment strategy maintains the traditional fee-for-service arrangement but includes quality and spending incentives. We examined Blue Cross Blue Shield of Michigan's Physician Group Incentive Program, which uses a fee-for-value approach focused on primary care physicians. We analyzed the program's impact on quality and spending from 2008 to 2011 for over three million beneficiaries in over 11,000 physician practices. Participation in the incentive program was associated with approximately 1.1 percent lower total spending for adults (5.1 percent lower for children) and the same or improved performance on eleven of fourteen quality measures over time. Our findings contribute to the growing body of evidence about the potential effectiveness of models that align payment with cost and quality performance, and they demonstrate that it is possible to transform reimbursement within a fee-for-service framework to encourage and incentivize physicians to provide high-quality care, while also reducing costs. Project HOPE—The People-to-People Health Foundation, Inc.

Reports of unintended consequences of financial incentives to improve management of hypertension.

PubMed

Hysong, Sylvia J; SoRelle, Richard; Broussard Smitham, Kristen; Petersen, Laura A

2017-01-01

Given the increase in financial-incentive programs nationwide, many physicians and physician groups are concerned about potential unintended consequences of providing financial incentives to improve quality of care. However, few studies examine whether actual unintended consequences result from providing financial incentives to physicians. We sought to document the extent to which the unintended consequences discussed in the literature were observable in a randomized clinical trial (RCT) of financial incentives. We conducted a qualitative observational study nested within a larger RCT of financial incentives to improve hypertension care. We conducted 30-minute telephone interviews with primary care personnel at facilities participating in the RCT housed at12 geographically dispersed Veterans Affairs Medical Centers nationwide. Participants answered questions about unintended effects, clinic team dynamics, organizational impact on care delivery, study participation. We employed a blend of inductive and deductive qualitative techniques for analysis. Sixty-five participants were recruited from RCT enrollees and personnel not enrolled in the larger RCT, plus one primary care leader per site. Emergent themes included possible patient harm, emphasis on documentation over improving care, reduced professional morale, and positive spillover. All discussions of unintended consequences involving patient harm were only concerns, not actual events. Several unintended consequences concerned ancillary initiatives for quality improvement (e.g., practice guidelines and performance measurement systems) rather than financial incentives. Many unintended consequences of financial incentives noted were either only concerns or attributable to ancillary quality-improvement initiatives. Actual unintended consequences included improved documentation of care without necessarily improving actual care, and positive unintended consequences. Clinicaltrials.gov Identifier: NCT00302718.

Behavioural incentive interventions for health behaviour change in young people (5-18 years old): A systematic review and meta-analysis.

PubMed

Corepal, Rekesh; Tully, Mark A; Kee, Frank; Miller, Sarah J; Hunter, Ruth F

2018-05-01

Physical inactivity, an unhealthy diet, smoking, and alcohol consumption are key determinants of morbidity and mortality. These health behaviours often begin at a young age and track into adulthood, emphasising a need for interventions in children and young people. Previous research has demonstrated the potential effectiveness of behavioural incentive (BI) interventions in adults. However, little is known about their effectiveness in children and adolescents. Eight bibliographic databases were searched. Eligibility criteria included controlled trials using behavioural incentives (rewards provided contingent on successful performance of the target behaviour) as an intervention component for health behaviour change in children and adolescents. Intervention effects (standardised mean differences or odds ratios) were calculated and pooled by health behaviour, using a random effects model. Twenty-two studies were included (of n = 8392 identified), 19 of which were eligible for meta-analysis: physical activity (n = 8); healthier eating (n = 3); and smoking (n = 8). There was strong evidence that behavioural incentives may encourage healthier eating behaviours, some evidence that behavioural incentives were effective for encouraging physical activity behaviour, and limited evidence to support the use of behavioural incentives for smoking cessation and prevention in adolescents. Findings suggest that behavioural incentives may encourage uptake and initiation of healthy eating and physical activity in young people. However, this is a limited evidence base and a wide range of incentive designs have yet to be explored. Future research should further investigate the acceptability of these intervention approaches for young people. Copyright © 2018 Elsevier Inc. All rights reserved.

Combining Theory-Driven Evaluation and Causal Loop Diagramming for Opening the ‘Black Box’ of an Intervention in the Health Sector: A Case of Performance-Based Financing in Western Uganda

PubMed Central

Holvoet, Nathalie; Criel, Bart

2017-01-01

Increased attention on “complexity” in health systems evaluation has resulted in many different methodological responses. Theory-driven evaluations and systems thinking are two such responses that aim for better understanding of the mechanisms underlying given outcomes. Here, we studied the implementation of a performance-based financing intervention by the Belgian Technical Cooperation in Western Uganda to illustrate a methodological strategy of combining these two approaches. We utilized a systems dynamics tool called causal loop diagramming (CLD) to generate hypotheses feeding into a theory-driven evaluation. Semi-structured interviews were conducted with 30 health workers from two districts (Kasese and Kyenjojo) and with 16 key informants. After CLD, we identified three relevant hypotheses: “success to the successful”, “growth and underinvestment”, and “supervision conundrum”. The first hypothesis leads to increasing improvements in performance, as better performance leads to more incentives, which in turn leads to better performance. The latter two hypotheses point to potential bottlenecks. Thus, the proposed methodological strategy was a useful tool for identifying hypotheses that can inform a theory-driven evaluation. The hypotheses are represented in a comprehensible way while highlighting the underlying assumptions, and are more easily falsifiable than hypotheses identified without using CLD. PMID:28869518

Road simulation for four-wheel vehicle whole input power spectral density

NASA Astrophysics Data System (ADS)

Wang, Jiangbo; Qiang, Baomin

2017-05-01

As the vibration of running vehicle mainly comes from road and influence vehicle ride performance. So the road roughness power spectral density simulation has great significance to analyze automobile suspension vibration system parameters and evaluate ride comfort. Firstly, this paper based on the mathematical model of road roughness power spectral density, established the integral white noise road random method. Then in the MATLAB/Simulink environment, according to the research method of automobile suspension frame from simple two degree of freedom single-wheel vehicle model to complex multiple degrees of freedom vehicle model, this paper built the simple single incentive input simulation model. Finally the spectrum matrix was used to build whole vehicle incentive input simulation model. This simulation method based on reliable and accurate mathematical theory and can be applied to the random road simulation of any specified spectral which provides pavement incentive model and foundation to vehicle ride performance research and vibration simulation.

Effect of preoperative incentive spirometry on fentanyl-induced cough: a prospective, randomized, controlled study.

