Hospital Pay for Performance Based on Gain-Sharing

摘要

Techniques for determining payment to a particular health care facility for health care delivery include determining target adverse results rate (ARR) for treatment of a particular range of patient health conditions (RHC). A first actual cost is determined for treatment of the RHC during a first time interval. A first ARR during the first time interval is determined. A second actual cost is determined for treatment of the RHC during a second time interval. A second ARR during the second time interval is determined. It is then determined whether the second actual cost prorated per case (CPC) is less than the first actual CPC and whether the second ARR is not farther from the target ARR. If so, then payments per case to the facility for the RHC are reduced based on a first fraction of the difference between the first actual CPC and the second actual CPC.