WorldWideScience

Sample records for performance-based incentive payment

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

    Science.gov (United States)

    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…

  2. Incentives and provider payment methods.

    Science.gov (United States)

    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.

  3. Countervailing incentives in value-based payment.

    Science.gov (United States)

    Arnold, Daniel R

    2017-09-01

    Payment reform has been at the forefront of the movement toward higher-value care in the U.S. health care system. A common belief is that volume-based incentives embedded in fee-for-service need to be replaced with value-based payments. While this belief is well-intended, value-based payment also contains perverse incentives. In particular, behavioral economists have identified several features of individual decision making that reverse some of the typical recommendations for inducing desirable behavior through financial incentives. This paper discusses the countervailing incentives associated with four behavioral economic concepts: loss aversion, relative social ranking, inertia or status quo bias, and extrinsic vs. intrinsic motivation. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Value affect of construction incentive payments on pavement performance.

    Science.gov (United States)

    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...

  5. 48 CFR 52.232-32 - Performance-Based Payments.

    Science.gov (United States)

    2010-10-01

    ... Contracting Officer, such excess shall be credited as a reduction in the unliquidated performance-based... adjustments. (e) Reduction or suspension of performance-based payments. The Contracting Officer may reduce or... sound and generally accepted accounting principles and practices: (i) Parts, materials, inventories, and...

  6. 48 CFR 32.1007 - Administration and payment of performance-based payments.

    Science.gov (United States)

    2010-10-01

    ... contractor's experience, performance record, reliability, financial strength, and the adequacy of controls... of performance-based payments. 32.1007 Section 32.1007 Federal Acquisition Regulations System FEDERAL ACQUISITION REGULATION GENERAL CONTRACTING REQUIREMENTS CONTRACT FINANCING Performance-Based Payments 32.1007...

  7. 41 CFR 302-14.7 - Are there tax consequences when I receive a home marketing incentive payment?

    Science.gov (United States)

    2010-07-01

    ... 14-HOME MARKETING INCENTIVE PAYMENTS Payment of Incentive to the Employee § 302-14.7 Are there tax..., on the home marketing incentive payment. You will not, however, receive a withholding tax allowance... taxes on the incentive payment. ...

  8. 10 CFR 451.6 - Duration of incentive payments.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 3 2010-01-01 2010-01-01 false Duration of incentive payments. 451.6 Section 451.6 Energy DEPARTMENT OF ENERGY ENERGY CONSERVATION RENEWABLE ENERGY PRODUCTION INCENTIVES § 451.6 Duration of incentive... part with respect to a qualified renewable energy facility for 10 consecutive fiscal years. Such period...

  9. 42 CFR 495.310 - Medicaid provider incentive payments.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Medicaid provider incentive payments. 495.310 Section 495.310 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.310 Medicaid provider incentive...

  10. The Impact of Payment System Design on Tiering Incentives

    OpenAIRE

    Robert Arculus; Jennifer Hancock; Greg Moran

    2012-01-01

    Tiering occurs when an institution does not participate directly in the central payment system but instead settles its payments through an agent. A high level of tiering can be a significant issue for payment system regulators because of the increased credit and concentration risk. This paper explores the impact of payment system design on institutions' incentives to tier using simulation analysis. Some evidence is found to support the hypothesis that the liquidity-saving mechanisms in Austra...

  11. Performance Based Supplementary Payment System at University Hospitals in Turkey

    Directory of Open Access Journals (Sweden)

    Vahit YÝÐÝT

    2017-06-01

    Results: The result of the analysis has revealed that PBSP system encourage physicians who would like to receive financial incentives. PBSP system supports the individual performance, reduces waiting times in patients, increases revenues and decreases expenditures and increases in efficiency of department. However, this payment system increases work load, number of examinations and provokes the conflict among personals. Conclusions: University hospitals are academic institutions that perform important missions such as research, medical education and health services provision. Therefore, PBSP system should be revised so as to encourage performing these missions at university hospitals. There is also shortage of financial resources at the university hospitals. This situation leads to less additional payments to physicians. [J Contemp Med 2017; 7(2.000: 126-131

  12. An index approach to performance-based payments for water quality.

    Science.gov (United States)

    Maille, Peter; Collins, Alan R

    2012-05-30

    In this paper we describe elements of a field research project that presented farmers with economic incentives to control nitrate runoff. The approach used is novel in that payments are based on ambient water quality and water quantity produced by a watershed rather than proxies for water quality conservation. Also, payments are made based on water quality relative to a control watershed, and therefore, account for stochastic fluctuations in background nitrate levels. Finally, the program pays farmers as a group to elicit team behavior. We present our approach to modeling that allowed us to estimate prices for water and resulting payment levels. We then compare these preliminary estimates to the actual values recorded over 33 months of fieldwork. We find that our actual payments were 29% less than our preliminary estimates, due in part to the failure of our ecological model to estimate discharge accurately. Despite this shortfall, the program attracted the participation of 53% of the farmers in the watershed, and resulted in substantial nitrate abatement activity. Given this favorable response, we propose that research efforts focus on implementing field trials of group-level performance-based payments. Ideally these programs would be low risk and control for naturally occurring contamination. Copyright © 2012 Elsevier Ltd. All rights reserved.

  13. Review of performance-based incentives in community-based family planning programmes

    Science.gov (United States)

    Bellows, Nicole M; Askew, Ian; Bellows, Benjamin

    2015-01-01

    Background One strategy for improving family planning (FP) uptake at the community level is the use of performance-based incentives (PBIs), which offer community distributors financial incentives to recruit more users of FP. This article examines the use of PBIs in community-based FP programmes via a literature search of the peer-reviewed and grey literature conducted in April 2013. Results A total of 28 community-based FP programmes in 21 countries were identified as having used PBIs. The most common approach was a sales commission model where distributors received commission for FP products sold, while a referral payment model for long-term methods was also used extensively. Six evaluations were identified that specifically examined the impact of the PBI in community-based FP programmes. Overall, the results of the evaluations are mixed and more research is needed; however, the findings suggest that easy-to-understand PBIs can be successful in increasing the use of FP at the community level. Conclusion For future use of PBIs in community-based FP programmes it is important to consider the ethics of incentivising FP and ensuring that PBIs are non-coercive and choice-enhancing. PMID:25037703

  14. When and why do university managers use publication incentive payments?

    DEFF Research Database (Denmark)

    Opstrup, Niels

    2017-01-01

    in Denmark that use publication incentive payments. Most often it is used when heads of department outside the humanities think it is a good idea to reward scholars financially for publications. In-depth analysis of the cases reveals, however, that department heads cannot only be divided between ‘believers......’ and ‘non-believers’. Almost half expressed confidence in that publication incentive payments motivate researchers to perform better, not because of the monetary reward, but because of the positive feedback signalled by the pay supplement...

  15. 41 CFR 302-14.100 - How should we administer our home marketing incentive payment program?

    Science.gov (United States)

    2010-07-01

    ... reduce your overall relocation costs. You must not make a home marketing incentive payment that exceeds... our home marketing incentive payment program? 302-14.100 Section 302-14.100 Public Contracts and... 14-HOME MARKETING INCENTIVE PAYMENTS Agency Responsibilities § 302-14.100 How should we administer...

  16. 42 CFR 495.104 - Incentive payments to eligible hospitals.

    Science.gov (United States)

    2010-10-01

    ... denominator of the Medicare share fraction using the charity care charges reported on the hospital's Medicare... eligible hospital's charges, not including any charges that are attributable to charity care, divided by... 42 Public Health 5 2010-10-01 2010-10-01 false Incentive payments to eligible hospitals. 495.104...

  17. 5 CFR 575.109 - Payment of recruitment incentives.

    Science.gov (United States)

    2010-01-01

    ... decimal places. For example, a service period covering 39 biweekly pay periods equals 546 days, and 546 days divided by 365 days equals 1.50 years. (c)(1) An authorized agency official may request that OPM... pay a recruitment incentive-(1) As an initial lump-sum payment at the commencement of the service...

  18. Combining auctions and performance-based payments in a forest enrichment field trial in Western Kenya.

    Science.gov (United States)

    Khalumba, Mercelyne; Wünscher, Tobias; Wunder, Sven; Büdenbender, Mirjam; Holm-Müller, Karin

    2014-06-01

    Cost-effectiveness is an important aspect in the assessment of payments for environmental services (PES) initiatives. In participatory field trials with communities in Western Kenya, we combined procurement auctions for forest enrichment contracts with performance-based payments and compared the outcomes with a baseline scenario currently used by the Kenyan Forest Service. Procurement auctions were the most cost-effective. The competitive nature of the auction reduced contracting expenses (provision costs), and the result-oriented payments provided additional incentives to care for the planted seedlings, resulting in their improved survival rates (service quantity). These gains clearly exceeded increases in transaction costs associated with conducting an auction. The number of income-poor auction participants and winners was disproportionately high and local institutional buy-in was remarkably strong. Our participatory approach may, however, require adaptations when conducted at a larger scale. Although the number of contracts we monitored was limited and prohibited the use of statistical tests, our study is one of the first to reveal the benefits of using auctions for PES in developing countries. © 2014 Society for Conservation Biology.

  19. 48 CFR 52.232-28 - Invitation To Propose Performance-Based Payments.

    Science.gov (United States)

    2010-10-01

    ... establishing performance bases and performance-based finance payment amounts). (2) A listing of— (i) The...). As prescribed in FAR 32.1005(b)(2), add the following paragraph (f) to the basic provision: (f) The...

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

    Science.gov (United States)

    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.

  1. A New Availability-Payment Model for Pricing Performance-Based Logistics Contracts

    Science.gov (United States)

    2014-05-01

    Grant number: N00244‐13‐1‐0009 A New “Availability‐ Payment ”  Model  for Pricing Performance‐ Based Logistics Contracts A. KashaniPour, X. Zhu, P...DATE MAY 2014 2. REPORT TYPE 3. DATES COVERED 00-00-2014 to 00-00-2014 4. TITLE AND SUBTITLE A New ’Availability‐ Payment ’ Model for...is how the  payment   model  in the contract  quantifies the contractor’s  performance for awarding incentives  or penalties Discrete‐Event Simulator ut

  2. The Theory of Value-Based Payment Incentives and Their Application to Health Care.

    Science.gov (United States)

    Conrad, Douglas A

    2015-12-01

    To present the implications of agency theory in microeconomics, augmented by behavioral economics, for different methods of value-based payment in health care; and to derive a set of future research questions and policy recommendations based on that conceptual analysis. Original literature of agency theory, and secondarily behavioral economics, combined with applied research and empirical evidence on the application of those principles to value-based payment. Conceptual analysis and targeted review of theoretical research and empirical literature relevant to value-based payment in health care. Agency theory and secondarily behavioral economics have powerful implications for design of value-based payment in health care. To achieve improved value-better patient experience, clinical quality, health outcomes, and lower costs of care-high-powered incentives should directly target improved care processes, enhanced patient experience, and create achievable benchmarks for improved outcomes. Differing forms of value-based payment (e.g., shared savings and risk, reference pricing, capitation, and bundled payment), coupled with adjunct incentives for quality and efficiency, can be tailored to different market conditions and organizational settings. Payment contracts that are "incentive compatible"-which directly encourage better care and reduced cost, mitigate gaming, and selectively induce clinically efficient providers to participate-will focus differentially on evidence-based care processes, will right-size and structure incentives to avoid crowd-out of providers' intrinsic motivation, and will align patient incentives with value. Future research should address the details of putting these and related principles into practice; further, by deploying these insights in payment design, policy makers will improve health care value for patients and purchasers. © Health Research and Educational Trust.

  3. 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.

    Science.gov (United States)

    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.

  4. 41 CFR 302-14.101 - What policies must we establish to govern our home marketing incentive payment program?

    Science.gov (United States)

    2010-07-01

    ... establish to govern our home marketing incentive payment program? 302-14.101 Section 302-14.101 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES 14-HOME MARKETING INCENTIVE PAYMENTS Agency Responsibilities § 302-14.101 What policies...

  5. Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the

    Science.gov (United States)

    2017-05-19

    This final rule finalizes May 20, 2017 as the effective date of the final rule titled "Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR)" originally published in the January 3, 2017 Federal Register. This final rule also finalizes a delay of the applicability date of the regulations at 42 CFR part 512 from July 1, 2017 to January 1, 2018 and delays the effective date of the specific CJR regulations listed in the DATES section from July 1, 2017 to January 1, 2018.

  6. 41 CFR 302-14.103 - What factors should we consider in determining the amount of a home marketing incentive payment?

    Science.gov (United States)

    2010-07-01

    ... intended to reduce your relocation costs. The amount of each home marketing incentive payment you make... consider in determining the amount of a home marketing incentive payment? 302-14.103 Section 302-14.103... TRANSACTION ALLOWANCES 14-HOME MARKETING INCENTIVE PAYMENTS Agency Responsibilities § 302-14.103 What factors...

  7. 41 CFR 302-14.2 - What is the purpose of a home marketing incentive payment?

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 4 2010-07-01 2010-07-01 false What is the purpose of a home marketing incentive payment? 302-14.2 Section 302-14.2 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES 14-HOME MARKETING...

  8. 5 CFR 575.209 - Payment of relocation incentives.

    Science.gov (United States)

    2010-01-01

    ... pay periods equals 546 days, and 546 days divided by 365 days equals 1.50 years. (c)(1) An authorized... pay a relocation incentive— (1) As an initial lump-sum payment at the commencement of the service... employee in a service period may not exceed 25 percent of the annual rate of basic pay of the employee at...

  9. Performance-based financial incentives for diabetes care: an effective strategy?

    Science.gov (United States)

    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.

  10. Effects of Performance-Based Financial Incentives on Work Performance: A Study of Technical-Level Employees in the Private Sector in Sri Lanka

    Science.gov (United States)

    Wickramasinghe, Vathsala; Dabere, Sampath

    2012-01-01

    The objective of the study is to investigate the effect of performance-based financial incentives on work performance. The study hypothesized that the design features of performance-based financial incentive schemes themselves may influence individuals' work performance. For the study, survey methodology was used and 93 technical-level employees…

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

    Science.gov (United States)

    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.

  12. Changing physician incentives for affordable, quality cancer care: results of an episode payment model.

    Science.gov (United States)

    Newcomer, Lee N; Gould, Bruce; Page, Ray D; Donelan, Sheila A; Perkins, Monica

    2014-09-01

    This study tested the combination of an episode payment coupled with actionable use and quality data as an incentive to improve quality and reduce costs. Medical oncologists were paid a single fee, in lieu of any drug margin, to treat their patients. Chemotherapy medications were reimbursed at the average sales price, a proxy for actual cost. Five volunteer medical groups were compared with a large national payer registry of fee-for-service patients with cancer to examine the difference in cost before and after the initiation of the payment change. Between October 2009 and December 2012, the five groups treated 810 patients with breast, colon, and lung cancer using the episode payments. The registry-predicted fee-for-service cost of the episodes cohort was $98,121,388, but the actual cost was $64,760,116. The predicted cost of chemotherapy drugs was $7,519,504, but the actual cost was $20,979,417. There was no difference between the groups on multiple quality measures. Modifying the current fee-for-service payment system for cancer therapy with feedback data and financial incentives that reward outcomes and cost efficiency resulted in a significant total cost reduction. Eliminating existing financial chemotherapy drug incentives paradoxically increased the use of chemotherapy. Copyright © 2014 by American Society of Clinical Oncology.

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

    Science.gov (United States)

    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

  14. Establishing sustainable performance-based incentive schemes: views of rural health workers from qualitative research in three sub-Saharan African countries.

    Science.gov (United States)

    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

  15. The Merit-based Incentive Payment System (MIPS): A Primer for Otolaryngologists.

    Science.gov (United States)

    Rathi, Vinay K; Naunheim, Matthew R; Varvares, Mark A; Holmes, Kenneth; Gagliano, Nancy; Hartnick, Christopher J

    2018-05-01

    Following passage of the 2015 Medicare Access and CHIP Reauthorization Act, most clinicians caring for Medicare Part B patients were required to participate in a new value-based reimbursement system known as the Merit-based Incentive Payment System (MIPS) beginning in 2017. The MIPS adjusts payment rates to providers based on a composite score of performance across 4 categories: quality, advancing care information, clinical practice improvement activities, and resource use. However, factors such as practice size, setting, informational capabilities, and patient population may pose challenges as otolaryngologists endeavor to adapt to this broad-reaching payment reform. Given potential barriers to adoption, otolaryngologists should be aware of several important initiatives to help optimize their performance, including advocacy efforts by the American Academy of Otolaryngology-Head and Neck Surgery, the development of otolaryngology-specific MIPS quality measures, and the launch of a Centers for Medicare & Medicaid Services-qualified otolaryngology clinical data registry to facilitate reporting.

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

    Directory of Open Access Journals (Sweden)

    Maurice Yé

    2016-01-01

    Full Text Available 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.

  17. Medicare incentive payments for meaningful use of electronic health records: accounting and reporting developments.

    Science.gov (United States)

    2012-02-01

    The Healthcare Financial Management Association through its Principles and Practices (P&P) Board publishes issue analyses to provide short-term practical assistance on emerging issues in healthcare financial management. In a new issue analysis excerpted in this article, HFMA's P&P Board provides some clarity to the healthcare industry on certain accounting and reporting issues resulting from incentive payments under the Medicare program for the meaningful use of electronic health record (EHR) technology. Consultation on these matters with independent auditors is highly recommended.

  18. Performance-based incentives may be appropriate to address challenges to delivery of prevention of vertical transmission of HIV services in rural Mozambique: a qualitative investigation.