PubMed

Goyal, Vipin Kumar; Bhargava, Suresh Kumar; Baj, Birbal

2017-10-01

Fentanyl-induced cough (FIC) has a reported incidence of 13-65% on induction of anesthesia. Incentive spirometry (IS) creates forceful inspiration, while stretching pulmonary receptors. We postulated that spirometry just before the fentanyl (F) bolus would decrease the incidence and severity of FIC. This study enrolled 200 patients aged 18-60 years and with American Society of Anesthesiologists status I or II. The patients were allocated to two groups of 100 patients each depending on whether they received preoperative incentive spirometry before fentanyl administration. Patients in the F+IS group performed incentive spirometry 10 times just before an intravenous bolus of 3 µg/kg fentanyl in the operating room. The onset time and number of coughs after fentanyl injection were recorded as primary outcomes. Any significant changes in blood pressure, heart rate, or adverse effects of the drug were recorded as secondary outcomes. Patients in the F+IS group had a significantly lower incidence of FIC than in the F group (6% vs. 26%) (P < 0.05). The severity of cough in the F+IS group was also significantly lower than that in group F (mild, 5 vs. 17; moderate 1 vs. 7; severe, 0 vs. 2) (P < 0.05). The median onset time was comparable in both groups (9 s [range: 6-12 s] in both groups). Preoperative incentive spirometry significantly reduces the incidence and severity of FIC when performed just before fentanyl administration.

Effect of preoperative incentive spirometry on fentanyl-induced cough: a prospective, randomized, controlled study

PubMed Central

Bhargava, Suresh Kumar; Baj, Birbal

2017-01-01

Background Fentanyl-induced cough (FIC) has a reported incidence of 13–65% on induction of anesthesia. Incentive spirometry (IS) creates forceful inspiration, while stretching pulmonary receptors. We postulated that spirometry just before the fentanyl (F) bolus would decrease the incidence and severity of FIC. Methods This study enrolled 200 patients aged 18–60 years and with American Society of Anesthesiologists status I or II. The patients were allocated to two groups of 100 patients each depending on whether they received preoperative incentive spirometry before fentanyl administration. Patients in the F+IS group performed incentive spirometry 10 times just before an intravenous bolus of 3 µg/kg fentanyl in the operating room. The onset time and number of coughs after fentanyl injection were recorded as primary outcomes. Any significant changes in blood pressure, heart rate, or adverse effects of the drug were recorded as secondary outcomes. Results Patients in the F+IS group had a significantly lower incidence of FIC than in the F group (6% vs. 26%) (P < 0.05). The severity of cough in the F+IS group was also significantly lower than that in group F (mild, 5 vs. 17; moderate 1 vs. 7; severe, 0 vs. 2) (P < 0.05). The median onset time was comparable in both groups (9 s [range: 6–12 s] in both groups). Conclusions Preoperative incentive spirometry significantly reduces the incidence and severity of FIC when performed just before fentanyl administration. PMID:29046775

Lead us not into tanktation: a simulation modelling approach to gain insights into incentives for sporting teams to tank.

PubMed

Tuck, Geoffrey N; Whitten, Athol R

2013-01-01

Annual draft systems are the principal method used by teams in major sporting leagues to recruit amateur players. These draft systems frequently take one of three forms: a lottery style draft, a weighted draft, or a reverse-order draft. Reverse-order drafts can create incentives for teams to deliberately under-perform, or tank, due to the perceived gain from obtaining quality players at higher draft picks. This paper uses a dynamic simulation model that captures the key components of a win-maximising sporting league, including the amateur player draft, draft choice error, player productivity, and between-team competition, to explore how competitive balance and incentives to under-perform vary according to league characteristics. We find reverse-order drafts can lead to some teams cycling between success and failure and to other teams being stuck in mid-ranking positions for extended periods of time. We also find that an incentive for teams to tank exists, but that this incentive decreases (i) as uncertainty in the ability to determine quality players in the draft increases, (ii) as the number of teams in the league reduces, (iii) as team size decreases, and (iv) as the number of teams adopting a tanking strategy increases. Simulation models can be used to explore complex stochastic dynamic systems such as sports leagues, where managers face difficult decisions regarding the structure of their league and the desire to maintain competitive balance.

Lead Us Not into Tanktation: A Simulation Modelling Approach to Gain Insights into Incentives for Sporting Teams to Tank

PubMed Central

Tuck, Geoffrey N.; Whitten, Athol R.

2013-01-01

Annual draft systems are the principal method used by teams in major sporting leagues to recruit amateur players. These draft systems frequently take one of three forms: a lottery style draft, a weighted draft, or a reverse-order draft. Reverse-order drafts can create incentives for teams to deliberately under-perform, or tank, due to the perceived gain from obtaining quality players at higher draft picks. This paper uses a dynamic simulation model that captures the key components of a win-maximising sporting league, including the amateur player draft, draft choice error, player productivity, and between-team competition, to explore how competitive balance and incentives to under-perform vary according to league characteristics. We find reverse-order drafts can lead to some teams cycling between success and failure and to other teams being stuck in mid-ranking positions for extended periods of time. We also find that an incentive for teams to tank exists, but that this incentive decreases (i) as uncertainty in the ability to determine quality players in the draft increases, (ii) as the number of teams in the league reduces, (iii) as team size decreases, and (iv) as the number of teams adopting a tanking strategy increases. Simulation models can be used to explore complex stochastic dynamic systems such as sports leagues, where managers face difficult decisions regarding the structure of their league and the desire to maintain competitive balance. PMID:24312243

Dopamine and incentive learning: a framework for considering antipsychotic medication effects.

PubMed

Beninger, Richard J

2006-12-01

Hyperfunction of brain dopamine (DA) systems is associated with psychosis in schizophrenia and the medications used to treat schizophrenia are DA receptor blockers. DA also plays a critical role in incentive learning produced by rewarding stimuli. Using DA as the link, these results suggest that psychosis in schizophrenia can be understood from the point of view of excessive incentive learning. Incentive learning is mediated through the non-declarative memory system and may rely on the striatum or medial prefrontal cortex depending on the task. Typical and atypical antipsychotics differentially affect expression of the immediate early gene c-fos, producing greater activity in the striatum and medial prefrontal cortex, respectively. This led to the hypothesis that performance of schizophrenic patients on tasks that depend on the striatum or medial prefrontal cortex will be differentially affected by their antipsychotic medication. Results from a number of published papers supported this dissociation. Furthermore, the effects of two atypical drugs, clozapine and olanzapine, on c-fos expression were different from another atypical, risperidone that resembles the typical antipsychotics. Similarly, in tests of incentive learning, risperidone acted like the typical antipsychotics. Thus, typical and atypical antipsychotic drugs differed in the types of cognitive performance they affected and, furthermore, members of the atypical class differed in their effects on cognition. It remains the task of researchers and clinicians to sort out the symptoms associated with the endogenous illness from possible iatrogenic symptoms resulting from the antipsychotic medications used to treat schizophrenia.

