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Quality & safety in the literature: July 2019
  1. Jennifer Meddings1,2,3,
  2. Nathan Houchens2,
  3. Ashwin Gupta2
  1. 1 Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
  2. 2 Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
  3. 3 Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor, Michigan, USA
  1. Correspondence to Dr Jennifer Meddings, 2800 Plymouth Road, NCRC Building 16, Room 427W, University of Michigan Medical School, Ann Arbor, MI 48109, USA; meddings{at}

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The term ‘value-based purchasing’ describes programmes implemented by healthcare payers that require a modification of payment for medical care services based on the quality and safety of the care delivered. The overall goal of these programmes is to motivate improved outcomes for patients while also reducing healthcare spending. There has been a recent rapid introduction of value-based purchasing programmes in the USA1 and the UK2–4 in response to growing healthcare costs, increasing recognition of healthcare-associated complication frequency and morbidity and variation in quality and cost of healthcare delivery.5 6 Earlier versions of these programmes involved voluntary participation of facilities competing for additional incentive payments (the proverbial ‘carrot’). More recent versions have evolved to include mandatory participation, requiring data collection and public reporting of various metrics, with the motivating incentive being to avoid the ‘stick’ of substantial reductions in payment and public reputation shaming for poor quality of care.

Value-based purchasing programmes are now common across all healthcare settings, from acute care in hospitals to post-acute care in facilities and at home. These programmes impact all ages of patients, and performance can be assessed and penalised at the level of the facility and/or individual physicians. Programmes have grown in scale through mandatory participation and increasing size of potential financial penalty, and several programmes impact Medicare beneficiaries in the USA.1 With this growth, they now function as large-scale interventions with potential for both positive and negative impacts for patients and healthcare providers. Unlike most other interventions reported in peer-reviewed journals, these value-based purchasing interventions are more commonly developed and implemented without undergoing the same types of institutional review board oversight, piloting and adverse event tracking that other clinical interventions would undergo before large-scale implementation. Instead, they are developed with input from legislature and its consultants as well as …

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  • Funding JM research was supported by an AHRQ grant K08HS019767 from 2010-2015 and is currently supported by AHRQ grants P30HS024385 and R01HS018334 as well as funding from the VA National Center for Patient Safety and the Centers for Disease Prevention and Control. JM research has recently been supported by contracts with the Health Research and Education Trust (HRET) involving the prevention of CAUTI, funded by AHRQ and the Centers for Disease Prevention and Control, and the Centers for Medicare and Medicaid Services. JM was also a recipient of the 2009–2015 National Institutes of Health (NIH) Clinical Loan Repayment Program. JM is a salaried employee of the University of Michigan and the VA Ann Arbor Healthcare System.

  • Competing interests Honoraria: JM has reported receiving honoraria from hospitals and professional societies devoted to complication prevention for lectures and teaching related to prevention and value-based purchasing policies involving catheter-associated urinary tract infection and hospital-acquired pressure ulcers. Intellectual Property/Product Development: JM research involves development of products to improve patient safety by reducing hospital-acquired complications. Her team has a patent issued involving one of these products that aims to reduce urinary catheter associated complications and has recently applied for a patent involving a device to reduce hospital-acquired pressure ulcers. She has no associations with any companies or manufacturers, has no ownership in a commercial entity, and receives no royalties.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.