    Science.gov (United States)

    Schuster, Roseanne C; de Sousa, Octávio; Rivera, Jacqueline; Olson, Rebecca; Pinault, Delphine; Young, Sera L

    2016-10-07

    Performance-based incentives (PBIs) have garnered global attention as a promising strategy to improve healthcare delivery to vulnerable populations. However, literature gaps in the context in which an intervention is implemented and how the PBIs were developed exist. Therefore, we (1) characterized the barriers and promoters to prevention of vertical transmission of HIV (PVT) service delivery in rural Mozambique, where the vertical transmission rate is 12 %, and (2) assessed the appropriateness for a PBI's intervention and application to PVT. We conducted 24 semi-structured interviews with nurses, volunteers, community health workers, and traditional birth attendants about the barriers and promoters they experienced delivering PVT services. We then explored emergent themes in subsequent focus group discussions (n = 7, total participants N = 92) and elicited participant perspectives on PBIs. The ecological motivation-opportunity-ability framework guided our iterative data collection and thematic analysis processes. The interviews revealed that while all health worker cadres were motivated intrinsically and by social recognition, they were dissatisfied with low and late remuneration. Facility-based staff were challenged by factors across the rest of the ecological levels, primarily in the opportunity domain, including the following: poor referral and record systems (work mandate), high workload, stock-outs, poor infrastructure (facility environment), and delays in obtaining patient results and donor payment discrepancies (administrative). Community-based cadres' opportunity challenges included lack of supplies, distance (work environment), lack of incorporation into the health system (administration), and ability challenges of incorrect knowledge (health worker). PBIs based on social recognition and that enable action on intrinsic motivation through training, supervision, and collaboration were thought to have the most potential for targeting improvements

  19. Asset-building payments for ecosystem services: assessing landowner perceptions of reforestation incentives in Lebanon

    International Nuclear Information System (INIS)

    Sarkissian, A.J.; Brook, R.M.; Talhouk, S.N.; Hockley, N.J.

    2017-01-01

    Aim of study: Incentivising landowners to supply ecosystem services remains challenging, especially when this requires long-term investments such as reforestation. We investigated how landowners perceive, and would respond to, distinct types of incentives for planting diverse native trees on private lands in Lebanon. Our aim was to understand landowners’ attitudes towards hypothetical Payments for Ecosystem Services (PES) contracts options; their likely participation; and the potential additionality they would provide. Area of study: Highland villages situated within eight of Lebanon’s 20 Important Plant Areas Materials and methods: Mixed-methods surveys were conducted with 34 landowners to determine past, present and future land-use strategies. Study participants were presented with three differently structured reforestation contract options (or schemes). The three schemes (results-based loan, action-based grant, and results-based payments) differed in their expected risks and benefits to landowners. Qualitative debriefing questions followed each of the schemes presented. Main results: Although the results-based loan did deter uptake relative to the lower risk action-based grant, results-based payments did not significantly increase uptake or planting area, suggesting asymmetric attitudes to risk. Qualitative probing revealed economic, social (e.g. trust) and institutional factors (e.g. legal implications of planting forest trees on private land) that limited willingness to participate in the results-based contract option. Research highlights: This study demonstrates the importance of combining qualitative and quantitative methods to better understand landowner perceptions of incentives and risks, particularly in challenging socio-political contexts.

  20. Asset-building payments for ecosystem services: assessing landowner perceptions of reforestation incentives in Lebanon

    Energy Technology Data Exchange (ETDEWEB)

    Sarkissian, A.J.; Brook, R.M.; Talhouk, S.N.; Hockley, N.J.

    2017-11-01

    Aim of study: Incentivising landowners to supply ecosystem services remains challenging, especially when this requires long-term investments such as reforestation. We investigated how landowners perceive, and would respond to, distinct types of incentives for planting diverse native trees on private lands in Lebanon. Our aim was to understand landowners’ attitudes towards hypothetical Payments for Ecosystem Services (PES) contracts options; their likely participation; and the potential additionality they would provide. Area of study: Highland villages situated within eight of Lebanon’s 20 Important Plant Areas Materials and methods: Mixed-methods surveys were conducted with 34 landowners to determine past, present and future land-use strategies. Study participants were presented with three differently structured reforestation contract options (or schemes). The three schemes (results-based loan, action-based grant, and results-based payments) differed in their expected risks and benefits to landowners. Qualitative debriefing questions followed each of the schemes presented. Main results: Although the results-based loan did deter uptake relative to the lower risk action-based grant, results-based payments did not significantly increase uptake or planting area, suggesting asymmetric attitudes to risk. Qualitative probing revealed economic, social (e.g. trust) and institutional factors (e.g. legal implications of planting forest trees on private land) that limited willingness to participate in the results-based contract option. Research highlights: This study demonstrates the importance of combining qualitative and quantitative methods to better understand landowner perceptions of incentives and risks, particularly in challenging socio-political contexts.

  1. Patient-centered medical home initiatives expanded in 2009-13: providers, patients, and payment incentives increased.

    Science.gov (United States)

    Edwards, Samuel T; Bitton, Asaf; Hong, Johan; Landon, Bruce E

    2014-10-01

    Patient-centered medical home initiatives are central to many efforts to reform the US health care delivery system. To better understand the extent and nature of these initiatives, in 2013 we performed a nationwide cross-sectional survey of initiatives that included payment reform incentives in their models, and we compared the results to those of a similar survey we conducted in 2009. We found that the number of initiatives featuring payment reform incentives had increased from 26 in 2009 to 114 in 2013. The number of patients covered by these initiatives had increased from nearly five million to almost twenty-one million. We also found that the proportion of time-limited initiatives--those with a planned end date--was 20 percent in 2013, a decrease from 77 percent in 2009. Finally, we found that the dominant payment model for patient-centered medical homes remained fee-for-service payments augmented by per member per month payments and pay-for-performance bonuses. However, those payments and bonuses were higher in 2013 than they were in 2009, and the use of shared-savings models was greater. The patient-centered medical home model is likely to continue both to become more common and to play an important role in delivery system reform. Project HOPE—The People-to-People Health Foundation, Inc.

  2. Merit-Based Incentive Payment System: Meaningful Changes in the Final Rule Brings Cautious Optimism.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Helm Ii, Standiford; Calodney, Aaron K; Hirsch, Joshua A

    2017-01-01

    The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) eliminated the flawed Sustainable Growth Rate (SGR) act formula - a longstanding crucial issue of concern for health care providers and Medicare beneficiaries. MACRA also included a quality improvement program entitled, "The Merit-Based Incentive Payment System, or MIPS." The proposed rule of MIPS sought to streamline existing federal quality efforts and therefore linked 4 distinct programs into one. Three existing programs, meaningful use (MU), Physician Quality Reporting System (PQRS), value-based payment (VBP) system were merged with the addition of Clinical Improvement Activity category. The proposed rule also changed the name of MU to Advancing Care Information, or ACI. ACI contributes to 25% of composite score of the four programs, PQRS contributes 50% of the composite score, while VBP system, which deals with resource use or cost, contributes to 10% of the composite score. The newest category, Improvement Activities or IA, contributes 15% to the composite score. The proposed rule also created what it called a design incentive that drives movement to delivery system reform principles with the inclusion of Advanced Alternative Payment Models (APMs).Following the release of the proposed rule, the medical community, as well as Congress, provided substantial input to Centers for Medicare and Medicaid Services (CMS),expressing their concern. American Society of Interventional Pain Physicians (ASIPP) focused on 3 important aspects: delay the implementation, provide a 3-month performance period, and provide ability to submit meaningful quality measures in a timely and economic manner. The final rule accepted many of the comments from various organizations, including several of those specifically emphasized by ASIPP, with acceptance of 3-month reporting period, as well as the ability to submit non-MIPS measures to improve real quality and make the system meaningful. CMS also provided a mechanism for

  3. Adapting industry-style business model to academia in a system of Performance-based Incentive Compensation.

    Science.gov (United States)

    Reece, E Albert; Nugent, Olan; Wheeler, Richard P; Smith, Charles W; Hough, Aubrey J; Winter, Charles

    2008-01-01

    Performance-Based Incentive Compensation (PBIC) plans currently prevail throughout industry and have repeatedly demonstrated effectiveness as powerful motivational tools for attracting and retaining top talent, enhancing key indicators, increasing employee productivity, and, ultimately, enhancing mission-based parameters. The University of Arkansas for Medical Sciences (UAMS) College of Medicine introduced its PBIC plan to further the transition of the college to a high-performing academic and clinical enterprise. A forward-thinking compensation plan was progressively implemented during a three-year period. After the introduction of an aggressive five-year vision plan in 2002, the college introduced a PBIC plan designed to ensure the retention and recruitment of high-quality faculty through the use of uncapped salaries that reflect each faculty member's clinical, research, and education duties. The PBIC plan was introduced with broad, schoolwide principles adaptable to each department and purposely flexible to allow for tailor-made algorithms to fit the specific approaches required by individual departments. As of July 2006, the college had begun to reap a variety of short-term benefits from Phase I of its PBIC program, including increases in revenue and faculty salaries, and increased faculty morale and satisfaction.Successful implementation of a PBIC plan depends on a host of factors, including the development of a process for evaluating performance that is considered fair and reliable to the entire faculty. The college has become more efficient and effective by adopting such a program, which has helped it to increase overall productivity. The PBIC program continues to challenge our faculty members to attain their highest potential while rewarding them accordingly.

  4. Medicare Program; Advancing Care Coordination Through Episode Payment Models (EPMs); Cardiac Rehabilitation Incentive Payment Model; and Changes to the Comprehensive Care for Joint Replacement Model (CJR). Final rule.

    Science.gov (United States)

    2017-01-03

    This final rule implements three new Medicare Parts A and B episode payment models, a Cardiac Rehabilitation (CR) Incentive Payment model and modifications to the existing Comprehensive Care for Joint Replacement model under section 1115A of the Social Security Act. Acute care hospitals in certain selected geographic areas will participate in retrospective episode payment models targeting care for Medicare fee-forservice beneficiaries receiving services during acute myocardial infarction, coronary artery bypass graft, and surgical hip/femur fracture treatment episodes. All related care within 90 days of hospital discharge will be included in the episode of care. We believe these models will further our goals of improving the efficiency and quality of care for Medicare beneficiaries receiving care for these common clinical conditions and procedures.

  5. Effect of incentive payments on chronic disease management and health services use in British Columbia, Canada: Interrupted time series analysis.

    Science.gov (United States)

    Lavergne, M Ruth; Law, Michael R; Peterson, Sandra; Garrison, Scott; Hurley, Jeremiah; Cheng, Lucy; McGrail, Kimberlyn

    2018-02-01

    We studied the effects of incentive payments to primary care physicians for the care of patients with diabetes, hypertension, and Chronic Obstructive Pulmonary Disease (COPD) in British Columbia, Canada. We used linked administrative health data to examine monthly primary care visits, continuity of care, laboratory testing, pharmaceutical dispensing, hospitalizations, and total h ealth care spending. We examined periods two years before and two years after each incentive was introduced, and used segmented regression to assess whether there were changes in level or trend of outcome measures across all eligible patients following incentive introduction, relative to pre-intervention periods. We observed no increases in primary care visits or continuity of care after incentives were introduced. Rates of ACR testing and antihypertensive dispensing increased among patients with hypertension, but none of the other modest increases in laboratory testing or prescriptions dispensed reached statistical significance. Rates of hospitalizations for stroke and heart failure among patients with hypertension fell relative to pre-intervention patterns, while hospitalizations for COPD increased. Total hospitalizations and hospitalizations via the emergency department did not change. Health care spending increased for patients with hypertension. This large-scale incentive scheme for primary care physicians showed some positive effects for patients with hypertension, but we observe no similar changes in patient management, reductions in hospitalizations, or changes in spending for patients with diabetes and COPD. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  6. Medicare Program; End-Stage Renal Disease Prospective Payment System, Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, and End-Stage Renal Disease Quality Incentive Program. Final rule.

    Science.gov (United States)

    2017-11-01

    This rule updates and makes revisions to the end-stage renal disease (ESRD) prospective payment system (PPS) for calendar year (CY) 2018. It also updates the payment rate for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury (AKI). This rule also sets forth requirements for the ESRD Quality Incentive Program (QIP), including for payment years (PYs) 2019 through 2021.

  7. 76 FR 70227 - Medicare Program; End-Stage Renal Disease Prospective Payment System and Quality Incentive...

    Science.gov (United States)

    2011-11-10

    ...-Neutrality Adjustment for CY 2011 4. Transition Budget-Neutrality Adjustment for CY 2012 5. Low-Volume... Adjustment for CY 2012 7. Updates to the Wage Index Values and Wage Index Floor for the Composite Rate Portion of the Blended Payment and the ESRD PPS Payment a. Reduction to the ESRD Wage Index Floor b...

  8. 5 CFR 576.102 - Voluntary Separation Incentive Payment implementation plans.

    Science.gov (United States)

    2010-01-01

    ... eliminated, identified by organizational unit, geographic location, occupational series, grade level and any... offered incentives identified by organizational unit, geographic location, occupational series, grade level and any other factors, such as skills, knowledge, or retirement eligibility (as discussed in...

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

    Directory of Open Access Journals (Sweden)

    Fleetcroft Robert

    2012-04-01

    Full Text Available Abstract 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

  10. How different types of participant payments alter task performance

    Directory of Open Access Journals (Sweden)

    Gary L. Brase

    2009-08-01

    Full Text Available Researchers typically use incentives (such as money or course credit in order to obtain participants who engage in the specific behaviors of interest to the researcher. There is, however, little understanding or agreement on the effects of different types and levels of incentives used. Some results in the domain of statistical reasoning suggest that performance differences --- previously deemed theoretically important --- may actually be due to differences in incentive types across studies. 704 participants completed one of five variants of a statistical reasoning task, for which they received either course credit, flat fee payment, or performance-based payment incentives. Successful task completion was more frequent with performance-based incentives than with either of the other incentive types. Performance on moderately difficult tasks (compared to very easy and very hard tasks was most sensitive to incentives. These results can help resolve existing debates about inconsistent findings, guide more accurate comparisons across studies, and be applied beyond research settings.

  11. MONETARY AND NON-MONETARY INCENTIVES TO BOOST TAX PAYMENT A CONTROLLED EXPERIMENT

    Directory of Open Access Journals (Sweden)

    Victoria, Giarrizzo

    2012-01-01

    Full Text Available After centuries in which control and punishment formed the basis of policies designed to combat tax evasion, the results in many world economies are far from expected. Paying taxes is a resisted action, a few people are predisposed to do so voluntarily and that bias is reduced if people perceive inefficiencies from the State. When that happens, controls and penalties, although necessary, become insufficient and it is necessary to create parallel incentives. This research shows evidence of the usefulness of positive incentives and the need to replace the traditional control scheme and penalties for a control scheme, punishments and rewards. Supported by a controlled experiment contrasts the results of the allocation of awards for a good contributor, showing some advantages of non-cash prizes on the prize money.

  12. Do family physicians need more payment for working better? Financial incentives in primary care.

    Science.gov (United States)

    Kolozsvári, László Róbert; Orozco-Beltran, Domingo; Rurik, Imre

    2014-05-01

    Financial incentives are widely used in health services to improve the quality of care or to reach some specific targets. Pay for performance systems were also introduced in the primary health care systems of many European countries. Our study aims to describe and compare recent existing primary care indicators and related financing in European countries. Literature search was performed and questionnaires were sent to primary care experts of different countries within the European General Practice Research Network. Ten countries have published primary care quality indicators (QI) associated with financial incentives. The number of QI varies from 1 to 134 and can modify the finances of physicians with up to 25% of their total income. The implementations of these schemes should be critically evaluated with continuous monitoring at national or regional level; comparison is required between targets and their achievements, health gains and use of resources as well. Copyright © 2013 Elsevier España, S.L. All rights reserved.

  13. Aligning incentives in the management of inguinal hernia: the impact of the payment model.

    Science.gov (United States)

    Devarajan, Karthik; Rogers, Loni; Smith, Paul; Schwaitzberg, Steven D

    2012-09-01

    The Affordable Care Act has stimulated discussion to find feasible, alternate payment models. Adopting a global payment (GP) mechanism may dampen the high number of procedures incentivized by the fee-for-service (FFS) system. The evolving payment mechanism should reflect collaboration between surgeon and system goals. Our aim was to model and perform simulation of a GP system for hernia care and its impact on cost, revenue, and physician reimbursement in an integrated health care system. The results of the 2006 Watchful Waiting (WW) vs Repair of Inguinal Hernia in Minimally Symptomatic Men trial was used as a clinical model for the natural history and progression of inguinal hernia disease Simulations were built using 2009 financial and clinical data from the Cambridge Health Alliance to model costs and revenues in managing care for a 4-year cohort of inguinal hernia patients; FFS, FFS-WW, and the GP-WW were modeled. To build this GP model, surgeons were paid a constant $500 per patient whether herniorrhaphy was performed or not. Compared with the actual combined physician and hospital revenue under the current FFS model ($308,820), implementing the FFS-WW system for 4 years for 139 hernia patients decreased hospital and physician revenues by $93,846 and $19,308, respectively. This resulted in a total savings of $113,154 for the payors only. In contrast, when using WW methodology within a GP model, system savings of $69,174 were observed after 4 years, with preservation of physician and hospital income. Collaboration to achieve shared savings can be accomplished by pooling physician and hospital revenue in order to meet the goals of all parties. Copyright © 2012 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

  14. Medicare Program; Cancellation of Advancing Care Coordination Through Episode Payment and Cardiac Rehabilitation Incentive Payment Models; Changes to Comprehensive Care for Joint Replacement Payment Model: Extreme and Uncontrollable Circumstances Policy for the Comprehensive Care for Joint Replacement Payment Model. Final rule; interim final rule with comment period.

    Science.gov (United States)

    2017-12-01

    This final rule cancels the Episode Payment Models (EPMs) and Cardiac Rehabilitation (CR) Incentive Payment Model and rescinds the regulations governing these models. It also implements certain revisions to the Comprehensive Care for Joint Replacement (CJR) model, including: Giving certain hospitals selected for participation in the CJR model a one-time option to choose whether to continue their participation in the model; technical refinements and clarifications for certain payment, reconciliation and quality provisions; and a change to increase the pool of eligible clinicians that qualify as affiliated practitioners under the Advanced Alternative Payment Model (Advanced APM) track. An interim final rule with comment period is being issued in conjunction with this final rule in order to address the need for a policy to provide some flexibility in the determination of episode costs for providers located in areas impacted by extreme and uncontrollable circumstances.