Toward a Culture of Consequences: Performance-Based Accountability Systems for Public Services.

PubMed

Stecher, Brian M; Camm, Frank; Damberg, Cheryl L; Hamilton, Laura S; Mullen, Kathleen J; Nelson, Christopher; Sorensen, Paul; Wachs, Martin; Yoh, Allison; Zellman, Gail L; Leuschner, Kristin J; Camm, Frank; Stecher, Brian M

2012-01-01

Performance-based accountability systems (PBASs), which link incentives to measured performance as a means of improving services to the public, have gained popularity. While PBASs can vary widely across sectors, they share three main components: goals, incentives, and measures. Research suggests that PBASs influence provider behaviors, but little is known about PBAS effectiveness at achieving performance goals or about government and agency experiences. This study examines nine PBASs that are drawn from five sectors: child care, education, health care, public health emergency preparedness, and transportation. In the right circumstances, a PBAS can be an effective strategy for improving service delivery. Optimum circumstances include having a widely shared goal, unambiguous observable measures, meaningful incentives for those with control over the relevant inputs and processes, few competing interests, and adequate resources to design, implement, and operate the PBAS. However, these conditions are rarely fully realized, so it is difficult to design and implement PBASs that are uniformly effective. PBASs represent a promising policy option for improving the quality of service-delivery activities in many contexts. The evidence supports continued experimentation with and adoption of this approach in appropriate circumstances. Even so, PBAS design and its prospects for success depend on the context in which it will operate. Also, ongoing system evaluation and monitoring are integral components of a PBAS; they inform refinements that improve system functioning over time. Empirical evidence of the effects of performance-based public management is scarce. This article also describes a framework used to evaluate a PBAS. Such a system identifies individuals or organizations that must change their behavior for the performance of an activity to improve, chooses an implicit or explicit incentive structure to motivate these organizations or individuals to change, and then chooses performance measures tailored to inform the incentive structure appropriately. The study focused on systems in the child care, education, health care, public health emergency preparedness, and transportation sectors, mainly in the United States. Analysts could use this framework to seek empirical information in other sectors and other parts of the world. Additional empirical information could help refine existing PBASs and, more broadly, improve decisions on where to initiate new PBASs, how to implement them, and then how to design, manage, and refine them over time.

Performance-based Incentives to Improve Health Status of Mothers and Newborns: What Does the Evidence Show?

PubMed Central

Agarwal, Koki; Askew, Ian; Iriarte, Emma; Morgan, Lindsay; Watson, Julia

2013-01-01

Performance-based incentives (PBIs) aim to counteract weak providers’ performance in health systems of many developing countries by providing rewards that are directly linked to better health outcomes for mothers and their newborns. Translating funding into better health requires many actions by a large number of people. The actions span from community to the national level. While different forms of PBIs are being implemented in a number of countries to improve health outcomes, there has not been a systematic review of the evidence of their impact on the health of mothers and newborns. This paper analyzes and synthesizes the available evidence from published studies on the impact of supply-side PBIs on the quantity and quality of health services for mothers and newborns. This paper reviews evidence from published and grey literature that spans PBI for public-sector facilities, PBI in social insurance reforms, and PBI in NGO contracting. Some initiatives focus on safe deliveries, and others reward a broader package of results that include deliveries. The Evidence Review Team that focused on supply-side incentives for the US Government Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives, reviewed published research reports and papers and added studies from additional grey literature that were deemed relevant. After collecting and reviewing 17 documents, nine studies were included in this review, three of which used before-after designs; four included comparison or control groups; one applied econometric methods to a five-year time series; and one reported results from a large-scale impact evaluation with randomly-assigned intervention and control facilities. The available evidence suggests that incentives that reward providers for institutional deliveries result in an increase in the number of institutional deliveries. There is some evidence that the content of antenatal care can improve with PBI. We found no direct evidence on the impact of PBI on neonatal health services or on mortality of mothers and newborns, although intention of the study was not to document impact on mortality. A number of studies describe approaches to rewarding quality as well as increases in the quantities of services provided, although how quality is defined and monitored is not always clear. Because incentives exist in all health systems, considering how to align the incentives of the many health workers and their supervisors so that they focus efforts on achieving health goals for mothers and newborns is critical if the health system is to perform more effectively and efficiently. A wide range of PBI models is being developed and tested, and there is still much to learn about what works best. Future studies should include a larger focus on rewarding quality and measuring its impact. Finally, more qualitative research to better understand PBI implementation and how various incentive models function in different settings is needed to help practitioners refine and improve their programmes.

Performance-based incentives to improve health status of mothers and newborns: what does the evidence show?

PubMed

Eichler, Rena; Agarwal, Koki; Askew, Ian; Iriarte, Emma; Morgan, Lindsay; Watson, Julia

2013-12-01

Performance-based incentives (PBIs) aim to counteract weak providers' performance in health systems of many developing countries by providing rewards that are directly linked to better health outcomes for mothers and their newborns. Translating funding into better health requires many actions by a large number of people. The actions span from community to the national level. While different forms of PBIs are being implemented in a number of countries to improve health outcomes, there has not been a systematic review of the evidence of their impact on the health of mothers and newborns. This paper analyzes and synthesizes the available evidence from published studies on the impact of supply-side PBIs on the quantity and quality of health services for mothers and newborns. This paper reviews evidence from published and grey literature that spans PBI for public-sector facilities, PBI in social insurance reforms, and PBI in NGO contracting. Some initiatives focus on safe deliveries, and others reward a broader package of results that include deliveries. The Evidence Review Team that focused on supply-side incentives for the US Government Evidence Summit on Enhancing Provision and Use of Maternal Health Services through Financial Incentives, reviewed published research reports and papers and added studies from additional grey literature that were deemed relevant. After collecting and reviewing 17 documents, nine studies were included in this review, three of which used before-after designs; four included comparison or control groups; one applied econometric methods to a five-year time series; and one reported results from a large-scale impact evaluation with randomly-assigned intervention and control facilities. The available evidence suggests that incentives that reward providers for institutional deliveries result in an increase in the number of institutional deliveries. There is some evidence that the content of antenatal care can improve with PBI. We found no direct evidence on the impact of PBI on neonatal health services or on mortality of mothers and newborns, although intention of the study was not to document impact on mortality. A number of studies describe approaches to rewarding quality as well as increases in the quantities of services provided, although how quality is defined and monitored is not always clear. Because incentives exist in all health systems, considering how to align the incentives of the many health workers and their supervisors so that they focus efforts on achieving health goals for mothers and newborns is critical if the health system is to perform more effectively and efficiently. A wide range of PBI models is being developed and tested, and there is still much to learn about what works best. Future studies should include a larger focus on rewarding quality and measuring its impact. Finally, more qualitative research to better understand PBI implementation and how various incentive models function in different settings is needed to help practitioners refine and improve their programmes.

