The Impact of a Merit-Based Incentive Payment System on Quality of Healthcare: A Framed Field Experiment

24 Pages Posted: 8 Nov 2017 Last revised: 2 Nov 2018

See all articles by Ellen Green

Ellen Green

ASU Health Solutions

Katherine Peterson

Mayo Clinic Hospital - Phoenix; Arizona State University (ASU)

Katherine Markiewicz

Mayo Clinic

Janet O’Brien

Arizona State University, College of Nursing and Health Innovation

Noël Arring

Mayo Clinic

Date Written: November 1, 2017

Abstract

We study the impact of a merit-based incentive payment system on provider behavior in the primary care setting using new experimental methods that leverage healthcare simulations with patient actors. Our approach allows us to exogenously change a provider’s incentives and to directly measure the consequences of alternative payment systems. Within our sample, we find that merit-based incentive payment systems increase the number of the incentivized measures met, but also lower quality of care through unintended effects on adherence to standards of care and patient satisfaction.

Keywords: MACRA, Medicare Access and Chip Reauthorization Act, pay-for-performance, MIPS, Experimental Design, Framed Field Experiment

JEL Classification: I1, C9

Suggested Citation

Green, Ellen and Peterson, Katherine and Markiewicz, Katherine and O’Brien, Janet and Arring, Noël, The Impact of a Merit-Based Incentive Payment System on Quality of Healthcare: A Framed Field Experiment (November 1, 2017). Available at SSRN: https://ssrn.com/abstract=3066257 or http://dx.doi.org/10.2139/ssrn.3066257

Ellen Green (Contact Author)

ASU Health Solutions ( email )

Nursing and Health Innovation Buildings 1 and 2
500 N. 3rd Street
Phoenix, AZ 85004
United States

Katherine Peterson

Mayo Clinic Hospital - Phoenix ( email )

5777 E Mayo Blvd
Phoenix, AZ 85054
United States

Arizona State University (ASU) ( email )

Farmer Building 440G PO Box 872011
Tempe, AZ 85287
United States

Katherine Markiewicz

Mayo Clinic ( email )

200 First Street SW
Rochester, MN (507) 284-2511 55905
United States

Janet O’Brien

Arizona State University, College of Nursing and Health Innovation ( email )

Farmer Building 440G PO Box 872011
Tempe, AZ 85287
United States
6024961415 (Phone)

Noël Arring

Mayo Clinic ( email )

200 First Street SW
Rochester, MN (507) 284-2511 55905
United States

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