  15. Is it all about the money? A qualitative exploration of the effects of performance-based financial incentives on Zimbabwe's voluntary male medical circumcision program.

    Directory of Open Access Journals (Sweden)

    Caryl Feldacker

    Full Text Available In 2013, Zimbabwe's voluntary medical male circumcision (VMMC program adopted performance-based financing (PBF to speed progress towards ambitious VMMC targets. The $25 USD PBF intended to encourage low-paid healthcare workers to remain in the public sector and to strengthen the public healthcare system. The majority of the incentive supports healthcare workers (HCWs who perform VMMC alongside other routine services; a small portion supports province, district, and facility levels.This qualitative study assessed the effect of the PBF on HCW motivation, satisfaction, and professional relationships. The study objectives were to: 1 Gain understanding of the advantages and disadvantages of PBF at the HCW level; 2 Gain understanding of the advantages and disadvantages of PBF at the site level; and 3 Inform scale up, modification, or discontinuation of PBF for the national VMMC program. Sixteen focus groups were conducted: eight with HCWs who received PBF for VMMC and eight with HCWs in the same clinics who did not work in VMMC and, therefore, did not receive PBF. Fourteen key informant interviews ascertained administrator opinion.Findings suggest that PBF appreciably increased motivation among VMMC teams and helped improve facilities where VMMC services are provided. However, PBF appears to contribute to antagonism at the workplace, creating divisiveness that may reach beyond VMMC. PBF may also cause distortion in the healthcare system: HCWs prioritized incentivized VMMC services over other routine duties. To reduce workplace tension and improve the VMMC program, participants suggested increasing HCW training in VMMC to expand PBF beneficiaries and strengthening integration of VMMC services into routine care.In the low-resource, short-staffed context of Zimbabwe, PBF enabled rapid VMMC scale up and achievement of ambitious targets; however, side effects make PBF less advantageous and sustainable than envisioned. Careful consideration is warranted in

  16. Linking payment to health outcomes: a taxonomy and examination of performance-based reimbursement schemes between healthcare payers and manufacturers.

    Science.gov (United States)

    Carlson, Josh J; Sullivan, Sean D; Garrison, Louis P; Neumann, Peter J; Veenstra, David L

    2010-08-01

    To identify, categorize and examine performance-based health outcomes reimbursement schemes for medical technology. We performed a review of performance-based health outcomes reimbursement schemes over the past 10 years (7/98-010/09) using publicly available databases, web and grey literature searches, and input from healthcare reimbursement experts. We developed a taxonomy of scheme types by inductively organizing the schemes identified according to the timing, execution, and health outcomes measured in the schemes. Our search yielded 34 coverage with evidence development schemes, 10 conditional treatment continuation schemes, and 14 performance-linked reimbursement schemes. The majority of schemes are in Europe and Australia, with an increasing number in Canada and the U.S. These schemes have the potential to alter the reimbursement and pricing landscape for medical technology, but significant challenges, including high transaction costs and insufficient information systems, may limit their long-term impact. Future studies regarding experiences and outcomes of implemented schemes are necessary. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  17. Issues in the use of payments in lieu of taxes to provide nuclear waste facility siting incentives

    International Nuclear Information System (INIS)

    Bjornstad, D.J.; Goss, E.

    1981-01-01

    High-level, nuclear waste isolation facilities will be federally owned and therefore exempt from local taxation. Because local residents view tax payments as a major benefit of industrial development, the absence of these payments, coupled with the inherent undesirability of hazardous-materials-handling activities, may discourage communities from accepting a facility. One method to overcome this disincentive is for the facility to make payments in lieu of taxes to localities. This paper examines the concept of payments in lieu of taxes and presents statistics describing local fiscal characteristics. The range these payments might take under alternative-payment arrangements is calculated, and the impact of such payments on the facility's user-free schedule is estimated. It is concluded that a payment plan based on hypothetical property-tax liabilities for an identical, but taxable, facility would have a significant revenue impact on most localities but would not increase user fees significantly. (Auth.)

  18. Can performance-based incentives improve motivation of nurses and midwives in primary facilities in northern Ghana? A quasi-experimental study.

    Science.gov (United States)

    Aninanya, Gifty Apiung; Howard, Natasha; Williams, John E; Apam, Benjamin; Prytherch, Helen; Loukanova, Svetla; Kamara, Eunice Karanja; Otupiri, Easmon

    2016-01-01

    Lack of an adequate and well-performing health workforce has emerged as the biggest barrier to scaling up health services provision in sub-Saharan Africa. As the global community commits to the Sustainable Development Goals and universal health coverage, health workforce challenges are critical. In northern Ghana, performance-based incentives (PBIs) were introduced to improve health worker motivation and service quality. The goal of this study was to determine the impact of PBIs on maternal health worker motivation in two districts in northern Ghana. A quasi-experimental study design with pre- and post-intervention measurement was used. PBIs were implemented for 2 years in six health facilities in Kassena-Nankana District with six health facilities in Builsa District serving as comparison sites. Fifty pre- and post-intervention structured interviews and 66 post-intervention in-depth interviews were conducted with health workers. Motivation was assessed using constructs for job satisfaction, pride, intrinsic motivation, timelines/attendance, and organisational commitment. Quantitative data were analysed to determine changes in motivation between intervention and comparison facilities pre- and post-intervention using STATA™ version 13. Qualitative data were analysed thematically using NVivo 10 to explore possible reasons for quantitative findings. PBIs were associated with slightly improved maternal health worker motivation. Mean values for overall motivation between intervention and comparison health workers were 0.6 versus 0.7 at baseline and 0.8 versus 0.7 at end line, respectively. Differences at baseline and end line were 0.1 ( p =0.40 and p =0.50 respectively), with an overall 0.01 difference in difference ( p =0.90). Qualitative interviews indicated that PBIs encouraged health workers to work harder and be more punctual, increasing reported pride and job satisfaction. The results contribute evidence on the effects of PBIs on motivational constructs among

  19. Can performance-based incentives improve motivation of nurses and midwives in primary facilities in northern Ghana? A quasi-experimental study

    Directory of Open Access Journals (Sweden)

    Gifty Apiung Aninanya

    2016-10-01

    Full Text Available Background: Lack of an adequate and well-performing health workforce has emerged as the biggest barrier to scaling up health services provision in sub-Saharan Africa. As the global community commits to the Sustainable Development Goals and universal health coverage, health workforce challenges are critical. In northern Ghana, performance-based incentives (PBIs were introduced to improve health worker motivation and service quality. Objective: The goal of this study was to determine the impact of PBIs on maternal health worker motivation in two districts in northern Ghana. Design: A quasi-experimental study design with pre- and post-intervention measurement was used. PBIs were implemented for 2 years in six health facilities in Kassena-Nankana District with six health facilities in Builsa District serving as comparison sites. Fifty pre- and post-intervention structured interviews and 66 post-intervention in-depth interviews were conducted with health workers. Motivation was assessed using constructs for job satisfaction, pride, intrinsic motivation, timelines/attendance, and organisational commitment. Quantitative data were analysed to determine changes in motivation between intervention and comparison facilities pre- and post-intervention using STATA™ version 13. Qualitative data were analysed thematically using NVivo 10 to explore possible reasons for quantitative findings. Results: PBIs were associated with slightly improved maternal health worker motivation. Mean values for overall motivation between intervention and comparison health workers were 0.6 versus 0.7 at baseline and 0.8 versus 0.7 at end line, respectively. Differences at baseline and end line were 0.1 (p=0.40 and p=0.50 respectively, with an overall 0.01 difference in difference (p=0.90. Qualitative interviews indicated that PBIs encouraged health workers to work harder and be more punctual, increasing reported pride and job satisfaction. Conclusions: The results contribute

  20. 42 CFR 495.370 - Appeals process for a Medicaid provider receiving electronic health record incentive payments.

    Science.gov (United States)

    2010-10-01

    ... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM Requirements Specific to the... provide that the provider (whether individual or entity) is also given any additional appeals rights that...

  1. The female community health volunteer programme in Nepal: decision makers' perceptions of volunteerism, payment and other incentives.

    Science.gov (United States)

    Glenton, Claire; Scheel, Inger B; Pradhan, Sabina; Lewin, Simon; Hodgins, Stephen; Shrestha, Vijaya

    2010-06-01

    The Female Community Health Volunteer (FCHV) Programme in Nepal has existed since the late 1980s and includes almost 50,000 volunteers. Although volunteer programmes are widely thought to be characterised by high attrition levels, the FCHV Programme loses fewer than 5% of its volunteers annually. The degree to which decision makers understand community health worker motivations and match these with appropriate incentives is likely to influence programme sustainability. The purpose of this study was to explore the views of stakeholders who have participated in the design and implementation of the Female Community Health Volunteer regarding Volunteer motivation and appropriate incentives, and to compare these views with the views and expectations of Volunteers. Semi-structured interviews were carried out in 2009 with 19 purposively selected non-Volunteer stakeholders, including policy makers and programme managers. Results were compared with data from previous studies of Female Community Health Volunteers and from interviews with four Volunteers and two Volunteer activists. Stakeholders saw Volunteers as motivated primarily by social respect, religious and moral duty. The freedom to deliver services at their leisure was seen as central to the volunteer concept. While stakeholders also saw the need for extrinsic incentives such as micro-credit, regular wages were regarded not only as financially unfeasible, but as a potential threat to the Volunteers' social respect, and thereby to their motivation. These views were reflected in interviews with and previous studies of Female Community Health Volunteers, and appear to be influenced by a tradition of volunteering as moral behaviour, a lack of respect for paid government workers, and the Programme's community embeddedness. Our study suggests that it may not be useful to promote a generic range of incentives, such as wages, to improve community health worker programme sustainability. Instead, programmes should ensure that

  2. Photovoltaic Incentive Design Handbook

    Energy Technology Data Exchange (ETDEWEB)

    Hoff, T. E.

    2006-12-01

    Investments in customer-owned grid-connected photovoltaic (PV) energy systems are growing at a steady pace. This is due, in part, to the availability of attractive economic incentives offered by public state agencies and utilities. In the United States, these incentives have largely been upfront lump payments tied to the system capacity rating. While capacity-based ''buydowns'' have stimulated the domestic PV market, they have been criticized for subsidizing systems with potentially poor energy performance. As a result, the industry has been forced to consider alternative incentive structures, particularly ones that pay based on long-term measured performance. The industry, however, lacks consensus in the debate over the tradeoffs between upfront incentive payments versus longer-term payments for energy delivery. This handbook is designed for agencies and utilities that offer or intend to offer incentive programs for customer-owned PV systems. Its purpose is to help select, design, and implement incentive programs that best meet programmatic goals. The handbook begins with a discussion of the various available incentive structures and then provides qualitative and quantitative tools necessary to design the most appropriate incentive structure. It concludes with program administration considerations.

  3. Intellectual capital performance and cash-based incentive payments for executive directors: Impact of remuneration committee and corporate governance features

    Directory of Open Access Journals (Sweden)

    J-L. W. Mitchell Van der Zahn

    2005-11-01

    Full Text Available We use a sample of 964 executive directors representing 354 Singapore publicly listed firms to examine linkage between firm performance and cash-based bonus payments. As a pooled OLS regression model may hide different models that characterize subsets of observations we use latent class analysis to further examine the data and to identify more specifically the influence of corporate governance features. Our latent class analysis results indicate that remuneration committees with members having their interests better aligned with shareholders (such as presence of a significant owner appear more likely to consider the incremental value of tying executive director compensation to intellectual capital performance. Remuneration committees with a lower risk of influence from managerial power were also found to be more likely to support a compensation linkage for executive directors to intellectual capital performance. The influence of the remuneration committee features is evident for both entrepreneurial and traditional firms. Overall, our findings are consistent with both the optimal-contract pricing and managerial power views of executive compensation setting.

  4. The Use of Payment for Electricity not Delivered in Norway: Is It Enough to Give Incentives for Investments?

    Energy Technology Data Exchange (ETDEWEB)

    Sand, Kjell [SINTEF Energy Research Institute, Trondheim (Norway)

    2003-11-01

    The impact of the Regulatory framework on transmission and distribution system (TandD) development, operation and maintenance has been substantial for the last decade in Norway. The origin for this development was the Energy Act of 1991, deregulating the electricity sector. As a part of these changes, the TandD monopolies were re-regulated i.e. new requirements were introduced from the Authorities (The Norwegian Water Resources and Energy Directorate, NVE). The grid utilities were urged to improve efficiency i.e. to cut costs - the monopolies entered a cost-cutting and more cost-conscious regime. For the TandD sector introducing an income cap regulation regime in 1997 further strengthened these incentives. In this model the Regulator is granting a maximum permitted income for the utilities separate from their actual costs. The consequences observed so far have been increased system utilisation and reduced component maintenance that might give a socio-economic negative impact on component and system reliability. From 2002, the grid regulation was slightly modified in direction of a cost-plus regulation. To monitor and to motivate efficiency improvements, NVE has worked with different benchmarking models since the early 90s. Utility performance in the benchmarking has a direct effect on utility permitted income - poor performance compared to other utilities gives stronger efficiency requirements. In the first period with Rate-of-return regulation, investments were by and large profitable to the company. Later, it became more profitable to reduce and/or delay investments - which in the long run might have an impact on power quality.

  5. Neural mechanisms underlying paradoxical performance for monetary incentives are driven by loss aversion.

    Science.gov (United States)

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

    2012-05-10

    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. Copyright © 2012 Elsevier Inc. All rights reserved.

  6. Incentive mechanisms to promote energy efficiency programs in power distribution companies

    International Nuclear Information System (INIS)

    Osorio, Karim; Sauma, Enzo

    2015-01-01

    Power distribution companies (DISCOs) play an important role in promoting energy efficiency (hereafter EE), mainly due to the fact that they have detailed information regarding their clients' consumption patterns. However, under the traditional regulatory framework, DISCOs have disincentives to promote EE, due to the fact that a reduction in sales also means a reduction in their revenues and profits. Most regulatory policies encouraging EE have some embedded payment schemes that allow financing EE programs. In this paper, we focus on these EE-programs' payment schemes that are embedded into the regulatory policies. Specifically, this paper studies two models of the Principal–Agent bi-level type in order to analyze the economic effects of implementing different payment schemes to foster EE in DISCOs. The main difference between each model is that uncertainty in energy savings is considered by the electricity regulatory institution in only one of the models. In terms of the results, it is observed that, in general terms, it is more convenient for the regulator to adopt a performance-based incentive mechanism than a payment scheme financing only the fixed costs of implementing EE programs. However, if the electricity regulatory institution seeks a higher level of minimum expected utility, it is optimal to adopt a mixed system of compensation, which takes into account the fixed cost compensation and performance-based incentive payments. - Highlights: • We studied different payment schemes to promote energy efficiency in DISCOs. • We propose two bi-level models based on the Principal–Agent theory. • Uncertainty associated with energy savings is incorporated in one of the models. • A performance-based payment scheme is generally more convenient for the regulator. • A mixed payment scheme is optimal when a lower level of uncertainty is tolerated

  7. Goal-oriented incentive payment in CUDAM institution and variation in medical visit indicators in children under one and pregnant women

    Directory of Open Access Journals (Sweden)

    Marcelo Morales

    2011-11-01

    % (117 additional pregnant respectively. Insitucional monthly income for the goal 1 was $1,915,200 (US$1 = $20.Average income/month was $1,637 and $2,364 per child and pregnant women respectively. We conclude that the target incentive payment of 1 allowed to significantly improve the indicators of child and maternal control of CUDAM.

  8. Cost savings from performance-based maintenance contracting

    NARCIS (Netherlands)

    Straub, A.

    2009-01-01

    New procurement approaches combined with performance-based building approaches should reduce costs, but empirical qualitative and quantitative studies are lacking. Performance-based maintenance contracts give maintenance suppliers incentives to improve their way of working. Innovative,

  9. EHR Incentive Programs - Data and Reports

    Data.gov (United States)

    U.S. Department of Health & Human Services — As of March 2013, more than 259,000 health care providers received payment for participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive...

  10. Future considerations for clinical dermatology in the setting of 21st century American policy reform: The Medicare Access and Children's Health Insurance Program Reauthorization Act and the Merit-based Incentive Payment System.

    Science.gov (United States)

    Barbieri, John S; Miller, Jeffrey J; Nguyen, Harrison P; Forman, Howard P; Bolognia, Jean L; VanBeek, Marta J

    2017-06-01

    As the implementation of the Medicare Access and Children's Health Insurance Program Reauthorization Act begins, many dermatologists who provide Medicare Part B services will be subject to the reporting requirements of the Merit-based Incentive Payment System (MIPS). Clinicians subject to MIPS will receive a composite score based on performance across 4 categories: quality, advancing care information, improvement activities, and cost. Depending on their overall MIPS score, clinicians will be eligible for a positive or negative payment adjustment. Quality will replace the Physician Quality Reporting System and clinicians will report on 6 measures from a list of over 250 options. Advancing care information will replace meaningful use and will assess clinicians on activities related to integration of electronic health record technology into their practice. Improvement activities will require clinicians to attest to completion of activities focused on improvements in care coordination, beneficiary engagement, and patient safety. Finally, cost will be determined automatically from Medicare claims data. In this article, we will provide a detailed review of the Medicare Access and Children's Health Insurance Program Reauthorization Act with a focus on MIPS and briefly discuss the potential implications for dermatologists. Copyright © 2017 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  11. Incentive Compatibility

    OpenAIRE

    Ledyard, John O.

    1987-01-01

    Incentive compatibility is described and discussed. A summary of the current state of understanding is provided. Key words are: incentive compatibility, game theory, implementation, mechanism, Bayes, Nash, and revelation.