Final Technical Report Power through Policy: "Best Practices" for Cost-Effective Distributed Wind

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

Rhoads-Weaver, Heather; Gagne, Matthew; Sahl, Kurt

2012-02-28

Power through Policy: 'Best Practices' for Cost-Effective Distributed Wind is a U.S. Department of Energy (DOE)-funded project to identify distributed wind technology policy best practices and to help policymakers, utilities, advocates, and consumers examine their effectiveness using a pro forma model. Incorporating a customized feed from the Database of State Incentives for Renewables and Efficiency (DSIRE), the Web-based Distributed Wind Policy Comparison Tool (Policy Tool) is designed to assist state, local, and utility officials in understanding the financial impacts of different policy options to help reduce the cost of distributed wind technologies. The project's final products include the Distributed Windmore » Policy Comparison Tool, found at www.windpolicytool.org, and its accompanying documentation: Distributed Wind Policy Comparison Tool Guidebook: User Instructions, Assumptions, and Case Studies. With only two initial user inputs required, the Policy Tool allows users to adjust and test a wide range of policy-related variables through a user-friendly dashboard interface with slider bars. The Policy Tool is populated with a variety of financial variables, including turbine costs, electricity rates, policies, and financial incentives; economic variables including discount and escalation rates; as well as technical variables that impact electricity production, such as turbine power curves and wind speed. The Policy Tool allows users to change many of the variables, including the policies, to gauge the expected impacts that various policy combinations could have on the cost of energy (COE), net present value (NPV), internal rate of return (IRR), and the simple payback of distributed wind projects ranging in size from 2.4 kilowatts (kW) to 100 kW. The project conducted case studies to demonstrate how the Policy Tool can provide insights into 'what if' scenarios and also allow the current status of incentives to be examined or defended when necessary. The ranking of distributed wind state policy and economic environments summarized in the attached report, based on the Policy Tool's default COE results, highlights favorable market opportunities for distributed wind growth as well as market conditions ripe for improvement. Best practices for distributed wind state policies are identified through an evaluation of their effect on improving the bottom line of project investments. The case studies and state rankings were based on incentives, power curves, and turbine pricing as of 2010, and may not match the current results from the Policy Tool. The Policy Tool can be used to evaluate the ways that a variety of federal and state policies and incentives impact the economics of distributed wind (and subsequently its expected market growth). It also allows policymakers to determine the impact of policy options, addressing market challenges identified in the U.S. DOE's '20% Wind Energy by 2030' report and helping to meet COE targets. In providing a simple and easy-to-use policy comparison tool that estimates financial performance, the Policy Tool and guidebook are expected to enhance market expansion by the small wind industry by increasing and refining the understanding of distributed wind costs, policy best practices, and key market opportunities in all 50 states. This comprehensive overview and customized software to quickly calculate and compare policy scenarios represent a fundamental step in allowing policymakers to see how their decisions impact the bottom line for distributed wind consumers, while estimating the relative advantages of different options available in their policy toolboxes. Interested stakeholders have suggested numerous ways to enhance and expand the initial effort to develop an even more user-friendly Policy Tool and guidebook, including the enhancement and expansion of the current tool, and conducting further analysis. The report and the project's Guidebook include further details on possible next steps. NREL Report No. BK-5500-53127; DOE/GO-102011-3453.« less

Improving response rate and quality of survey data with a scratch lottery ticket incentive

PubMed Central

2012-01-01

Background The quality of data collected in survey research is usually indicated by the response rate; the representativeness of the sample, and; the rate of completed questions (item-response). In attempting to improve a generally declining response rate in surveys considerable efforts are being made through follow-up mailings and various types of incentives. This study examines effects of including a scratch lottery ticket in the invitation letter to a survey. Method Questionnaires concerning oral health were mailed to a random sample of 2,400 adults. A systematically selected half of the sample (1,200 adults) received a questionnaire including a scratch lottery ticket. One reminder without the incentive was sent. Results The incentive increased the response rate and improved representativeness by reaching more respondents with lower education. Furthermore, it reduced item nonresponse. The initial incentive had no effect on the propensity to respond after the reminder. Conclusion When attempting to improve survey data, three issues become important: response rate, representativeness, and item-response. This study shows that including a scratch lottery ticket in the invitation letter performs well on all the three. PMID:22515335

Interface Between Cosmetic and Migraine Surgery.

PubMed

Gfrerer, Lisa; Guyuron, Bahman

2017-10-01

This article describes connections between migraine surgery and cosmetic surgery including technical overlap, benefits for patients, and why every plastic surgeon may consider screening cosmetic surgery patients for migraine headache (MH). Contemporary migraine surgery began by an observation made following forehead rejuvenation, and the connection has continued. The prevalence of MH among females in the USA is 26%, and females account for 91% of cosmetic surgery procedures and 81-91% of migraine surgery procedures, which suggests substantial overlap between both patient populations. At the same time, recent reports show an overall increase in cosmetic facial procedures. Surgical techniques between some of the most commonly performed facial surgeries and migraine surgery overlap, creating opportunity for consolidation. In particular, forehead lift, blepharoplasty, septo-rhinoplasty, and rhytidectomy can easily be part of the migraine surgery, depending on the migraine trigger sites. Patients could benefit from simultaneous improvement in MH symptoms and rejuvenation of the face. Simple tools such as the Migraine Headache Index could be used to screen cosmetic surgery patients for MH. Similarity between patient populations, demand for both facial and MH procedures, and technical overlap suggest great incentive for plastic surgeons to combine both. Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

"Mind the gap!" Evaluation of the performance gap attributable to exception reporting and target thresholds in the new GMS contract: National database analysis.