  12. Advancing the application of systems thinking in health: provider payment and service supply behaviour and incentives in the Ghana National Health Insurance Scheme – a systems approach

    OpenAIRE

    Agyepong, Irene A; Aryeetey, Geneieve C; Nonvignon, Justice; Asenso-Boadi, Francis; Dzikunu, Helen; Antwi, Edward; Ankrah, Daniel; Adjei-Acquah, Charles; Esena, Reuben; Aikins, Moses; Arhinful, Daniel K

    2014-01-01

    Background Assuring equitable universal access to essential health services without exposure to undue financial hardship requires adequate resource mobilization, efficient use of resources, and attention to quality and responsiveness of services. The way providers are paid is a critical part of this process because it can create incentives and patterns of behaviour related to supply. The objective of this work was to describe provider behaviour related to supply of health services to insured ...

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

    Science.gov (United States)

    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.

  14. The use of financial incentives in Australian general practice.

    Science.gov (United States)

    Kecmanovic, Milica; Hall, Jane P

    2015-05-18

    To examine the uptake of financial incentive payments in general practice, and identify what types of practitioners are more likely to participate in these schemes. Analysis of data on general practitioners and GP registrars from the Medicine in Australia - Balancing Employment and Life (MABEL) longitudinal panel survey of medical practitioners in Australia, from 2008 to 2011. Income received by GPs from government incentive schemes and grants and factors associated with the likelihood of claiming such incentives. Around half of GPs reported receiving income from financial incentives in 2008, and there was a small fall in this proportion by 2011. There was considerable movement into and out of the incentives schemes, with more GPs exiting than taking up grants and payments. GPs working in larger practices with greater administrative support, GPs practising in rural areas and those who were principals or partners in practices were more likely to use grants and incentive payments. Administrative support available to GPs appears to be an increasingly important predictor of incentive use, suggesting that the administrative burden of claiming incentives is large and not always worth the effort. It is, therefore, crucial to consider such costs (especially relative to the size of the payment) when designing incentive payments. As market conditions are also likely to influence participation in incentive schemes, the impact of incentives can change over time and these schemes should be reviewed regularly.

  15. 48 CFR 1852.216-88 - Performance incentive.

    Science.gov (United States)

    2010-10-01

    ... credit the next payment voucher for the amount due, as directed by the Contracting Officer. (2) When the performance level exceeds the standard level, the Contractor may request payment of the incentive amount associated with a given level of performance, provided that such payments shall not be more frequent than...

  16. Payments for Ecosystem Services

    DEFF Research Database (Denmark)

    Chan, Kai M.A; Anderson, Emily K.; Chapman, Mollie

    2017-01-01

    Payments for ecosystem services (PES) programs are one prominent strategy to address economic externalities of resource extraction and commodity production, improving both social and ecological outcomes. But do PES and related incentive programs achieve that lofty goal? Along with considerable en...... sustainable relationships with nature, conserving and restoring ecosystems and their benefits for people now and in the future....

  17. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment period.

    Science.gov (United States)

    2015-08-17

    We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the

  18. 48 CFR 970.1100-1 - Performance-based contracting.

    Science.gov (United States)

    2010-10-01

    ... Federal Procurement Policy's Seven Steps to Performance-Based Acquisition located at Web site http://www...) performance standards and objectives and quality assurance surveillance plans; provide performance incentives... planning processes. Measurable performance criteria, objective measures, and where appropriate, performance...

  19. Irregular incentives

    International Nuclear Information System (INIS)

    Cicchetti, M.A.

    1993-01-01

    Public utility regulation lacks a formal proxy for the economic profits that can be earned in an effectively competitive market if a firm is efficient or innovative. After all, public utility regulation operated on cost-plus basis. If a utility is efficient or innovative and lowers its costs, its typical reward is to have its rates reduced. This is a perverse incentive to motivate a utility to produce at the most efficient level. In addition, since regulation operates on this cost-plus basis, a utility can increase its net income, all other things being equal, by overinvesting in (or open-quotes gold-platingclose quotes) its system, another perverse incentive. Recognizing these flaws of regulation, academicians, utility executives, regulators, and legislators have tried over the last several years to implement incentive regulation plans that correct such perverse incentives. However, under many of the earnings-sharing or price-regulation incentive plans, the rewards for efficient production are not tied directly to measures under a company's control. In fact, such plans could prove highly detrimental to ratepayers and competitors of the regulated company and its affiliates. An incentive regulation plan that ties an appropriate reward for efficient production to specific efficiency gains is a better proxy of an effectively competitive environment. What's more, it is superior to an incentive plan that rewards circumstances beyond the company's control or self-serving manipulation. This is particularly true if no earnings cap is associated with the reward for efficiency. Rewards for efficient production should be tied to specific actions. A suitable incentive plan does not preclude appropriately derived flexible prices for certain products or services where warranted

  20. Impact of performance-based financing on primary health care services in Haiti.

    Science.gov (United States)

    Zeng, Wu; Cros, Marion; Wright, Katherine D; Shepard, Donald S

    2013-09-01

    To strengthen Haiti's primary health care (PHC) system, the country first piloted performance-based financing (PBF) in 1999 and subsequently expanded the approach to most internationally funded non-government organizations. PBF complements support (training and technical assistance). This study evaluates (a) the separate impact of PBF and international support on PHC's service delivery; (b) the combined impact of PBF and technical assistance on PHC's service delivery; and (c) the costs of PBF implementation in Haiti. To minimize the risk of facilities neglecting potential non-incentivized services, the incentivized indicators were randomly chosen at the end of each year. We obtained quantities of key services from four departments for 217 health centres (15 with PBF and 202 without) from 2008 through 2010, computed quarterly growth rates and analysed the results using a difference-in-differences approach by comparing the growth of incentivized and non-incentivized services between PBF and non-PBF facilities. To interpret the statistical analyses, we also interviewed staff in four facilities. Whereas international support added 39% to base costs of PHC, incentive payments added only 6%. Support alone increased the quantities of PHC services over 3 years by 35% (2.7%/quarter). However, support plus incentives increased these amounts by 87% over 3 years (5.7%/quarter) compared with facilities with neither input. Incentives alone was associated with a net 39% increase over this period, and more than doubled the growth of services (P < 0.05). Interview findings found no adverse impacts and, in fact, indicated beneficial impacts on quality. Incentives proved to be a relatively inexpensive, well accepted and very effective complement to support, suggesting that a small amount of money, strategically used, can substantially improve PHC. Haiti's experience, after more than a decade of use, indicates that incentives are an effective tool to strengthen PHC.

  1. New Technologies in the Payment System Industries: The SEPA Project

    OpenAIRE

    Armando Calabrese; Massimo Gastaldi; Irene Iacovelli; Nathan L. Ghiron

    2010-01-01

    Problem statement: The Single Euro Payments Area (SEPA) project plans to establish an integrated market for extending European integration to retail payments; it aims to provide incentives for using payment systems instead of cash for all micro payments, in order to improve both efficiency and competition in the Euro area. In this study we described the SEPA and its effects on competition and innovation in the payment systems. Moreover, we will discuss the main technologic...

  2. Peace Incentives

    DEFF Research Database (Denmark)

    Emmanuel, Nikolas G.

    2015-01-01

    How does economic assistance influence the success or failure of peace processes in Africa? Can economic assistance act as an incentive to facilitate an end to conflict? The literature largely ignores aid as a factor supporting peace processes. In addressing this topic, the current study tries...

  3. Using financial incentives to improve value in orthopaedics.

    Science.gov (United States)

    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.

  4. Rehabilitation of compensable workplace injuries: effective payment models for quality vocational rehabilitation outcomes in a changing social landscape.

    Science.gov (United States)

    Matthews, Lynda R; Hanley, Francine; Lewis, Virginia; Howe, Caroline

    2015-01-01

    With social and economic costs of workplace injury on the increase, efficient payment models that deliver quality rehabilitation outcomes are of increasing interest. This paper provides a perspective on the issue informed by both refereed literature and published research material not available commercially (gray literature). A review of payment models, workers' compensation and compensable injury identified relevant peer-reviewed and gray literature that informed our discussion. Fee-for-service and performance-based payment models dominate the health and rehabilitation literature, each described as having benefits and challenges to achieving quality outcomes for consumers. There appears to be a movement toward performance-based payments in compensable workplace injury settings as they are perceived to promote time-efficient services and support innovation in rehabilitation practice. However, it appears that the challenges that arise for workplace-based rehabilitation providers and professionals when working under the various payment models, such as staff retention and quality of client-practitioner relationship, are absent from the literature and this could lead to flawed policy decisions. Robust evidence of the benefits and costs associated with different payment models - from the perspectives of clients/consumers, funders and service providers - is needed to inform best practice in rehabilitation of compensable workplace injuries. Available but limited evidence suggests that payment models providing financial incentives for stakeholder-agreed vocational rehabilitation outcomes tend to improve service effectiveness in workers' compensation settings, although there is little evidence of service quality or client satisfaction. Working in a system that identifies payments for stakeholder-agreed outcomes may be more satisfying for rehabilitation practitioners in workers' compensation settings by allowing more clinical autonomy and innovative practice. Researchers

  5. Layoffs as part of an optimal incentive mix:

    DEFF Research Database (Denmark)

    Frederiksen, Anders; Takáts, Elöd

    Firms offer highly complex contracts to their employees. These contracts contain a mix of incentives, such as fixed wages, bonus payments, promotion options, and layoff threats. In general, economists understand how incentives motivate employees but not why a particular mix should be used....... In this paper we present a model in which the observed incentive mix is an optimal contract. In particular, we show that it can be optimal for firms to combine cost-efficient incentives such as promotions and bonuses with layoffs. The intuition is that layoffs play a dual role. First, they create incentives...

  6. 38 CFR 36.4319 - Servicer loss-mitigation options and incentives.

    Science.gov (United States)

    2010-07-01

    ... options or alternatives to foreclosure completed: repayment plans, special forbearance agreements, loan modifications, compromise sales, and deeds-in-lieu of foreclosure. Only one incentive payment will be made with.... (b) The amount of the incentive payment is as follows: Tier ranking One Two Three Four Repayment Plan...

  7. Merger and Innovation Incentives in a Differentiated Industry

    OpenAIRE

    Kesavayuth, Dusanee; Lee, Sang-Ho; Zikos, Vasileios

    2017-01-01

    In this paper, we consider a duopoly with product differentiation and examine the interaction between merger and innovation incentives. The analysis reveals that a merger tends to discourage innovation, unless the investment cost is sufficiently low. This result holds whether or not side payments between firms are allowed. When side payments are permitted, a bilateral merger-to-monopoly is always profitable, a standard result in the literature. When side payments are not permitted, however, w...

  8. Incentives for smoking cessation.

    Science.gov (United States)

    Cahill, Kate; Hartmann-Boyce, Jamie; Perera, Rafael

    2015-05-18

    Material or financial incentives are widely used in an attempt to precipitate or reinforce behaviour change, including smoking cessation. They operate in workplaces, in clinics and hospitals, and to a lesser extent within community programmes. In this third update of our review we now include trials conducted in pregnant women, to reflect the increasing activity and resources now targeting this high-risk group of smokers. To determine whether incentives and contingency management programmes lead to higher long-term quit rates. We searched the Cochrane Tobacco Addiction Group Specialised Register, with additional searches of MEDLINE, EMBASE, CINAHL and PsycINFO. The most recent searches were in December 2014, although we also include two trials published in 2015. We considered randomised controlled trials, allocating individuals, workplaces, groups within workplaces, or communities to experimental or control conditions. We also considered controlled studies with baseline and post-intervention measures. We include studies in a mixed-population setting (e.g. community-, work-, institution-based), and also, for this update, trials in pregnant smokers. One author (KC) extracted data and a second (JH-B) checked them. We contacted study authors for additional data where necessary. The main outcome measure in the mixed-population studies was abstinence from smoking at longest follow-up, and at least six months from the start of the intervention. In the trials of pregnant smokers abstinence was measured at the longest follow-up, and at least to the end of the pregnancy. Twenty-one mixed-population studies met our inclusion criteria, covering more than 8400 participants. Ten studies were set in clinics or health centres, one in Thai villages served by community health workers, two in academic institutions, and the rest in worksites. All but six of the trials were run in the USA. The incentives included lottery tickets or prize draws, cash payments, vouchers for goods and

  9. Provider Payment Trends and Methods in the Massachusetts Health Care System

    OpenAIRE

    Allison Barrett; Timothy Lake

    2010-01-01

    This report investigates provider payment methods in Massachusetts. Payments include fee-for-service, the predominant model; global payments, which pay providers a single fee for all or most required services during a contract period; and pay-for-performance models, which layer quality incentives onto payments.

  10. Are health workers motivated by income? Job motivation of Cambodian primary health workers implementing performance-based financing.

    Science.gov (United States)

    Khim, Keovathanak

    2016-01-01

    Financial incentives are widely used in performance-based financing (PBF) schemes, but their contribution to health workers' incomes and job motivation is poorly understood. Cambodia undertook health sector reform from the middle of 2009 and PBF was employed as a part of the reform process. This study examines job motivation for primary health workers (PHWs) under PBF reform in Cambodia and assesses the relationship between job motivation and income. A cross-sectional self-administered survey was conducted on 266 PHWs, from 54 health centers in the 15 districts involved in the reform. The health workers were asked to report all sources of income from public sector jobs and provide answers to 20 items related to job motivation. Factor analysis was conducted to identify the latent variables of job motivation. Factors associated with motivation were identified through multivariable regression. PHWs reported multiple sources of income and an average total income of US$190 per month. Financial incentives under the PBF scheme account for 42% of the average total income. PHWs had an index motivation score of 4.9 (on a scale from one to six), suggesting they had generally high job motivation that was related to a sense of community service, respect, and job benefits. Regression analysis indicated that income and the perception of a fair distribution of incentives were both statistically significant in association with higher job motivation scores. Financial incentives used in the reform formed a significant part of health workers' income and influenced their job motivation. Improving job motivation requires fixing payment mechanisms and increasing the size of incentives. PBF is more likely to succeed when income, training needs, and the desire for a sense of community service are addressed and institutionalized within the health system.

  11. Conjoint Analysis of Farmers’ Response to Conservation Incentives

    Directory of Open Access Journals (Sweden)

    David Conner

    2016-07-01

    Full Text Available Environmental degradation threatens the long term resiliency of the US food and farming system. While USDA has provided conservation incentives for the adoption of best management practices (BMPs, only a small percentage of farms have participated in such conservation programs. This study uses conjoint analysis to examine Vermont farmers’ underlying preferences and willingness-to-accept (WTA incentives for three common BMPs. Based on the results of this survey, we hypothesize that federal cost share programs’ payments are below preferred incentive levels and that less familiar and more complex BMPs require a higher payment. Our implications focus on strategies to test these hypotheses and align incentive payments and other non-monetary options to increase BMP adoption.

  12. Motivating health workers up to a limit: partial effects of performance-based financing on working environments in Nigeria.

    Science.gov (United States)

    Bhatnagar, Aarushi; George, Asha S

    2016-09-01

    In 2012, the Nigerian government launched performance-based financing (PBF) in three districts providing financial incentives to health workers based on the quantity and quality of service provision. They were given autonomy to use funds for operational costs and performance bonuses. This study aims to understand changes in perceived motivation among health workers with the introduction of PBF in Wamba district, Nigeria. The study used a qualitative research design to compare perceptions of health workers in facilities receiving PBF payments in the pilot district of Wamba to those that were not. In-depth semi-structured interviews (n = 39) were conducted with health workers from PBF and non-PBF facilities along with managers of the PBF project. Framework analysis was used to identify patterns and variations in responses. Facility records were collated and triangulated with qualitative data. Health workers receiving PBF payments reported to be 'awakened' by performance bonuses and improved working environments including routine supportive supervision and availability of essential drugs. They recounted being more punctual, hard working and proud of providing better services to their communities. In comparison, health workers in non-PBF facilities complained about the dearth of basic equipment and lack of motivating strategies. However, health workers from both sets of facilities considered there to be a severe shortage of manpower resulting in excessive workload, fatigue and general dissatisfaction. PBF strategies can succeed in motivating health workers by bringing about a change in incentives and working conditions. However, such programmes need to be aligned with human resource reforms including timely recruitment and appropriate distribution of health workers to prevent burn out and attrition. As people working on the frontline of constrained health systems, health workers are responsive to improved incentives and working conditions, but need more

  13. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2015 rates; quality reporting requirements for specific providers; reasonable compensation equivalents for physician services in excluded hospitals and certain teaching hospitals; provider administrative appeals and judicial review; enforcement provisions for organ transplant centers; and electronic health record (EHR) incentive program. Final rule.

    Science.gov (United States)

    2014-08-22

    are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. In addition, we are making technical corrections to the regulations governing provider administrative appeals and judicial review; updating the reasonable compensation equivalent (RCE) limits, and revising the methodology for determining such limits, for services furnished by physicians to certain teaching hospitals and hospitals excluded from the IPPS; making regulatory revisions to broaden the specified uses of Medicare Advantage (MA) risk adjustment data and to specify the conditions for release of such risk adjustment data to entities outside of CMS; and making changes to the enforcement procedures for organ transplant centers. We are aligning the reporting and submission timelines for clinical quality measures for the Medicare HER Incentive Program for eligible hospitals and critical access hospitals (CAHs) with the reporting and submission timelines for the Hospital IQR Program. In addition, we provide guidance and clarification of certain policies for eligible hospitals and CAHs such as our policy for reporting zero denominators on clinical quality measures and our policy for case threshold exemptions. In this document, we are finalizing two interim final rules with comment period relating to criteria for disproportionate share hospital uncompensated care payments and extensions of temporary changes to the payment adjustment for low-volume hospitals and of the Medicare-Dependent, Small Rural Hospital (MDH) Program.

  14. Payment - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Payment measures – national data. This data set includes national-level data for the payment measures associated with an episode of care for heart attack, heart...

  15. Payment - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Payment measures – state data. This data set includes state-level data for the payment measures associated with an episode of care for heart attack, heart failure,...

  16. 41 CFR 302-14.102 - What factors should we consider in determining whether to establish a home marketing incentive...

    Science.gov (United States)

    2010-07-01

    ... consider in determining whether to establish a home marketing incentive payment program? 302-14.102 Section 302-14.102 Public Contracts and Property Management Federal Travel Regulation System RELOCATION ALLOWANCES RESIDENCE TRANSACTION ALLOWANCES 14-HOME MARKETING INCENTIVE PAYMENTS Agency Responsibilities...

  17. DSM shareholder incentives: Current designs and economic theory

    International Nuclear Information System (INIS)

    Stoft, S.; Eto, J.; Kito, S.

    1995-01-01

    This report reviews recent DSM shareholder incentive designs and performance at 10 US utilities identifies opportunities for regulators to improve the design of DSM shareholder incentive mechanisms to increase the procurement of cost-effective DSM resources. We develop six recommendations: (1) apply shared-savings incentives to DSM resource programs; (2) use markup incentives for individual programs only when net benefits are difficult to measure, but are known to be positive; (3) set expected incentive payments based on covering a utility's open-quotes hidden costs,close quotes which include some transitional management and risk-adjusted opportunity costs; (4) use higher marginal incentives rates than are currently found in practice, but limit total incentive payments by adding a fixed charge; (5) mitigate risks to regulators and utilities by lowering marginal incentive rates at high and low performance levels; and (6) use an aggregate incentive mechanism for all DSM resource programs, with limited exceptions (e.g., information programs where markups are more appropriate)

  18. Aligning ambition and incentives

    DEFF Research Database (Denmark)

    Koch, Alexander; Peyrache, Eloïc

    2011-01-01

    Labor turnover creates longer term career concerns incentives that motivate employees in addition to the short term monetary incentives provided by the current employer. We analyze how these incentives interact, and derive implications for the design of incentive contracts and organizational choice...

  19. Aligning Ambition and Incentives

    DEFF Research Database (Denmark)

    Koch, Alexander; Peyrache, Eloïc

    Labor turnover creates longer term career concerns incentives that motivate employees in addition to the short term monetary incentives provided by the current employer. We analyze how these incentives interact and derive implications for the design of incentive contracts and organizational choice...

  20. Specialty Payment Model Opportunities and Assessment

    Science.gov (United States)

    Mulcahy, Andrew W.; Chan, Chris; Hirshman, Samuel; Huckfeldt, Peter J.; Kofner, Aaron; Liu, Jodi L.; Lovejoy, Susan L.; Popescu, Ioana; Timbie, Justin W.; Hussey, Peter S.

    2015-01-01

    Abstract Gastroenterology and cardiology services are common and costly among Medicare beneficiaries. Episode-based payment, which aims to create incentives for high-quality, low-cost care, has been identified as a promising alternative payment model. This article describes research related to the design of episode-based payment models for ambulatory gastroenterology and cardiology services for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services (CMS). The authors analyzed Medicare claims data to describe the frequency and characteristics of gastroenterology and cardiology index procedures, the practices that delivered index procedures, and the patients that received index procedures. The results of these analyses can help inform CMS decisions about the definition of episodes in an episode-based payment model; payment adjustments for service setting, multiple procedures, or other factors; and eligibility for the payment model. PMID:28083363

  1. Fee-for-service will remain a feature of major payment reforms, requiring more changes in Medicare physician payment.

    Science.gov (United States)

    Ginsburg, Paul B

    2012-09-01

    Many health policy analysts envision provider payment reforms currently under development as replacements for the traditional fee-for-service payment system. Reforms include per episode bundled payment and elements of capitation, such as global payments or accountable care organizations. But even if these approaches succeed and are widely adopted, the core method of payment to many physicians for the services they provide is likely to remain fee-for-service. It is therefore critical to address the current shortcomings in the Medicare physician fee schedule, because it will affect physician incentives and will continue to play an important role in determining the payment amounts under payment reform. This article reviews how the current payment system developed and is applied, and it highlights areas that require careful review and modification to ensure the success of broader payment reform.

  2. Economic Incentives, Perceptions and Compliance with Marine Turtle Egg Harvesting Regulation in Nicaragua

    Directory of Open Access Journals (Sweden)

    Róger Madrigal-Ballestero

    2017-01-01

    Full Text Available La Flor Wildlife Refuge and nearby beaches on the Pacific coast of Nicaragua are important nesting sites for various species of endangered marine turtles. However, illegal harvesting of turtle eggs threatens the survival of marine turtles. In this study, we analysed the different motivations of local villagers for complying with a ban on harvesting marine turtle eggs in a context, in which government authorities do not have the means to fully enforce existing regulations. We also analysed the effectiveness and the participation of locals in an incipient performance-based nest conservation payment programme to protect turtle eggs. The analysis of survey-based data from 180 households living in Ostional, the largest village near La Flor Wildlife Refuge, indicates remarkable socio-economic differences between harvesters and non-harvesters. Our findings suggest that harvesters are associated mainly with a lack of income from other activities and the absence of productive assets, such as land for cattle and/or agriculture. In addition, the lack of legitimacy of prevailing institutions (i.e., actual regulations also seems to perpetuate illegal harvesting. The performance-based payments programme is an effective option for protecting nests on isolated beaches, however, it is not clear if it changes harvesting behaviour overall. Normative motivations to protect the turtles are important determinants of participation in this programme, although the financial reward is also an important incentive, particularly since most participants who are egg harvesters depend on this activity as their main source of income.

  3. Effects of physician payment reform on provision of home dialysis.

    Science.gov (United States)

    Erickson, Kevin F; Winkelmayer, Wolfgang C; Chertow, Glenn M; Bhattacharya, Jay

    2016-06-01

    Patients with end-stage renal disease can receive dialysis at home or in-center. In 2004, CMS reformed physician payment for in-center hemodialysis care from a capitated to a tiered fee-for-service model, augmenting physician payment for frequent in-center visits. We evaluated whether payment reform influenced dialysis modality assignment. Cohort study of patients starting dialysis in the United States in the 3 years before and the 3 years after payment reform. We conducted difference-in-difference analyses comparing patients with traditional Medicare coverage (who were affected by the policy) to others with Medicare Advantage (who were unaffected by the policy). We also examined whether the policy had a more pronounced influence on dialysis modality assignment in areas with lower costs of traveling to dialysis facilities. Patients with traditional Medicare coverage experienced a 0.7% (95% CI, 0.2%-1.1%; P = .003) reduction in the absolute probability of home dialysis use following payment reform compared with patients with Medicare Advantage. Patients living in areas with larger dialysis facilities (where payment reform made in-center hemodialysis comparatively more lucrative for physicians) experienced a 0.9% (95% CI, 0.5%-1.4%; P home dialysis use following payment reform compared with patients living in areas with smaller facilities (where payment reform made in-center hemodialysis comparatively less lucrative for physicians). The transition from a capitated to a tiered fee-for-service payment model for in-center hemodialysis care resulted in fewer patients receiving home dialysis. This area of policy failure highlights the importance of considering unintended consequences of future physician payment reform efforts.

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

    Science.gov (United States)

    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…

  5. Economic incentives to promote innovation in healthcare delivery.

    Science.gov (United States)

    Luft, Harold S

    2009-10-01

    Economics influences how medical care is delivered, organized, and progresses. Fee-for-service payment encourages delivery of services. Fee-for-individual-service, however, offers no incentives for clinicians to efficiently organize the care their patients need. Global capitation provides such incentives; it works well in highly integrated practices but not for independent practitioners. The failures of utilization management in the 1990s demonstrated the need for a third alternative to better align incentives, such as bundling payment for an episode of care. Building on Medicare's approach to hospital payment, one can define expanded diagnosis-related groups that include all hospital, physician, and other costs during the stay and appropriate preadmission and postdischarge periods. Physicians and hospitals voluntarily forming a new entity (a care delivery team) would receive such bundled payments along with complete flexibility in allocating the funds. Modifications to gainsharing and antikickback rules, as well as reforms to malpractice liability laws, will facilitate the functioning of the care delivery teams. The implicit financial incentives encourage efficient care for the patient; the episode focus will facilitate measuring patient outcomes. Payment can be based on the resources used by those care delivery teams achieving superior outcomes, thereby fostering innovation improving outcomes and reducing waste.

  6. Payment Platform

    DEFF Research Database (Denmark)

    Hjelholt, Morten; Damsgaard, Jan

    2012-01-01

    thoroughly and substitute current payment standards in the decades to come. This paper portrays how digital payment platforms evolve in socio-technical niches and how various technological platforms aim for institutional attention in their attempt to challenge earlier platforms and standards. The paper...... applies a co-evolutionary multilevel perspective to model the interplay and processes between technology and society wherein digital payment platforms potentially will substitute other payment platforms just like the credit card negated the check. On this basis this paper formulate a multilevel conceptual...

  7. Episodic payments (bundling): PART I.

    Science.gov (United States)

    Jacofsky, D J

    2017-10-01

    Episodic, or bundled payments, is a concept now familiar to most in the healthcare arena, but the models are often misunderstood. Under a traditional fee-for-service model, each provider bills separately for their services which creates financial incentives to maximise volumes. Under a bundled payment, a single entity, often referred to as a convener (maybe the hospital, the physician group, or a third party) assumes the risk through a payer contract for all services provided within a defined episode of care, and receives a single (bundled) payment for all services provided for that episode. The time frame around the intervention is variable, but defined in advance, as are included and excluded costs. Timing of the actual payment in a bundle may either be before the episode occurs (prospective payment model), or after the end of the episode through a reconciliation (retrospective payment model). In either case, the defined costs over the defined time frame are borne by the convener. Cite this article: Bone Joint J 2017;99-B:1280-5. ©2017 The British Editorial Society of Bone & Joint Surgery.

  8. Performance-Based Funding Brief

    Science.gov (United States)

    Washington Higher Education Coordinating Board, 2011

    2011-01-01

    A number of states have made progress in implementing performance-based funding (PFB) and accountability. This policy brief summarizes main features of performance-based funding systems in three states: Tennessee, Ohio, and Indiana. The brief also identifies key issues that states considering performance-based funding must address, as well as…

  9. The Effect of Financial Incentives on Quality of Care: The Case of Diabetes

    OpenAIRE

    Anthony Scott; Stefanie Schurer; Paul H. Jensen; Peter Sivey

    2008-01-01

    Australia introduced an incentive payment scheme for general practitioners to ensure systematic and high quality care in chronic disease management. There is little empirical evidence and ambiguous theoretical guidance on which effects to expect on the quality of care. This paper evaluates the impact of the payment incentives on quality of care in diabetes, as measured by the probability of ordering an HbA1c test. The empirical analysis is conducted with a unique data set and a multivariate p...

  10. The Effects of Financial Incentives on Quality of Care: The Case of Diabetes

    OpenAIRE

    Scott, A; Schurer, S; Jensen, P H; Sivey, P

    2008-01-01

    Australia introduced an incentive payment scheme for general practitioners to ensure systematic and high quality care in chronic disease management. There is little empirical evidence and ambiguous theoretical guidance on which effects to expect on the quality of care. This paper evaluates the impact of the payment incentives on quality of care in diabetes, as measured by the probability of ordering an HbA1c test. The empirical analysis is conducted with a unique data set and a multivariate p...

  11. ANALYSIS OF ALTERNATIVE PAYMENT DESIGNS FOR FARMLAND DEVELOPMENT RIGHTS

    OpenAIRE

    Hanson, Steven D.

    1999-01-01

    Four alternative payment rules were examined to evaluate their ability to accomplish the objectives of the development rights purchase program. Paying the true economic value for the development rights does not allow the program to target high quality agricultural land. Modifying the payment strategy by offering a minimum payment will provide some extra incentive for high quality agricultural land in areas with little development pressure, but will provide little help in areas with high devel...

  12. Incentive delegation and collusion

    NARCIS (Netherlands)

    Mukherjee, A.

    2000-01-01

    In an infinitely repeated duopoly the implications of strategic incentive delegation are shown. Whether incentive delegation makes consumers or producers better-off depends on the nature of competition. WeThe presence or absence of incentive delegation may affect the interests of the consumers and

  13. Medicare Program; End-Stage Renal Disease Prospective Payment System, Coverage and Payment for Renal Dialysis Services Furnished to Individuals With Acute Kidney Injury, End-Stage Renal Disease Quality Incentive Program, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program Bid Surety Bonds, State Licensure and Appeals Process for Breach of Contract Actions, Durable Medical Equipment, Prosthetics, Orthotics and Supplies Competitive Bidding Program and Fee Schedule Adjustments, Access to Care Issues for Durable Medical Equipment; and the Comprehensive End-Stage Renal Disease Care Model. Final rule.

    Science.gov (United States)

    2016-11-04

    This rule updates and makes revisions to the End-Stage Renal Disease (ESRD) Prospective Payment System (PPS) for calendar year 2017. It also finalizes policies for coverage and payment for renal dialysis services furnished by an ESRD facility to individuals with acute kidney injury. This rule also sets forth requirements for the ESRD Quality Incentive Program, including the inclusion of new quality measures beginning with payment year (PY) 2020 and provides updates to programmatic policies for the PY 2018 and PY 2019 ESRD QIP. This rule also implements statutory requirements for bid surety bonds and state licensure for the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program (CBP). This rule also expands suppliers' appeal rights in the event of a breach of contract action taken by CMS, by revising the appeals regulation to extend the appeals process to all types of actions taken by CMS for a supplier's breach of contract, rather than limit an appeal for the termination of a competitive bidding contract. The rule also finalizes changes to the methodologies for adjusting fee schedule amounts for DMEPOS using information from CBPs and for submitting bids and establishing single payment amounts under the CBPs for certain groupings of similar items with different features to address price inversions. Final changes also are made to the method for establishing bid limits for items under the DMEPOS CBPs. In addition, this rule summarizes comments on the impacts of coordinating Medicare and Medicaid Durable Medical Equipment for dually eligible beneficiaries. Finally, this rule also summarizes comments received in response to a request for information related to the Comprehensive ESRD Care Model and future payment models affecting renal care.

  14. Commercialization of biomass energy projects: Outline for maximizing use of valuable tax credits and incentives

    International Nuclear Information System (INIS)

    Sanderson, G.A.

    1994-01-01

    The Federal Government offers a number of incentives designed specifically to promote biomass energy. These incentives include various tax credits, deductions and exemptions, as well as direct subsidy payments and grants. Additionally, equipment manufacturers and project developers may find several other tax provisions useful, including tax incentives for exporting U.S. good and engineering services, as well as incentives for the development of new technologies. This paper outlines the available incentives, and also addresses ways to coordinate the use of tax breaks with government grants and tax-free bond financing in order to maximize benefits for biomass energy projects

  15. Salary administration as part of employee incentive system at industrial enterprises

    Directory of Open Access Journals (Sweden)

    Sagandykov Michail

    2017-01-01

    Full Text Available The article analyses the financial staff incentives at industrial enterprises. The paper concludes that the incentive system should be developed taking into account the developed staff motivation. The only efficient target of influence is the existing staff motivation components. A 3-element employee incentive framework for industrial enterprises is suggested. The article presents the critical analysis of the existing payroll systems of several industrial enterprises, elicits the common flaws of the incentive payments, and develops requirements for such systems. The paper also provides an industrial enterprise needs matrix and an incentive payment types matrix required to build up a rational monetary staff incentive system. These matrices can be adapted for any industrial enterprise with regard to its long-term objectives.

  16. 75 FR 1843 - Medicare and Medicaid Programs; Electronic Health Record Incentive Program

    Science.gov (United States)

    2010-01-13

    ... Payment Calculation for Eligible Hospitals c. Medicare Share d. Charity Care e. Transition Factor f...) and eligible hospitals participating in Medicare and Medicaid programs that adopt and meaningfully use... an EP and eligible hospital must meet in order to qualify for the incentive payment; calculation of...

  17. Effects of Physician Payment Reform on Provision of Home Dialysis

    Science.gov (United States)

    Erickson, Kevin F.; Winkelmayer, Wolfgang C.; Chertow, Glenn M.; Bhattacharya, Jay

    2016-01-01

    Objectives Patients with end-stage renal disease can receive dialysis at home or in-center. In 2004 the Centers for Medicare and Medicaid Services reformed physician payment for in-center hemodialysis care from a capitated to a tiered fee-for-service model, augmenting physician payment for frequent in-center visits. We evaluated whether payment reform influenced dialysis modality assignment. Study Design Cohort study of patients starting dialysis in the US in the three years before and after payment reform. Methods We conducted difference-in-difference analyses comparing patients with Traditional Medicare coverage (who were affected by the policy) to others with Medicare Advantage (who were unaffected by the policy). We also examined whether the policy had a more pronounced influence on dialysis modality assignment in areas with lower costs of traveling to dialysis facilities. Results Patients with Traditional Medicare coverage experienced a 0.7% (95% CI 0.2%–1.1%; p=0.003) reduction in the absolute probability of home dialysis use following payment reform compared to patients with Medicare Advantage. Patients living in areas with larger dialysis facilities (where payment reform made in-center hemodialysis comparatively more lucrative for physicians) experienced a 0.9% (95% CI 0.5%–1.4%; ppayment model for dialysis care resulted in fewer patients receiving home dialysis. This area of policy failure highlights the importance of considering unintended consequences of future physician payment reform efforts. PMID:27355909

  18. Payment Cards

    Directory of Open Access Journals (Sweden)

    Kantnerová Liběna

    2016-09-01

    Full Text Available The aim of this paper is to analyze the use of payment cards in retail in the Czech Republic from the side of clients (buyers and the side of sellers. Questionnaires for clients examine satisfaction with cards and the service connected with them. Sellers’ satisfaction with the profit and function of cards is analyzed. The data indicated that 92% of the 352 respondents in South Bohemia had a payment card and more than 35% had more than one card. In retail, 70% of sellers had a payment terminal.

  19. 12 CFR 2.4 - Bonus and incentive plans.

    Science.gov (United States)

    2010-01-01

    ... plan based on the sale of credit life insurance if payments to the employee or officer in any one year... 12 Banks and Banking 1 2010-01-01 2010-01-01 false Bonus and incentive plans. 2.4 Section 2.4 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY SALES OF CREDIT LIFE INSURANCE...