PubMed

Fleetcroft, Robert; Steel, Nicholas; Cookson, Richard; Howe, Amanda

2008-06-17

The 2003 revision of the UK GMS contract rewards general practices for performance against clinical quality indicators. Practices can exempt patients from treatment, and can receive maximum payment for less than full coverage of eligible patients. This paper aims to estimate the gap between the percentage of maximum incentive gained and the percentage of patients receiving indicated care (the pay-performance gap), and to estimate how much of the gap is attributable respectively to thresholds and to exception reporting. Analysis of Quality Outcomes Framework data in the National Primary Care Database and exception reporting data from the Information Centre from 8407 practices in England in 2005 - 6. The main outcome measures were the gap between the percentage of maximum incentive gained and the percentage of patients receiving indicated care at the practice level, both for individual indicators and a combined composite score. An additional outcome was the percentage of that gap attributable respectively to exception reporting and maximum threshold targets set at less than 100%. The mean pay-performance gap for the 65 aggregated clinical indicators was 13.3% (range 2.9% to 48%). 52% of this gap (6.9% of eligible patients) is attributable to thresholds being set at less than 100%, and 48% to patients being exception reported. The gap was greater than 25% in 9 indicators: beta blockers and cholesterol control in heart disease; cholesterol control in stroke; influenza immunization in asthma; blood pressure, sugar and cholesterol control in diabetes; seizures in epilepsy and treatment of hypertension. Threshold targets and exception reporting introduce an incentive ceiling, which substantially reduces the percentage of eligible patients that UK practices need to treat in order to receive maximum incentive payments for delivering that care. There are good clinical reasons for exception reporting, but after unsuitable patients have been exempted from treatment, there is no reason why all maximum thresholds should not be 100%, whilst retaining the current lower thresholds to provide incentives for lower performing practices.

Incentive Sensitivity as a Behavioral Marker of Clinical Remission From Major Depressive Episode.

PubMed

Mauras, Thomas; Masson, Marc; Fossati, Philippe; Pessiglione, Mathias

2016-06-01

Reduction of goal-directed behaviors is frequently observed in depression and may be linked to dysfunction of incentive motivation process. To investigate whether incentive sensitivity could constitute a behavioral marker of clinical remission in major depression. A handgrip force measurement device was employed to assess the impact of incentive motivation and emotional manipulation on the effort produced by remitted patients (n = 20) compared to matched depressed patients (n = 22) and healthy controls (n = 26). Depressed and remitted patients fulfilled the major depressive disorder DSM-IV criteria for current episode and remission state, respectively. The study was performed between March and July 2013. Relative to patients with acute depression, patients after remission retrieved a normal sensitivity to incentives (t1,40 = 4.18, P < 1.5 × 10-4), but relative to healthy controls, they kept an abnormally high susceptibility to emotional arousal (t1,44 = 2.4, P = .02). Normalization of incentive sensitivity exhibited in the behavioral test was associated with improvement of apathy measured on the clinical scale. Using a simple behavioral paradigm at patients' bedside, we could identify the factors influencing effort production, so as to discriminate remitted patients from both depressed patients and healthy controls. © Copyright 2016 Physicians Postgraduate Press, Inc.

Use of care management practices in small- and medium-sized physician groups: do public reporting of physician quality and financial incentives matter?

PubMed

Alexander, Jeffrey A; Maeng, Daniel; Casalino, Lawrence P; Rittenhouse, Diane

2013-04-01

To examine the effect of public reporting (PR) and financial incentives tied to quality performance on the use of care management practices (CMPs) among small- and medium-sized physician groups. Survey data from The National Study of Small and Medium-sized Physician Practices were used. Primary data collection was also conducted to assess community-level PR activities. The final sample included 643 practices engaged in quality reporting; about half of these practices were subject to PR. We used a treatment effects model. The instrumental variables were the community-level variables that capture the level of PR activity in each community in which the practices operate. (1) PR is associated with increased use of CMPs, but the estimate is not statistically significant; (2) financial incentives are associated with greater use of CMPs; (3) practices' awareness/sensitivity to quality reports is positively related to their use of CMPs; and (4) combined PR and financial incentives jointly affect CMP use to a greater degree than either of these factors alone. Small- to medium-sized practices appear to respond to PR and financial incentives by greater use of CMPs. Future research needs to investigate the appropriate mix and type of incentive arrangements and quality reporting. © Health Research and Educational Trust.

[Incentives to attract and retain the health workforce in rural areas of Peru: a qualitative study].

PubMed

Huicho, Luis; Canseco, Francisco Díez; Lema, Claudia; Miranda, J Jaime; Lescano, Andrés G

2012-04-01

The study aimed to identify the main incentives for attracting and retaining health workers in rural and remote health facilities in Ayacucho, Peru. In-depth interviews were performed with 80 physicians, obstetricians, nurses, and nurse technicians in the poorest areas (20 per group), plus 11 health managers. Ayacucho lacks systematic policies for attracting and retaining human resources. The main incentives, in order of relevance, were higher wages, opportunities for further training, longer/permanent contracts, better infrastructure and medical equipment, and more staff. Interviewees also mentioned improved housing conditions and food, the opportunity to be closer to family, and recognition by the health system. Health workers and policymakers share perceptions on key incentives to encourage work in rural areas. However, there are also singularities to be considered when designing specific strategies. Public initiatives thus need to be monitored and evaluated closely in order to ensure the intended impact.

Incentive relativity in middle aged rats.

PubMed

Justel, N; Mustaca, A; Boccia, M; Ruetti, E

2014-01-24

Response to a reinforcer is affected by prior experience with different reward values of that reward, a phenomenon known as incentive relativity. Two different procedures to study this phenomenon are the incentive downshift (ID) and the consummatory anticipatory negative contrast (cANC), the former is an emotional-cognitive protocol and the latter cognitive one. Aged rodents, as also well described in aged humans, exhibit alterations in cognitive functions. The main goal of this work was to evaluate the effect of age in the incentive' assessment using these two procedures. The results indicated that aged rats had an adequate assessment of the rewards but their performance is not completely comparable to that of young subjects. They recover faster from the ID and they had a cognitive impairment in the cANC. The results are discussed in relation to age-related changes in memory and emotion. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

An Assessment of Causes of PEV Success Across U.S. Metro Areas

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

Zhou, Y.; Santini, D.; Rood, M.