  20. Designing Scholarships to Improve College Success: Final Report on the Performance-Based Scholarship Demonstration

    Science.gov (United States)

    Mayer, Alexander K.; Patel, Reshma; Rudd, Timothy; Ratledge, Alyssa

    2015-01-01

    Performance-based scholarships have two main goals: (1) to give students more money for college; and (2) to provide incentives for academic progress. MDRC launched the Performance-Based Scholarship (PBS) Demonstration in 2008 to evaluate the effectiveness of these scholarships in a diverse set of states, institutions, and low-income student…

  1. The cost of policy simplification in conservation incentive programs

    DEFF Research Database (Denmark)

    Armsworth, Paul R.; Acs, Szvetlana; Dallimer, Martin

    2012-01-01

    of biodiversity. Common policy simplifications result in a 49100% loss in biodiversity benefits depending on the conservation target chosen. Failure to differentiate prices for conservation improvements in space is particularly problematic. Additional implementation costs that accompany more complicated policies......Incentive payments to private landowners provide a common strategy to conserve biodiversity and enhance the supply of goods and services from ecosystems. To deliver cost-effective improvements in biodiversity, payment schemes must trade-off inefficiencies that result from over-simplified policies...... with the administrative burden of implementing more complex incentive designs. We examine the effectiveness of different payment schemes using field parameterized, ecological economic models of extensive grazing farms. We focus on profit maximising farm management plans and use bird species as a policy-relevant indicator...

  2. Adapting Evaluations of Alternative Payment Models to a Changing Environment.

    Science.gov (United States)

    Grannemann, Thomas W; Brown, Randall S

    2018-04-01

    To identify the most robust methods for evaluating alternative payment models (APMs) in the emerging health care delivery system environment. We assess the impact of widespread testing of alternative payment models on the ability to find credible comparison groups. We consider the applicability of factorial research designs for assessing the effects of these models. The widespread adoption of alternative payment models could effectively eliminate the possibility of comparing APM results with a "pure" control or comparison group unaffected by other interventions. In this new environment, factorial experiments have distinct advantages over the single-model experimental or quasi-experimental designs that have been the mainstay of recent tests of Medicare payment and delivery models. The best prospects for producing definitive evidence of the effects of payment incentives for APMs include fractional factorial experiments that systematically vary requirements and payment provisions within a payment model. © Health Research and Educational Trust.

  3. Centers for medicare and medicaid services: using an episode-based payment model to improve oncology care.

    Science.gov (United States)

    Kline, Ronald M; Bazell, Carol; Smith, Erin; Schumacher, Heidi; Rajkumar, Rahul; Conway, Patrick H

    2015-03-01

    Cancer is a medically complex and expensive disease with costs projected to rise further as new treatment options increase and the United States population ages. Studies showing significant regional variation in oncology quality and costs and model tests demonstrating cost savings without adverse outcomes suggest there are opportunities to create a system of oncology care in the US that delivers higher quality care at lower cost. The Centers for Medicare and Medicaid Services (CMS) have designed an episode-based payment model centered around 6 month periods of chemotherapy treatment. Monthly per-patient care management payments will be made to practices to support practice transformation, including additional patient services and specific infrastructure enhancements. Quarterly reporting of quality metrics will drive continuous quality improvement and the adoption of best practices among participants. Practices achieving cost savings will also be eligible for performance-based payments. Savings are expected through improved care coordination and appropriately aligned payment incentives, resulting in decreased avoidable emergency department visits and hospitalizations and more efficient and evidence-based use of imaging, laboratory tests, and therapeutic agents, as well as improved end of life care. New therapies and better supportive care have significantly improved cancer survival in recent decades. This has come at a high cost, with cancer therapy consuming $124 billion in 2010. CMS has designed an episode-based model of oncology care that incorporates elements from several successful model tests. By providing care management and performance based payments in conjunction with quality metrics and a rapid learning environment, it is hoped that this model will demonstrate how oncology care in the US can transform into a high value, high quality system. Copyright © 2015 by American Society of Clinical Oncology.

  4. Marine Corps Pay Incentives

    Science.gov (United States)

    Marines from 2000 to 2017. The thesis includes a literature review on economic theory related to pay incentives in the Department of Defense, a...The purpose of this thesis to provide the Marine Corps with a comprehensive report on pay incentive programs and special pay that were available to...summarization of pay incentive categories, a data analysis on take-up rates and average annual amounts at the end of each fiscal year, and a program review

  5. Incentive-Based Primary Care: Cost and Utilization Analysis.

    Science.gov (United States)

    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.

  6. Investment incentives in the Korean electricity market

    International Nuclear Information System (INIS)

    Park, Jung-Yeon; Ahn, Nam-Sung; Yoon, Yong-Beum; Koh, Kyung-Ho; Bunn, Derek W.

    2007-01-01

    This paper develops a model-based analysis of the effects of various capacity incentive systems on new investment in the Korean electricity market. The restructuring process in Korea allocated power generation to six firms, competing within a wholesale market, albeit strictly on a cost basis. Because of this cost-based pool, capacity payments were also introduced to encourage new investment. However, it is an open question whether the current fixed capacity payment scheme is enough to secure resource adequacy, and consideration is being given to alternative mechanisms such as the use of LOLP. Using a detailed market simulation model, based on system dynamics, we compare these approaches in terms of how they may influence the investors' decisions and thereby determine the system reserve margin. The simulation results suggest that there may be serious problems in staying with the current fixed capacity payments in order to achieve resource adequacy. In contrast, an LOLP-based capacity mechanism may, in the longer term, increase the reserve margin compared with a fixed capacity payment. More generally, this paper indicates how crucial the effective modeling of the investment behavior of the independent power producers is for adequate policy support, even if they only constitute a fringe in a substantially centrally influenced market

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

    Science.gov (United States)

    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.

  8. Contingent valuation and incentives

    Science.gov (United States)

    Patricia A. Champ; Nicholas E. Flores; Thomas C. Brown; James Chivers

    2002-01-01

    We empirically investigate the effect of the payment mechanism on contingent values by asking a willingness-to-pay question with one of three different payment mechanisms: individual contribution, contribution with provision point, and referendum. We find statistical evidence of more affirmative responses in the referendum treatment relative to the individual...

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

    Science.gov (United States)

    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 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 financial incentives with additional efforts to address the needs of practices with less experience with such incentives to promote value-based payment

  10. Bundling Post-Acute Care Services into MS-DRG Payments

    Data.gov (United States)

    U.S. Department of Health & Human Services — A bundled hospital payment system that encompasses both acute and post-acute care has been proposed as a means of creating financial incentives in the Medicare...

  11. Internalizing Externalities through Payments for Environmental Services

    Directory of Open Access Journals (Sweden)

    Sudarsono Soedomo

    2012-08-01

    Full Text Available Forest ecosystems, including plantation forests, provide goods and services that are marketable and non-marketable. Positive externalities produced by forest ecosystems are rarely considered in pricing of marketable products that result in economic inefficiencies. Internalizing externalities is required to improve the economic efficiency. The traditional way to internalize an externality is by providing subsidies or imposing taxes. Recently, payments for environmental services  are receiving more attention as an instrument for internalizing externalities provided by forest ecosystems. This promising alternative to improve our environment needs to be studied more extensively. In this paper, it can be indicated theoretically that the Pigovian tax, as a traditional way of addressing environmental problems, is able to mimic the result derived from the employment of environmental services payment. The difference is that environmental services payment improves the welfare of environmental service producers, whereas the Pigovian tax reduces it. A positive Pigovian tax increases the optimal rotation, which is positively associated with environmental improvement, but certainly reduces forest owner's welfare. This difference should be taken into account in the public policymaking so that perverse incentive may be avoided. Payment for environmental services  as an additional income to forest growers, not as alternative source of income, is a potential tool to address simultaneously issues of environment and poverty that are frequently contested.Keywords: externalities, payments for environmental services, tax, perverse incentive, social welfare

  12. Designing PV Incentive Programs to Promote System Performance: AReview of Current Practice

    Energy Technology Data Exchange (ETDEWEB)

    Barbose, Galen; Wiser, Ryan; Bolinger, Mark

    2006-11-12

    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 of 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

  13. Alternative Payment Models in Radiology: The Legislative and Regulatory Roadmap for Reform.

    Science.gov (United States)

    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.

  14. Fundamental Reform of Payment for Adult Primary Care: Comprehensive Payment for Comprehensive Care

    Science.gov (United States)

    Berenson, Robert A.; Schoenbaum, Stephen C.; Gardner, Laurence B.

    2007-01-01

    Primary care is essential to the effective and efficient functioning of health care delivery systems, yet there is an impending crisis in the field due in part to a dysfunctional payment system. We present a fundamentally new model of payment for primary care, replacing encounter-based imbursement with comprehensive payment for comprehensive care. Unlike former iterations of primary care capitation (which simply bundled inadequate fee-for-service payments), our comprehensive payment model represents new investment in adult primary care, with substantial increases in payment over current levels. The comprehensive payment is directed to practices to include support for the modern systems and teams essential to the delivery of comprehensive, coordinated care. Income to primary physicians is increased commensurate with the high level of responsibility expected. To ensure optimal allocation of resources and the rewarding of desired outcomes, the comprehensive payment is needs/risk-adjusted and performance-based. Our model establishes a new social contract with the primary care community, substantially increasing payment in return for achieving important societal health system goals, including improved accessibility, quality, safety, and efficiency. Attainment of these goals should help offset and justify the costs of the investment. Field tests of this and other new models of payment for primary care are urgently needed. PMID:17356977

  15. Participatory development of incentives to coexist with jaguars and pumas.

    Science.gov (United States)

    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.

  16. The effect of explicit financial incentives on physician behavior.

    Science.gov (United States)

    Armour, B S; Pitts, M M; Maclean, R; Cangialose, C; Kishel, M; Imai, H; Etchason, J

    2001-05-28

    Managed care organizations use explicit financial incentives to influence physicians' use of resources. This has contributed to concerns regarding conflicts of interest for physicians and adverse effects on the quality of patient care. In light of recent publicized legislative and legal battles about this issue, we reviewed the literature and analyzed studies that examine the effect of these explicit financial incentives on the behavior of physicians. The method used to undertake the literature review followed the approach set forth in the Cochrane Collaboration handbook. Our literature review revealed a paucity of data on the effect of explicit financial incentives. Based on this limited evidence, explicit incentives that place individual physicians at financial risk appear to be effective in reducing physician resource use. However, the empirical evidence regarding the effectiveness of bonus payments on physician resource use is mixed. Similarly, our review revealed mixed effects of the influence of explicit financial incentives on the quality of patient care. The effect of explicit financial incentives on physician behavior is complicated by a lack of understanding of the incentive structure by the managed care organization and the physician. The lack of a universally acceptable definition of quality renders it important that future researchers identify the term explicitly.

  17. Rewards and Performance Incentives.

    Science.gov (United States)

    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)

  18. Tax Incentives and Borrowing

    DEFF Research Database (Denmark)

    Alan, Sule; Leth-Petersen, Søren; Munk-Nielsen, Anders

    2016-01-01

    We estimate the effect of a Danish 1987 tax reform, which reduced the tax rate applied to interest deductions from 73% to 50% for households with high incomes, but less for households with middle or low incomes. Using high quality panel data we find that households responded to the reduced tax su...... subsidy by lowering interest payments and we find that the responsiveness to the tax subsidy varies by the initial level of interest payments....

  19. Value-Based Payment Reform and the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015: A Primer for Plastic Surgeons.

    Science.gov (United States)

    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.

  20. Incentive Use in Research: Protecting Vulnerable Populations from Exploitation

    Directory of Open Access Journals (Sweden)

    Haruna Muwonge

    2013-06-01

    Full Text Available Global investment in Medical Research and Development has markedly increased in the last few decades. However, due to the decreasing public altruism, researchers have come under increased pressures from the funding bodies to produce results. Out of desperation, some researchers have resorted to using incentives as a means of sourcing for volunteers. Consequently, the research burden has disproportionately been shared among the most vulnerable populations in the society. Incentives especially monetary ones present an ethical dilemma because of the uncertainties’ surrounding the morality, amount and type of payment, vulnerability of volunteers and possible threats to voluntary participation. Several studies done on the use of incentives in medical research have noted that financial motivation was the number one reason for subjects to volunteer in Medical research. Mutual benefit and freedom of choice by participants were given as reasons to support their use. However, scientists who are against the use of incentives believe that they are coercive or undue inducements, and may influence a subjects’ ability to give an informed consent. Guidelines exist that protect vulnerable groups from exploitation, although none sheds light into the use of incentives. Nonetheless, in the face of the waning public altruism, the benefits of using incentives far outweigh the dangers, although researchers should avoid situations where their use may become problematic. As a mode of payment to research subjects, researchers should adopt a combination of the Dickerts’ Wage and re-imbursement models as guides in quantifying the incentive. [Archives Medical Review Journal 2013; 22(3.000: 408-417

  1. 42 CFR 495.320 - FFP for payments to Medicaid providers.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false FFP for payments to Medicaid providers. 495.320 Section 495.320 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN... INCENTIVE PROGRAM Requirements Specific to the Medicaid Program § 495.320 FFP for payments to Medicaid...

  2. The incentive regulation in the network management. A cross-sectorial investigation of the network managements energy, telecommunication and railway; Die Anreizregulierung in den Netzwirtschaften. Eine sektoruebergreifende Untersuchung der Netzwirtschaften Energie, Telekommunikation und Eisenbahn

    Energy Technology Data Exchange (ETDEWEB)

    Berndt, Andrea

    2011-07-01

    The author of the book under consideration reports on a cross-sectoral analysis of network management of energy, telecommunications and railways with regard to incentive regulation. The cross-sectoral analysis of incentive regulation requires a systematization of the instrument of payment regulation. Using the example of the incentive regulation, the author provides a rather jurisprudential contribution to a network management dogma.

  3. How Incentives Affect the Adoption of Anaerobic Digesters in the United States

    Directory of Open Access Journals (Sweden)

    Anh Sam

    2017-07-01

    Full Text Available Various government incentives support the adoption of anaerobic digester systems to manage farm waste and serve as a source of renewable energy in the United States. We examine the effectiveness of US state-level incentives promoting the adoption of anaerobic digester systems. We find that performance-based incentives and adoption of renewable portfolio standards best promote anaerobic digester system adoption.

  4. ADVANCE PAYMENTS

    CERN Multimedia

    Human Resources Division

    2002-01-01

    Administrative Circular Nº 8 makes provision for the granting of advance payments, repayable in several monthly instalments, by the Organization to the members of its personnel. Members of the personnel are reminded that these advances are only authorized in exceptional circumstances and at the discretion of the Director-General. In view of the current financial situation of the Organization, and in particular the loans it will have to incur, the Directorate has decided to restrict the granting of such advances to exceptional or unforeseen circumstances entailing heavy expenditure and more specifically those pertaining to social issues. Human Resources Division Tel. 73962

  5. Advance payments

    CERN Multimedia

    Human Resources Division

    2003-01-01

    Administrative Circular N 8 makes provision for the granting of advance payments, repayable in several monthly instalments, by the Organization to the members of its personnel. Members of the personnel are reminded that these advances are only authorized in exceptional circumstances and at the discretion of the Director-General. In view of the current financial situation of the Organization, and in particular the loans it will have to incur, the Directorate has decided to restrict the granting of such advances to exceptional or unforeseen circumstances entailing heavy expenditure and more specifically those pertaining to social issues. Human Resources Division Tel. 73962

  6. Drilling contracts and incentives

    International Nuclear Information System (INIS)

    Osmundsen, Petter; Sorenes, Terje; Toft, Anders

    2008-01-01

    Shortages of rigs and personnel have encouraged discussion of designing incentive contracts in the drilling sector. However, for the drilling contracts, there are not a large variety of contract types in use. This article describes and analyses incentives for drilling contractors. These are directly represented by the compensation formats utilised in the present and in the consecutive drilling contracts. Indirectly, incentives are also provided by the evaluation criteria that oil companies use for awarding drilling assignments. Changes in contract format pose a number of relevant questions relating to resource management, and the article takes an in-depth look at some of these. Do evaluation criteria for awarding drilling assignments encourage the development of new technology and solutions? How will a stronger focus on drilling efficiency influence reservoir utilisation?

  7. Payments for watershed services: opportunities and realities

    Energy Technology Data Exchange (ETDEWEB)

    Bond, Ivan

    2007-08-15

    Many nations have found that regulatory approaches to land and water management have limited impact. An alternative is to create incentives for sound management - under mechanisms known as payments for ecosystem services. It is a simple idea: people who look after ecosystems that benefit others should be recognised and rewarded. In the case of watersheds, downstream beneficiaries of wise upstream land and water use should compensate the stewards. To be effective these 'payments for watershed services' must cover the cost of watershed management. In developing countries, they might also aid local development and reduce poverty. But new research shows that the problems in watersheds are complex and not easily solved. Payments for watershed services do not guarantee poverty reduction and cannot replace the best aspects of regulation.

  8. Perceptions and experiences of financial incentives: a qualitative study of dialysis care in England.

    Science.gov (United States)

    Abma, Inger; Jayanti, Anuradha; Bayer, Steffen; Mitra, Sandip; Barlow, James

    2014-02-12

    The objective of the study was to understand the extent to which financial incentives such as Payment by Results and other payment mechanisms motivate kidney centres in England to change their practices. The study followed a qualitative design. Data collection involved 32 in-depth semistructured interviews with healthcare professionals and managers, focusing on their subjective experience of payment structures. Participants were kidney healthcare professionals, clinical directors, kidney centre managers and finance managers. Healthcare commissioners from different parts of England were also interviewed. Participants worked at five kidney centres from across England. The selection was based on the prevalence of home haemodialysis, ranging from low (8%) prevalence, with at least one centre in each one of these categories at the time of selection. While the tariff for home haemodialysis is not a clear incentive for its adoption due to uncertainty about operational costs, Commissioning for Quality and Innovation (CQUIN) targets and the Best Practice Tariff for vascular access were seen by our case study centres as a motivator to change practices. The impact of financial incentives designed at a policy level is influenced by the understanding of cost and benefits at the local operational level. In a situation where costs are unclear, incentives which are based on the improvement of profit margins have a smaller impact than incentives which provide an additional direct payment, even if this extra financial support is relatively small.