Using 2014 U.S. light duty PEV registrations by make and model, this paper assesses the causes of Plug-in Electric Vehicle (PEV) success across U.S. states focusing on areas that had incentive and utility programs supporting PEV adoption. Market segments investigated were (1) luxury/performance (>$60,000 list price), (2) mid-market ($40-50,000), (3) mass market (<$40.000), and (4) total. States with either exclusive or preferential BEV incentives are a focus. BEV-biased incentives proved to be very effective in promoting mass market BEVs. After controlling for these attributes, case studies for several utility service areas were conducted to gauge whether PEVs were more ormore » less successfully implemented via outreach by those utilities. These investigations suggest ways that utilities can successfully increase PEV registrations, after taking local climate and state incentives into consideration.« less

Duncan Aims to Make Incentives Key Element of ESEA: Education Secretary Weighs Priorities for Law's Renewal

ERIC Educational Resources Information Center

Klein, Alyson

2009-01-01

U.S. Secretary of Education Arne Duncan said last week that he envisions a significant new emphasis on federal incentives for high-performing schools, districts, and states in the renewal of the Elementary and Secondary Education Act (ESEA), expected to be taken up by Congress as early as next year. Duncan said the Department of Education is…

Enhancing Incentive Programs with Proximal Goals and Immediate Feedback: Engineered Labor Standards and Technology Enhancements in Stocker Replenishment

ERIC Educational Resources Information Center

Goomas, David T.; Ludwig, Timothy D.

2007-01-01

Under baseline conditions warehouse stockers (n = 23) could earn incentives if their team performed above the team quota of 18 cases stocked per hour. They were also subject to disciplinary action if they failed to regularly meet individual stocking quotas. In spite of these contingencies the stockers failed to receive bonus payments most of the…

How Do You Take Time? Work-Life Balance Policies versus Neoliberal, Social and Cultural Incentive Mechanisms in Icelandic Higher Education

ERIC Educational Resources Information Center

Smidt, Thomas Brorsen; Pétursdóttir, Gyða Margrét; Einarsdóttir, Þorgerður

2017-01-01

It is suggested that the realization of work-life balance policies at the University of Iceland is compromised by an emphasis on neoliberal notions of growth and performance measurements in the form of new public management strategies. This is sustained by overt and covert incentive mechanisms, which in turn create a range of different gendered…

A Study of the School Principal Labor Market in Arkansas: Implications for Incentive-Based Compensation Policies to Improve Principal Quality

ERIC Educational Resources Information Center

Holley, Marc Jacob

2009-01-01

Improving principal quality in Arkansas may be a partial solution to the public policy problem of low performing public schools. Just as policymakers in other states are beginning to explore incentive-based compensation policies to improve principal quality, education policymakers in Arkansas should look to these policies as a way to align goals…

The complex remuneration of human resources for health in low-income settings: policy implications and a research agenda for designing effective financial incentives.

PubMed

Bertone, Maria Paola; Witter, Sophie

2015-07-28

Human resources for health represent an essential component of health systems and play a key role to accelerate progress towards universal health coverage. Many countries in sub-Saharan Africa face challenges regarding the availability, distribution and performance of health workers, which could be in part addressed by providing effective financial incentives. Based on an overview of the existing literature, the paper highlights the gaps in the existing research in low-income countries exploring the different components of health workers' incomes. It then proposes a novel approach to the analysis of financial incentives and delineates a research agenda, which could contribute to shed light on this topic. The article finds that, while there is ample research that investigates separately each of the incomes health workers may earn (for example, salary, fee-for-service payments, informal incomes, "top-ups" and per diems, dual practice and non-health activities), there is a dearth of studies which look at the health workers' "complex remuneration", that is, the whole of the financial incentives available. Little research exists which analyses simultaneously all revenues of health workers, quantifies the overall remuneration and explores its complexity, its multiple components and their features, as well as the possible interaction between income components. However, such a comprehensive approach is essential to fully comprehend health workers' incentives, by investigating the causes (at individual and system level) of the fragmentation in the income structure and the variability in income levels, as well as the consequences of the "complex remuneration" on motivation and performance. This proposition has important policy implications in terms of devising effective incentive packages as it calls for an active consideration of the role that "complex remuneration" plays in determining recruitment, retention and motivation patterns, as well as, more broadly, the performance of health systems. This paper argues that research focusing on the health workers' "complex remuneration" is critical to address some of the most challenging issues affecting human resources for health. An empirical research agenda is proposed to fill the gap in our understanding.

Neural basis of the undermining effect of monetary reward on intrinsic motivation

PubMed Central

Murayama, Kou; Matsumoto, Madoka; Izuma, Keise; Matsumoto, Kenji

2010-01-01

Contrary to the widespread belief that people are positively motivated by reward incentives, some studies have shown that performance-based extrinsic reward can actually undermine a person's intrinsic motivation to engage in a task. This “undermining effect” has timely practical implications, given the burgeoning of performance-based incentive systems in contemporary society. It also presents a theoretical challenge for economic and reinforcement learning theories, which tend to assume that monetary incentives monotonically increase motivation. Despite the practical and theoretical importance of this provocative phenomenon, however, little is known about its neural basis. Herein we induced the behavioral undermining effect using a newly developed task, and we tracked its neural correlates using functional MRI. Our results show that performance-based monetary reward indeed undermines intrinsic motivation, as assessed by the number of voluntary engagements in the task. We found that activity in the anterior striatum and the prefrontal areas decreased along with this behavioral undermining effect. These findings suggest that the corticobasal ganglia valuation system underlies the undermining effect through the integration of extrinsic reward value and intrinsic task value. PMID:21078974

Neural basis of the undermining effect of monetary reward on intrinsic motivation.

PubMed

Murayama, Kou; Matsumoto, Madoka; Izuma, Keise; Matsumoto, Kenji

2010-12-07

Contrary to the widespread belief that people are positively motivated by reward incentives, some studies have shown that performance-based extrinsic reward can actually undermine a person's intrinsic motivation to engage in a task. This "undermining effect" has timely practical implications, given the burgeoning of performance-based incentive systems in contemporary society. It also presents a theoretical challenge for economic and reinforcement learning theories, which tend to assume that monetary incentives monotonically increase motivation. Despite the practical and theoretical importance of this provocative phenomenon, however, little is known about its neural basis. Herein we induced the behavioral undermining effect using a newly developed task, and we tracked its neural correlates using functional MRI. Our results show that performance-based monetary reward indeed undermines intrinsic motivation, as assessed by the number of voluntary engagements in the task. We found that activity in the anterior striatum and the prefrontal areas decreased along with this behavioral undermining effect. These findings suggest that the corticobasal ganglia valuation system underlies the undermining effect through the integration of extrinsic reward value and intrinsic task value.

Importance-satisfaction analysis for primary care physicians' perspective on EHRs in Taiwan.