  9. The Performance-based Funding Scheme of Universities

    Directory of Open Access Journals (Sweden)

    Juha KETTUNEN

    2016-05-01

    Full Text Available The purpose of this study is to analyse the effectiveness of the performance-based funding scheme of the Finnish universities that was adopted at the beginning of 2013. The political decision-makers expect that the funding scheme will create incentives for the universities to improve performance, but these funding schemes have largely failed in many other countries, primarily because public funding is only a small share of the total funding of universities. This study is interesting because Finnish universities have no tuition fees, unlike in many other countries, and the state allocates funding based on the objectives achieved. The empirical evidence of the graduation rates indicates that graduation rates increased when a new scheme was adopted, especially among male students, who have more room for improvement than female students. The new performance-based funding scheme allocates the funding according to the output-based indicators and limits the scope of strategic planning and the autonomy of the university. The performance-based funding scheme is transformed to the strategy map of the balanced scorecard. The new funding scheme steers universities in many respects but leaves the research and teaching skills to the discretion of the universities. The new scheme has also diminished the importance of the performance agreements between the university and the Ministry. The scheme increases the incentives for universities to improve the processes and structures in order to attain as much public funding as possible. It is optimal for the central administration of the university to allocate resources to faculties and other organisational units following the criteria of the performance-based funding scheme. The new funding scheme has made the universities compete with each other, because the total funding to the universities is allocated to each university according to the funding scheme. There is a tendency that the funding schemes are occasionally

  10. Cost incentives for doctors

    DEFF Research Database (Denmark)

    Schottmüller, Christoph

    2013-01-01

    If doctors take the costs of treatment into account when prescribing medication, their objectives differ from their patients' objectives because the patients are insured. This misalignment of interests hampers communication between patient and doctor. Giving cost incentives to doctors increases...... welfare if (i) the doctor's examination technology is sufficiently good or (ii) (marginal) costs of treatment are high enough. If the planner can costlessly choose the extent to which doctors take costs into account, he will opt for less than 100%. Optimal health care systems should implement different...... degrees of cost incentives depending on type of disease and/or doctor....

  11. Incentives and Earnings Growth

    DEFF Research Database (Denmark)

    Frederiksen, Anders

    2013-01-01

    The career prospects of newly recruited employees differ substantially within an organization. The stars experience considerable growth in earnings; others can hardly maintain their entry salaries. This article sheds light on the mechanisms generating the observed heterogeneity in earnings growth...... by investigating the effects that explicit short-run incentives and implicit incentives have on earnings growth. The model’s predictions are tested using personnel records from a large bank and are found to be consistent with the observed earnings growth during the first half of the employees’ careers....

  12. Three experiments exploring how preferences, motivations and incentives influence behaviour

    OpenAIRE

    ZACHARY JAMES MOAR DORNER

    2018-01-01

    We can make better choices with a deeper understanding of what drives our behaviours. This thesis uses economic experiments to shed light on health and environmental behaviours. The first paper identifies that risk averse people care about the security of supply of city water. The second paper finds that small monetary payments can work better than high monetary payments for motivating people because large incentives can significantly reduce intrinsic motivation. The third paper shows that mo...

  13. Federal tax incentives affecting coal and nuclear power economics

    International Nuclear Information System (INIS)

    Chapman, D.

    1982-01-01

    This paper analyzes the effect of federal corporate income tax incentives on coal and nuclear power developments. It estimates (1) the magnitudes of tax incentives in relationship to utility costs, (2) the relative magnitude of benefits going to coal and nuclear facilities, and (3) the influence which the time paths of tax payments and after-tax net income have upon possible incentives for premature construction and excess capacity. Utility planners currently believe that nuclear power enjoys an after-tax competitive advantage over coal plants. Investigation of investment-related credits, deductions, and exclusions in the Internal Revenue Code shows that nuclear power enjoys a more favorable tax subsidy because of its greater capital intensity. In the absence of tax subsidies, no utility would prefer nuclear power to coal generation. Tax changes now under consideration could increase the tax benefits to both without disturbing the differential advantage held by nuclear power. 43 references, 2 figures, 4 tables

  14. A consideration of user financial incentives to address health inequalities.

    Science.gov (United States)

    Oliver, Adam; Brown, Lawrence D

    2012-04-01

    Health inequalities and user financial incentives to encourage health-related behavior change are two topical issues in the health policy discourse, and this article attempts to combine the two; namely, we try to address whether the latter can be used to reduce the former in the contexts of the United Kingdom and the United States. Payments for some aspects of medical adherence may offer a promising way to address, to some extent, inequalities in health and health care in both countries. However, payments for more sustained behavior change, such as that associated with smoking cessation and weight loss, have thus far shown little long-term effect, although more research that tests the effectiveness of different incentive mechanism designs, informed by the findings of behavioral economics, ought to be undertaken. Many practical, political, ethical, and ideological objections can be waged against user financial incentives in health, and this article reviews a number of them, but the justifiability of and limits to these incentives require more academic and public discourse so as to gain a better understanding of the circumstances in which they can legitimately be used.

  15. Incentives, Selection, and Teacher Performance: Evidence from IMPACT

    Science.gov (United States)

    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…

  16. Are Performance-Based Accountability Systems Effective? Evidence from Five Sectors. Research Brief

    Science.gov (United States)

    Leuschner, Kristin J.

    2010-01-01

    During the past two decades, performance-based accountability systems (PBASs), which link financial or other incentives to measured performance as a means of improving services, have gained popularity among policymakers. Although PBASs can vary widely across sectors, they share three main components: goals (i.e., one or more long-term outcomes to…

  17. Targeting the poorest in a performance-based financing programme in northern Cameroon

    NARCIS (Netherlands)

    I.J.E. Flink (Ilse); Ziebe, R. (Roland); Vagaï, D. (Djebba); Van De Looij, F. (Frank); Van 'T Riet, H. (Hilda); A.J. Houweling (Tanja)

    2016-01-01

    textabstractPerformance-Based Financing (PBF) is a promising approach to improve health system performance in developing countries, but there are concerns that it may inadequately address inequalities in access to care. Incentives for reaching the poor may prove beneficial, but evidence remains

  18. The Massachusetts Community College Performance-Based Funding Formula: A New Model for New England?

    Science.gov (United States)

    Salomon-Fernandez, Yves

    2014-01-01

    The Massachusetts community college system is entering a second year with funding for each of its 15 schools determined using a new performance-based formula. Under the new model, 50% of each college's allocation is based on performance on metrics related to enrollment and student success, with added incentives for "at-risk" students…

  19. Performance-Based Compensation: Linking Performance to Teacher Salaries. Ask the Team

    Science.gov (United States)

    Behrstock-Sherratt, Ellen; Potemski, Amy

    2013-01-01

    To achieve the goal of attracting and retaining talented professionals in education, performance-based compensation systems (PBCS) must offer salaries that are both fair and sufficiently competitive at each point across an educator's career continuum. Although many states, especially with the support of the Teacher Incentive Fund (TIF) grants,…

  20. Persistence to Graduation for Students with Disabilities: Implications for Performance-Based Outcomes

    Science.gov (United States)

    Knight, William; Wessel, Roger D.; Markle, Larry

    2018-01-01

    The study sought to determine whether students with disabilities are disadvantaged because of state and institutional performance-based policies providing incentives for 4-year graduation. In a longitudinal study of 32,187 students at a Midwestern Research University, the retention and graduation rates, and mean years to graduation, of students…

  1. Tax Incentives : Using Tax Incentives to Attract Foreign Direct Investment

    OpenAIRE

    Morisset, Jacques

    2003-01-01

    The increasing mobility of international firms and the gradual elimination of barriers to global capital flows have stimulated competition among governments to attract foreign direct investment, often through tax incentives. This note reviews the debate about the effectiveness of tax incentives, examining two much-contested questions: can tax incentives attract foreign investment? And what...

  2. Incentives for partitioning, revisited

    International Nuclear Information System (INIS)

    Cloninger, M.O.

    1980-01-01

    The incentives for separating and eliminating various elements from radioactive waste prior to final geologic disposal were investigated. Exposure pathways to humans were defined, and potential radiation doses to an individual living within the region of influence of the underground storage site were calculated. The assumed radionuclide source was 1/5 of the accumulated high-level waste from the US nuclear power economy through the year 2000. The repository containing the waste was assumed to be located in a reference salt site geology. The study required numerous assumptions concerning the transport of radioactivity from the geologic storage site to man. The assumptions used maximized the estimated potential radiation doses, particularly in the case of the intrusion water well scenario, where hydrologic flow field dispersion effects were ignored. Thus, incentives for removing elements from the waste tended to be maximized. Incentives were also maximized by assuming that elements removed from the waste could be eliminated from the earth without risk. The results of the study indicate that for reasonable disposal conditions, incentives for partitioning any elements from the waste in order to minimize the risk to humans are marginal at best

  3. Incentives and moral hazard

    DEFF Research Database (Denmark)

    Wendimu, Mengistu Assefa; Henningsen, Arne; Czekaj, Tomasz Gerard

    2017-01-01

    system and thus, the incentives to the workers. We compare the productivity of these two production schemes using a cross-sectional plot-level data set. As sugarcane production depends on various exogenous factors that are measured as categorical variables (e.g., soil type, cane variety, etc.), we...

  4. Incentives for Recruiters

    Science.gov (United States)

    1992-09-01

    promotions, with prizes for the kids: anything from football ti’kets to trips to Disneyland ." [Ref. 10:p. 68] Any publisher who wants a successful...such as a trip to Disneyland . The latter focuses more on providing an 29 incentive to the carrier to get a certain number of new customers in a short

  5. Dynamic Incentives in Organizations

    DEFF Research Database (Denmark)

    Ruckes, Martin; Rønde, Thomas

    2015-01-01

    to this inertial tendency is either to increase the financial incentives to encourage searching or to accept no searching. The former response increases search efforts and total profits; the latter response has the opposite results. Inertia can be removed by restructuring the firm in period 2, but this may create...

  6. Payment Instrument Characteristics

    DEFF Research Database (Denmark)

    Holst, Jacques; Kjeldsen, Martin; Hedman, Jonas

    2015-01-01

    Over the last decade, we have witnessed payment innovations that fundamentally have changed the ways we pay. Payment innovations, such as mobile payments and on-line banking, include characteristics or features that are essential to understand if we want to know how and why payers choose among...... payment innovations. Using the Repertory Grid technique to explore 15 payers’ perception of six payment instruments, including coins, banknotes, debit cards, credit cards, mobile payments, and on-line banking, we identify 16 payment characteristics. The characteristics aggregate seventy-six unique...

  7. Mergers, managerial incentives, and efficiencies

    OpenAIRE

    Jovanovic, Dragan

    2014-01-01

    We analyze the effects of synergies from horizontal mergers in a Cournot oligopoly where principals provide their agents with incentives to cut marginal costs prior to choosing output. We stress that synergies come at a cost which possibly leads to a countervailing incentive effect: The merged firm's principal may be induced to stifle managerial incentives in order to reduce her agency costs. Whenever this incentive effect dominates the well-known direct synergy effect, synergies actually red...

  8. Incentives Between Firms (and Within)

    OpenAIRE

    Robert Gibbons

    2005-01-01

    This paper reviews the significant progress in Üagency theoryÝ (i.e., the economic theory of incentives) during the 1990s, with an eye toward applications to supply transactions. I emphasize six recent models, in three pairs: (1) new foundations for the theory of incentive contracts, (2) new directions in incentive theory, and (3) new applications to supply transactions. By reviewing these six models, I hope to establish three things. First, the theory of incentive contracts needed and receiv...

  9. 42 CFR 495.106 - Incentive payments to CAHs.

    Science.gov (United States)

    2010-10-01

    ..., and making estimates or using proxies of, inpatient-bed-days, hospital charges, charity charges, and... meaningful EHR user at § 495.4, if it were an eligible hospital. Reasonable costs incurred for the purchase...

  10. The efficacy of incentives to motivate continued fitness-center attendance in college first-year students: a randomized controlled trial.

    Science.gov (United States)

    Pope, Lizzy; Harvey, Jean

    2014-01-01

    To determine whether fitness-center attendance established with the provision of weekly monetary incentives persisted after the discontinuation, or decreased frequency, of incentives. One hundred seventeen first-year college students participated during the 2011-2012 academic year. A randomized controlled trial with control, discontinued-incentive, and continued-incentive conditions was conducted. During fall semester, students in incentive conditions received weekly monetary payments for meeting fitness-center attendance goals. During spring semester, discontinued-incentive condition participants no longer received incentives, whereas continued-incentive condition participants received payments on a variable-interval schedule. ID-card attendance records tracked fitness-center attendance. Goal completion decreased from 63% in the incentive groups during the fall semester to 3% in the discontinued-incentive condition, and 39% in the continued-incentive condition during the spring semester. There was not a significant interaction between condition and body mass index change, F(6, 332) = 0.67, p = .68. Incentive discontinuation resulted in students no longer meeting fitness-center attendance goals. A variable-interval reward schedule better maintained attendance.

  11. Team incentives in relational contracts

    International Nuclear Information System (INIS)

    Kvaloey, Ola

    2003-01-01

    Incentive schemes for teams are compared. I ask: under which conditions are relational incentive contracts based on joint performance evaluation, relative performance evaluation and independent performance evaluation self-enforceable. The framework of Che and Yoo (2001) on team incentives is combined with the framework of Baker, Gibbons and Murphy (2002) on relational contracts. In a repeated game between one principal and two agents, I find that incentives based on relative or independent performance are expected to dominate when the productivity of effort is high, while joint performance evaluation dominates when productivity is low. Incentives based on independent performance are more probable if the agents own critical assets. (author)

  12. Strategic interaction among hospitals and nursing facilities: the efficiency effects of payment systems and vertical integration.

    Science.gov (United States)

    Banks, D; Parker, E; Wendel, J

    2001-03-01

    Rising post-acute care expenditures for Medicare transfer patients and increasing vertical integration between hospitals and nursing facilities raise questions about the links between payment system structure, the incentive for vertical integration and the impact on efficiency. In the United States, policy-makers are responding to these concerns by initiating prospective payments to nursing facilities, and are exploring the bundling of payments to hospitals. This paper develops a static profit-maximization model of the strategic interaction between the transferring hospital and a receiving nursing facility. This model suggests that the post-1984 system of prospective payment for hospital care, coupled with nursing facility payments that reimburse for services performed, induces inefficient under-provision of hospital services and encourages vertical integration. It further indicates that the extension of prospective payment to nursing facilities will not eliminate the incentive to vertically integrate, and will not result in efficient production unless such integration takes place. Bundling prospective payments for hospitals and nursing facilities will neither remove the incentive for vertical integration nor induce production efficiency without such vertical integration. However, bundled payment will induce efficient production, with or without vertical integration, if nursing facilities are reimbursed for services performed. Copyright 2001 John Wiley & Sons, Ltd.

  13. The impact of government incentives for hybrid-electric vehicles: Evidence from US states

    International Nuclear Information System (INIS)

    Diamond, David

    2009-01-01

    This paper examines the impact of government incentives policies designed to promote the adoption of hybrid-electric vehicles (HEVs). As a primary methodology, it employs cross-sectional analysis of hybrid registration data over time from US states to test the relationship between hybrid adoption and a variety of socioeconomic and policy variables. It also compares hybrid adoption patterns over time to the US average for specific states that have changed incentive policies, to examine how differences in incentive schemes influence their efficacy. The results of these analyses suggest a strong relationship between gasoline prices and hybrid adoption, but a much weaker relationship between incentive policies and hybrid adoption. Incentives that provide payments upfront also appear to be the most effective

  14. Institutional analysis of incentive schemes for ecosystem service provision - a comparative study across four European countries

    DEFF Research Database (Denmark)

    Prokofieva, Irina; Górriz, Elena; Boon, Tove Enggrob

    2014-01-01

    Incentive schemes and payments for ecosystem services attract increasing attention as a means for aligning the interests of landowners and society by remunerating forest owners for the goods and services their forests produce. As incentive schemes expand around the world, questions related...... and Italy. The analysed schemes are predominantly aimed at enhancing biodiversity and improving recreation. One of the schemes is also related to preserving a variety of forest ecosystem services from forest fires. The incentive schemes are studied following a framework for the institutional analysis of PES...... developed by Prokofieva and Gorriz (Prokofieva, I. and Gorriz, E. 2013: Institutional analysis of incentives for the provision of forest goods and services: an assessment of incentive schemes in Catalonia (North-East Spain), Forest Policy and Economics, 37, 104-114.). We focus on actor and institutional...

  15. Risk management versus incentives

    International Nuclear Information System (INIS)

    Aven, E.; Lovas, K.; Osmundsen, P.

    2006-01-01

    Portfolio theory indicates that risk management should take place at the group level. Hedging at the project level or in the individual business areas may lead to suboptimal results. However, the efficiency of a profit centre depends on its management's being able to influence factors that are crucial to the unit's financial results. Price hedging could be one such factor. In the wider perspective, this constitutes part of the balancing between centralisation and decentralisation. This article covers important elements of risk management and incentive design. It goes on to discuss the balancing of overall risk management at the group level and incentive design in profit centres and corporate units. Throughout the article, the oil industry serves as a case. (author)

  16. Opposing incentives for collaboration

    DEFF Research Database (Denmark)

    Dorch, Bertil F.; Wien, Charlotte; Larsen, Asger Væring

    , and gives a bonus for publications done through inter-institutionary collaboration. Credits given to universities are fractionalized between the participating universities. So far credits are not assigned to the individual authors but only to their institutions. However, it turns out that research...... collaboration is associated with a higher number of citations than single authorship which may present the author with two opposing incentives for research collaboration....