PubMed

Ho, Cheng-Hsun; Wene, Hsyien-Chia; Chu, Chi-Ming; Wu, Yi-Syuan; Wang, Jen-Leng

2014-06-06

The Taiwan government has been promoting Electronic Health Records (EHRs) to primary care physicians. How to extend EHRs adoption rate by measuring physicians' perspective of importance and performance of EHRs has become one of the critical issues for healthcare organizations. We conducted a comprehensive survey in 2010 in which a total of 1034 questionnaires which were distributed to primary care physicians. The project was sponsored by the Department of Health to accelerate the adoption of EHRs. 556 valid responses were analyzed resulting in a valid response rate of 53.77%. The data were analyzed based on a data-centered analytical framework (5-point Likert scale). The mean of importance and satisfaction of four dimensions were 4.16, 3.44 (installation and maintenance), 4.12, 3.51 (product effectiveness), 4.10, 3.31 (system function) and 4.34, 3.70 (customer service) respectively. This study provided a direction to government by focusing on attributes which physicians found important but were dissatisfied with, to close the gap between actual and expected performance of the EHRs. The authorities should emphasize the potential advantages in meaningful use and provide training programs, conferences, technical assistance and incentives to enhance the national level implementation of EHRs for primary physicians.

REDD+ emissions estimation and reporting: dealing with uncertainty

NASA Astrophysics Data System (ADS)

Pelletier, Johanne; Martin, Davy; Potvin, Catherine

2013-09-01

The United Nations Framework Convention on Climate Change (UNFCCC) defined the technical and financial modalities of policy approaches and incentives to reduce emissions from deforestation and forest degradation in developing countries (REDD+). Substantial technical challenges hinder precise and accurate estimation of forest-related emissions and removals, as well as the setting and assessment of reference levels. These challenges could limit country participation in REDD+, especially if REDD+ emission reductions were to meet quality standards required to serve as compliance grade offsets for developed countries’ emissions. Using Panama as a case study, we tested the matrix approach proposed by Bucki et al (2012 Environ. Res. Lett. 7 024005) to perform sensitivity and uncertainty analysis distinguishing between ‘modelling sources’ of uncertainty, which refers to model-specific parameters and assumptions, and ‘recurring sources’ of uncertainty, which refers to random and systematic errors in emission factors and activity data. The sensitivity analysis estimated differences in the resulting fluxes ranging from 4.2% to 262.2% of the reference emission level. The classification of fallows and the carbon stock increment or carbon accumulation of intact forest lands were the two key parameters showing the largest sensitivity. The highest error propagated using Monte Carlo simulations was caused by modelling sources of uncertainty, which calls for special attention to ensure consistency in REDD+ reporting which is essential for securing environmental integrity. Due to the role of these modelling sources of uncertainty, the adoption of strict rules for estimation and reporting would favour comparability of emission reductions between countries. We believe that a reduction of the bias in emission factors will arise, among other things, from a globally concerted effort to improve allometric equations for tropical forests. Public access to datasets and methodology used to evaluate reference level and emission reductions would strengthen the credibility of the system by promoting accountability and transparency. To secure conservativeness and deal with uncertainty, we consider the need for further research using real data available to developing countries to test the applicability of conservative discounts including the trend uncertainty and other possible options that would allow real incentives and stimulate improvements over time. Finally, we argue that REDD+ result-based actions assessed on the basis of a dashboard of performance indicators, not only in ‘tonnes CO2 equ. per year’ might provide a more holistic approach, at least until better accuracy and certainty of forest carbon stocks emission and removal estimates to support a REDD+ policy can be reached.

Effects of social incentives on task performance in the elderly.

PubMed

Levendusky, P G

1978-07-01

The performance of 60 elderly volunteers (mean age = 74.5 years) on two cancellation tasks was examined under one of three experimental conditions: social praise, social reproof, or no comment. When compared with the no-comment group, subjects in the reproof condition showed response increments over baseline performance (p less than .05). Praise, when compared with no comment, failed to reach statistical significance. Results are interpreted in terms of the possible negative reinforcement, challenge, or informational properties of reproof. The clear implications from these data are that social incentives may well facilitate behavioral change in the aged and that there is a need for further examination of the effects of this variable.

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.

The INCENTIVE protocol: an evaluation of the organisation and delivery of NHS dental healthcare to patients—innovation in the commissioning of primary dental care service delivery and organisation in the UK

PubMed Central

Pavitt, Sue H; Baxter, Paul D; Brunton, Paul A; Douglas, Gail; Edlin, Richard; Gibson, Barry J; Godson, Jenny; Hall, Melanie; Porritt, Jenny; Robinson, Peter G; Vinall, Karen; Hulme, Claire

2014-01-01

Introduction In England, in 2006, new dental contracts devolved commissioning of dental services locally to Primary Care Trusts to meet the needs of their local population. The new national General Dental Services contracts (nGDS) were based on payment for Units of Dental Activity (UDAs) awarded in three treatment bands based on complexity of care. Recently, contract currency in UK dentistry is evolving from UDAs based on volume and case complexity towards ‘blended contracts’ that include incentives linked with key performance indicators such as quality and improved health outcome. Overall, evidence of the effectiveness of incentive-driven contracting of health providers is still emerging. The INCENTIVE Study aims to evaluate a blended contract model (incentive-driven) compared to traditional nGDS contracts on dental service delivery in practices in West Yorkshire, England. Methods and analysis The INCENTIVE model uses a mixed methods approach to comprehensively evaluate a new incentive-driven model of NHS dental service delivery. The study includes 6 dental surgeries located across three newly commissioned dental practices (blended contract) and three existing traditional practices (nGDS contracts). The newly commissioned practices have been matched to traditional practices by deprivation index, age profile, ethnicity, size of practice and taking on new patients. The study consists of three interlinked work packages: a qualitative study to explore stakeholder perspectives of the new service delivery model; an effectiveness study to assess the INCENTIVE model in reducing the risk of and amount of dental disease and enhance oral health-related quality of life in patients; and an economic study to assess cost-effectiveness of the INCENTIVE model in relation to clinical status and oral health-related quality of life. Ethics and dissemination The study has been approved by NRES Committee London, Bromley. The results of this study will be disseminated at national and international conferences and in international journals. PMID:25231492

Incentive effect on inhibitory control in adolescents with early-life stress: an antisaccade study.

PubMed

Mueller, Sven C; Hardin, Michael G; Korelitz, Katherine; Daniele, Teresa; Bemis, Jessica; Dozier, Mary; Peloso, Elizabeth; Maheu, Francoise S; Pine, Daniel S; Ernst, Monique

2012-03-01

Early-life stress (ES) such as adoption, change of caregiver, or experience of emotional neglect may influence the way in which affected individuals respond to emotional stimuli of positive or negative valence. These modified responses may stem from a direct alteration of how emotional stimuli are coded, and/or the cognitive function implicated in emotion modulation, such as self-regulation or inhibition. These ES effects have been probed on tasks either targeting reward and inhibitory function. Findings revealed deficits in both reward processing and inhibitory control in ES youths. However, no work has yet examined whether incentives can improve automatic response or inhibitory control in ES youths. To determine whether incentives would only improve self-regulated voluntary actions or generalize to automated motoric responses, participants were tested on a mixed eye movement task that included reflex-like prosaccades and voluntary controlled antisaccade eye movements. Seventeen adopted children (10 females, mean age 11.3 years) with a documented history of neglect and 29 typical healthy youths (16 females, mean age 11.9 years) performed the mixed prosaccade/antisaccade task during monetary incentive conditions or during no-incentive conditions. Across both saccade types, ES adolescents responded more slowly than controls. As expected, control participants committed fewer errors on antisaccades during the monetary incentive condition relative to the no-incentive condition. By contrast, ES youths failed to show this incentive-related improvement on inhibitory control. No significant incentive effects were found with prepotent prosaccades trials in either group. Finally, co-morbid psychopathology did not modulate the findings. These data suggest that youths with experience of early stress exhibit deficient modulation of inhibitory control by reward processes, in tandem with a reward-independent deficit in preparation for both automatic and controlled responses. These data may be relevant to interventions in ES youths. Published by Elsevier Ltd.

Establishing sustainable performance-based incentive schemes: views of rural health workers from qualitative research in three sub-Saharan African countries.

PubMed

Yé, M; Aninanya, G A; Sié, A; Kakoko, D C V; Chatio, S; Kagoné, M; Prytherch, H; Loukanova, S; Williams, J E; Sauerborn, R

2014-01-01

Performance-based incentives (PBIs) are currently receiving attention as a strategy for improving the quality of care that health providers deliver. Experiences from several African countries have shown that PBIs can trigger improvements, particularly in the area of maternal and neonatal health. The involvement of health workers in deciding how their performance should be measured is recommended. Only limited information is available about how such schemes can be made sustainable. This study explored the types of PBIs that rural health workers suggested, their ideas regarding the management and sustainability of such schemes, and their views on which indicators best lend themselves to the monitoring of performance. In this article the authors reported the findings from a cross-country survey conducted in Burkina Faso, Ghana and Tanzania. The study was exploratory with qualitative methodology. In-depth interviews were conducted with 29 maternal and neonatal healthcare providers, four district health managers and two policy makers (total 35 respondents) from one district in each of the three countries. The respondents were purposively selected from six peripheral health facilities. Care was taken to include providers who had a management role. By also including respondents from district and policy level a comparison of perspectives from different levels of the health system was facilitated. The data that was collected was coded and analysed with support of NVivo v8 software. The most frequently suggested PBIs amongst the respondents in Burkina Faso were training with per-diems, bonuses and recognition of work done. The respondents in Tanzania favoured training with per-diems, as well as payment of overtime, and timely promotion. The respondents in Ghana also called for training, including paid study leave, payment of overtime and recognition schemes for health workers or facilities. Respondents in the three countries supported the mobilisation of local resources to make incentive schemes more sustainable. There was a general view that it was easier to integrate the cost of non-financial incentives in local budgets. There were concerns about the fairness of such schemes from the provider level in all three countries. District managers were worried about the workload that would be required to manage the schemes. The providers themselves were less clear about which indicators best lent themselves to the purpose of performance monitoring. District managers and policy makers most commonly suggested indicators that were in line with national maternal and neonatal healthcare indicators. The study showed that health workers have considerable interest in performance-based incentive schemes and are concerned about their sustainability. There is a need to further explore the use of non-financial incentives in PBI schemes, as such incentives were considered to stand a greater chance of being integrated into local budgets. Ensuring participation of healthcare providers in the design of such schemes is likely to achieve buy-in and endorsement from the health workers involved. However, input from managers and policy makers is essential to keep expectations realistic and to ensure the indicators selected fit the purpose and are part of routine reporting systems.

Alternative Payment Models in Radiology: The Legislative and Regulatory Roadmap for Reform.

PubMed

Silva, Ezequiel; McGinty, Geraldine B; Hughes, Danny R; Duszak, Richard

2016-10-01

The Medicare Access and CHIP Reauthorization Act (MACRA) replaces the sustainable growth rate with a payment system based on the Merit-Based Incentive Payment System and incentives for alternative payment model participation. It is important that radiologists understand the statutory requirements of MACRA. This includes the nature of the Merit-Based Incentive Payment System composite performance score and its impact on payments. The timeline for MACRA implementation is fairly aggressive and includes a robust effort to define episode groups, which include radiologic services. A number of organizations, including the ACR, are commenting on the structure of MACRA-directed initiatives. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights reserved.

P4P4P: An Agenda for Research on Pay for Performance for Patients

PubMed Central

Volpp, Kevin G.; Pauly, Mark V.; Loewenstein, George; Bangsberg, David

2012-01-01

Unhealthy behaviors are a major cause of poor health outcomes and high health care costs. In this Commentary, we describe an agenda for research to guide broader use of patient-targeted financial incentives either in conjunction with provider-targeted financial incentives (P4P) or in clinical contexts where provider-targeted approaches are unlikely to be effective. We discuss evidence of proven effectiveness and limitations of the existing evidence, reasons for underutilization of these approaches, and options for operationalizing wider use. Patient-targeted incentives have great potential, and systematic testing will help determine how they can best be used to improve population health. PMID:19124872

Motivational incentives modulate age differences in visual perception.

PubMed

Spaniol, Julia; Voss, Andreas; Bowen, Holly J; Grady, Cheryl L

2011-12-01

This study examined whether motivational incentives modulate age-related perceptual deficits. Younger and older adults performed a perceptual discrimination task in which bicolored stimuli had to be classified according to their dominating color. The valent color was associated with either a positive or negative payoff, whereas the neutral color was not associated with a payoff. Effects of incentives on perceptual efficiency and response bias were estimated using the diffusion model (Ratcliff, 1978). Perception of neutral stimuli showed age-related decline, whereas perception of valent stimuli, both positive and negative, showed no age difference. This finding is interpreted in terms of preserved top-down control over the allocation of perceptual processing resources in healthy aging.