  17. Incentives and Prosocial Behavior

    OpenAIRE

    Roland Bénabou; Jean Tirole

    2005-01-01

    We develop a theory of prosocial behavior that combines heterogeneity in individual altruism and greed with concerns for social reputation or self-respect. Rewards or punishments (whether material or image-related) create doubt about the true motive for which good deeds are performed, and this ?overjustification effect? can induce a partial or even net crowding out of prosocial behavior by extrinsic incentives. We also identify the settings that are conducive to multiple social norms and, mor...

  18. Incentives and Prosocial Behaviour

    OpenAIRE

    Bénabou, Roland; Tirole, Jean

    2004-01-01

    We build a theory of prosocial behaviour that combines heterogeneity in individual altruism and greed with concerns for social reputation or self-respect. The presence of rewards or punishments creates doubt as to the true motive for which good deeds are performed, and this ‘overjustification effect’ can result in a net crowding out of prosocial behaviour by extrinsic incentives. The model also allows us to identify settings that are conducive to multiple social norms of behaviour, and those ...

  19. Anti-double dipping rules for federal tax incentives

    Energy Technology Data Exchange (ETDEWEB)

    Ing, E.T.C. [Law Office of Edwin T.C. Ing, Washington, DC (United States)

    1997-12-31

    Political as well as technological changes are now reshaping the electric utility industry. While accommodating these changes, state legislative and regulatory agencies have the opportunity to promote public policies. In this regard, various state entities are evaluating appropriate incentives for renewable energy development so as to introduce greater competition in electric generation. For example, the California legislature is considering a supplemental production payment and the State of Iowa has instituted a low-interest loan program for wind and other alternative energy generation. By complementing the existing federal tax incentives, state incentives can spur the wind industry`s growth. If structured in the wrong way, however, state assistance programs will undercut the value of the federal tax incentives. The federal anti-double dipping rules apply to certain state programs. If a developer utilizes the wrong type of state assistance for a wind project, the anti-double dipping rules will reduce the federal tax incentives and this in turn will decrease the project`s profitability. Rather than suffer these results, very few if any developer will use the state program. Despite the time and effort a state may expend to enact a program for alternative energy development, the state assistance will be ineffectual. This paper reviews the counterproductive results which state assistance can have on a wind project because of the federal anti-double dipping rules.

  20. Managing risk selection incentives in health sector reforms.

    Science.gov (United States)

    Puig-Junoy, J

    1999-01-01

    The object of the paper is to review theoretical and empirical contributions to the optimal management of risk selection incentives ('cream skimming') in health sector reforms. The trade-off between efficiency and risk selection is fostered in health sector reforms by the introduction of competitive mechanisms such as price competition or prospective payment systems. The effects of two main forms of competition in health sector reforms are observed when health insurance is mandatory: competition in the market for health insurance, and in the market for health services. Market and government failures contribute to the assessment of the different forms of risk selection employed by insurers and providers, as the effects of selection incentives on efficiency and their proposed remedies to reduce the impact of these perverse incentives. Two European (Netherlands and Spain) and two Latin American (Chile and Colombia) case studies of health sector reforms are examined in order to observe selection incentives, their effects on efficiency and costs in the health system, and regulation policies implemented in each country to mitigate incentives to 'cream skim' good risks.

  1. Universal health insurance through incentives reform.

    Science.gov (United States)

    Enthoven, A C; Kronick, R

    1991-05-15

    Roughly 35 million Americans have no health care coverage. Health care expenditures are out of control. The problems of access and cost are inextricably related. Important correctable causes include cost-unconscious demand, a system not organized for quality and economy, market failure, and public funds not distributed equitably or effectively to motivate widespread coverage. We propose Public Sponsor agencies to offer subsidized coverage to those otherwise uninsured, mandated employer-provided health insurance, premium contributions from all employers and employees, a limit on tax-free employer contributions to employee health insurance, and "managed competition". Our proposed new government revenues equal proposed new outlays. We believe our proposal will work because efficient managed care does exist and can provide satisfactory care for a cost far below that of the traditional fee-for-service third-party payment system. Presented with an opportunity to make an economically responsible choice, people choose value for money; the dynamic created by these individual choices will give providers strong incentives to render high-quality, economical care. We believe that providers will respond to these incentives.

  2. Structuring economic incentives to reduce emissions from deforestation within Indonesia.

    Science.gov (United States)

    Busch, Jonah; Lubowski, Ruben N; Godoy, Fabiano; Steininger, Marc; Yusuf, Arief A; Austin, Kemen; Hewson, Jenny; Juhn, Daniel; Farid, Muhammad; Boltz, Frederick

    2012-01-24

    We estimate and map the impacts that alternative national and subnational economic incentive structures for reducing emissions from deforestation (REDD+) in Indonesia would have had on greenhouse gas emissions and national and local revenue if they had been in place from 2000 to 2005. The impact of carbon payments on deforestation is calibrated econometrically from the pattern of observed deforestation and spatial variation in the benefits and costs of converting land to agriculture over that time period. We estimate that at an international carbon price of $10/tCO(2)e, a "mandatory incentive structure," such as a cap-and-trade or symmetric tax-and-subsidy program, would have reduced emissions by 163-247 MtCO(2)e/y (20-31% below the without-REDD+ reference scenario), while generating a programmatic budget surplus. In contrast, a "basic voluntary incentive structure" modeled after a standard payment-for-environmental-services program would have reduced emissions nationally by only 45-76 MtCO(2)e/y (6-9%), while generating a programmatic budget shortfall. By making four policy improvements--paying for net emission reductions at the scale of an entire district rather than site-by-site; paying for reductions relative to reference levels that match business-as-usual levels; sharing a portion of district-level revenues with the national government; and sharing a portion of the national government's responsibility for costs with districts--an "improved voluntary incentive structure" would have been nearly as effective as a mandatory incentive structure, reducing emissions by 136-207 MtCO(2)e/y (17-26%) and generating a programmatic budget surplus.

  3. Structuring economic incentives to reduce emissions from deforestation within Indonesia

    Science.gov (United States)

    Busch, Jonah; Lubowski, Ruben N.; Godoy, Fabiano; Steininger, Marc; Yusuf, Arief A.; Austin, Kemen; Hewson, Jenny; Juhn, Daniel; Farid, Muhammad; Boltz, Frederick

    2012-01-01

    We estimate and map the impacts that alternative national and subnational economic incentive structures for reducing emissions from deforestation (REDD+) in Indonesia would have had on greenhouse gas emissions and national and local revenue if they had been in place from 2000 to 2005. The impact of carbon payments on deforestation is calibrated econometrically from the pattern of observed deforestation and spatial variation in the benefits and costs of converting land to agriculture over that time period. We estimate that at an international carbon price of $10/tCO2e, a “mandatory incentive structure,” such as a cap-and-trade or symmetric tax-and-subsidy program, would have reduced emissions by 163–247 MtCO2e/y (20–31% below the without-REDD+ reference scenario), while generating a programmatic budget surplus. In contrast, a “basic voluntary incentive structure” modeled after a standard payment-for-environmental-services program would have reduced emissions nationally by only 45–76 MtCO2e/y (6–9%), while generating a programmatic budget shortfall. By making four policy improvements—paying for net emission reductions at the scale of an entire district rather than site-by-site; paying for reductions relative to reference levels that match business-as-usual levels; sharing a portion of district-level revenues with the national government; and sharing a portion of the national government's responsibility for costs with districts—an “improved voluntary incentive structure” would have been nearly as effective as a mandatory incentive structure, reducing emissions by 136–207 MtCO2e/y (17–26%) and generating a programmatic budget surplus. PMID:22232665

  4. Incentives, health promotion and equality.

    Science.gov (United States)

    Voigt, Kristin

    2012-07-01

    The use of incentives to encourage individuals to adopt 'healthier' behaviours is an increasingly popular instrument in health policy. Much of the literature has been critical of 'negative' incentives, often due to concerns about equality; 'positive' incentives, however, have largely been welcomed as an instrument for the improvement of population health and possibly the reduction of health inequalities. The aim of this paper is to provide a more systematic assessment of the use of incentives from the perspective of equality. The paper begins with an overview of existing and proposed incentive schemes. I then suggest that the distinction between 'positive' and 'negative' incentives - or 'carrots' and 'sticks' - is of limited use in distinguishing those incentive schemes that raise concerns of equality from those that do not. The paper assesses incentive schemes with respect to two important considerations of equality: equality of access and equality of outcomes. While our assessment of incentive schemes will, ultimately, depend on various empirical facts, the paper aims to advance the debate by identifying some of the empirical questions we need to ask. The paper concludes by considering a number of trade-offs and caveats relevant to the assessment of incentive schemes.

  5. Balancing Government Risks with Contractor Incentives in Performance-Based Logistics Contracts

    National Research Council Canada - National Science Library

    Gardner, Christopher P

    2008-01-01

    ...: the PBL goal of developing long-term partnerships that encourage investment from commercial partners is best achieved through lengthy, guaranteed contracts -- but such contracts increase the DoD's...

  6. Performance-Based Incentives and the Behavior of Accounting Academics: Responding to Changes

    Science.gov (United States)

    Moya, Soledad; Prior, Diego; Rodríguez-Pérez, Gonzalo

    2015-01-01

    When laws change the rules of the game, it is important to observe the effects on the players' behavior. Some effects can be anticipated while others are difficult to enunciate before the law comes into force. In this paper we have analyzed articles authored by Spanish accounting academics between 1996 and 2005 to assess the impact of a change in…

  7. Effects of compensation methods and physician group structure on physicians' perceived incentives to alter services to patients.

    Science.gov (United States)

    Reschovsky, James D; Hadley, Jack; Landon, Bruce E

    2006-08-01

    To examine how health plan payment, group ownership, compensation methods, and other practice management tools affect physician perceptions of whether their overall financial incentives tilt toward increasing or decreasing services to patients. Nationally representative data on physicians are from the 2000-2001 Community Tracking Study Physician Survey (N=12,406). Ordered and multinomial logistic regression were used to explore how physician, group, and market characteristics are associated with physician reports of whether overall financial incentives are to increase services, decrease services, or neither. Seven percent of physicians report financial incentives are to reduce services to patients, whereas 23 percent report incentives to increase services. Reported incentives to reduce services were associated with reports of lower ability to provide quality care. Group revenue in the form of capitation was associated with incentives to reduce services whereas practice ownership and variable compensation and bonuses for employee physicians were mostly associated with incentives to increase services to patients. Full ownership of groups, productivity incentives, and perceived competitive markets for patients were associated with incentives to both increase and reduce services. Practice ownership and the ways physicians are compensated affect their perceived incentives to increase or decrease services to patients. In the latter case, this adversely affects perceived quality of care and satisfaction, although incentives to increase services may also have adverse implications for quality, cost, and insurance coverage.

  8. Open Payments Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — Open Payments (otherwise known as the Sunshine Act) - Open Payments is a Congressionally-mandated transparency program that increases awareness of financial...

  9. Heart Attack Payment - National

    Data.gov (United States)

    U.S. Department of Health & Human Services — Payment for heart attack patients measure – national data. This data set includes national-level data for payments associated with a 30-day episode of care for heart...

  10. Heart Attack Payment - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — Payment for heart attack patients measure – provider data. This data set includes provider data for payments associated with a 30-day episode of care for heart...

  11. Heart Attack Payment - State

    Data.gov (United States)

    U.S. Department of Health & Human Services — Payment for heart attack patients measure – state data. This data set includes state-level data for payments associated with a 30-day episode of care for heart...

  12. A human-centered framework for innovation in conservation incentive programs.

    Science.gov (United States)

    Sorice, Michael G; Donlan, C Josh

    2015-12-01

    The promise of environmental conservation incentive programs that provide direct payments in exchange for conservation outcomes is that they enhance the value of engaging in stewardship behaviors. An insidious but important concern is that a narrow focus on optimizing payment levels can ultimately suppress program participation and subvert participants' internal motivation to engage in long-term conservation behaviors. Increasing participation and engendering stewardship can be achieved by recognizing that participation is not simply a function of the payment; it is a function of the overall structure and administration of the program. Key to creating innovative and more sustainable programs is fitting them within the existing needs and values of target participants. By focusing on empathy for participants, co-designing program approaches, and learning from the rapid prototyping of program concepts, a human-centered approach to conservation incentive program design enhances the propensity for discovery of novel and innovative solutions to pressing conservation issues.

  13. Electronic payment systems

    OpenAIRE

    Mláka, Michal

    2010-01-01

    This bachelor thesis analysis issue of electronic payment systems. It discusses their use for payments on the internet and sending funds via e-mail. The first part is devoted to the theoretical definition and legislation of the issuance of electronic money and activities of electronic money institutions. The main part of the work clearly focuses on the use of e-wallets, which is an integral part of electronic payment systems. E-wallet of electronic payment system Moneybookers is considered as...

  14. Empirical studies of regulatory restructuring and incentives

    Science.gov (United States)

    Knittel, Christopher Roland

    gas is also an input into the generation of electricity. However because these firms are regulated, these differing incentives would only be acted upon if regulation is imperfect in some way. Chapter 2 analyzes these issues. In particular, I estimate equilibrium pricing and investment equations that capture the relative incentives of single and dual-product electricity firms. The results imply that both electricity prices and reliance on natural gas generation are higher in a dual-product setting, both suggesting that regulators respond to the relative incentives of electricity and natural gas firms. Chapter 3 analyzes electricity firm production incentives when regulated via performance based regulation. Although many electricity markets are currently considering adopting a competitive market for electricity generation, and still others have already done so, the vast majority of electricity markets remain tightly regulated. Within this traditional regulatory environment, the use of incentive regulation schemes in US electricity markets has grown during the past two decades. While every state has some program that it refers to as an incentive regulation program, these programs differ in both their goals and how they attempt to meet these goals. In this chapter, I discuss the wide array of programs that have been utilized to alter the incentives of US investor-owned utilities (IOUs). In addition, using stochastic frontier methods, I provide empirical analysis of the impact that a number of incentive regulation programs have on the efficiency of a large set of coal and natural gas generator units.

  15. Auctioning payment entitlements

    DEFF Research Database (Denmark)

    Nielsen, Kurt

    2005-01-01

    Payment entitlements is a new commodity that arises from the new European common agricultural policy. The agricultural subsidies are decoupled from the actual production and replaced by the so-called payment entitlements. A payment entitlement has a farm specific value and may be freely traded. T...

  16. PAYMENT CAPACITY SENSITIVITY FACTORS

    Directory of Open Access Journals (Sweden)

    Daniel BRÎNDESCU – OLARIU

    2014-11-01

    The results of the study facilitate the determination and classification of the main sensitivity factors for the payment capacity at sample level, the establishment of general benchmarks for the payment capacity (as no such benchmarks currently exist in the Romanian literature and the identification of the mechanisms through which the variation of different factors impacts the payment capacity.

  17. Tax incentives in emerging economies

    OpenAIRE

    Brodzka, Alicja

    2013-01-01

    Emerging economies have introduced tax incentives for various reasons. In some countries in transition, such instruments may be seen as a counterweight to the investment disincentives inherent in the general tax system. In other countries, the incentives are intended to offset other disadvantages that investors may face, such as a lack of infrastructure, complicated and antiquated laws, bureaucratic complexities and weak administration. The article brings closer the issue of tax incentives of...

  18. Staff background paper on performance-based rate making

    International Nuclear Information System (INIS)

    Fraser, J.; Brownell, B.

    1998-10-01

    An alternative to the traditional cost of service (COS) regulation for electric utilities in British Columbia has been proposed. The alternative to pure COS regulation is performance-based rate making (PBR). PBR partially decouples a utility's rates from its costs and ties utility profits to performance relative to specific benchmarks. The motivation underlying PBR is that ideally, it provides incentives for utilities to cost-effectively achieve pre-defined goals. This report describes the design of PBR mechanisms, base rate PBR formulas, base rate PBR in other jurisdictions including New York, California, Maine and New Jersey. The report also describes gas procurement PBR in other jurisdictions, as well as British Columbia Utilities' Commission's own experience with PBR. In general, PBR has the potential to provide resource efficiency, allocative efficiency, support for introduction of new services, and reduced regulatory administrative costs. 15 refs., 4 tabs

  19. Payment and economic evaluation of integrated care

    Directory of Open Access Journals (Sweden)

    Apostolos Tsiachristas

    2015-04-01

    Full Text Available Chronic diseases have an increasingly negative impact on (1 population health by increasing morbidity and mortality, (2 society by increasing health inequalities and burden to informal caregivers, and (3 economy by requiring enormous financial resources and jeopardising macro-economic development (e.g. consumption, capital accumulation, labour productivity and labour supply. Integrated care is the most promising concept in redesigning care to tackle the increasing threat of chronic diseases. Several European countries have experimented with models for integrating care, most frequently in the form of disease management programmes. These models were often supported by payment schemes to provide financial incentives to health care providers for implementing integrated care. This thesis aimed to investigate these payment schemes and assess their impact, explore the variability in costs of disease management programmes, and determine the costs and effects of disease management programmes.

  20. The influence of provider characteristics and market forces on response to financial incentives.

    Science.gov (United States)

    O'Neil, Brock; Tyson, Mark; Graves, Amy J; Barocas, Daniel A; Chang, Sam S; Penson, David F; Resnick, Matthew J

    2017-11-01

    Alternative payment models, such as accountable care organizations, use financial incentives as levers for change to facilitate the transition from volume to value. However, implementation raises concerns about adverse changes in market competition and the resultant physician response. We sought to identify physician characteristics and market-level factors associated with variation in response to financial incentives for cancer care that may ultimately be leveraged in risk-shared payment models. Retrospective cohort study of physicians providing minimally invasive bladder cancer procedures to fee-for-service Medicare beneficiaries. We examined the relationship of between-group differences in market-level factors (competition [Herfindahl-Hirschman Index (HHI)] and provider density) and physician-level factors (use of unique billing codes, number of billing codes per patient, and competing financial interest) to responsiveness to financial incentives. Incentive-responsive providers had increased odds (odds ratio [OR], 1.19; 95% CI, 1.04-1.35) of practicing in markets with the highest quartile of provider density but not HHI (OR, 0.96; 95% CI, 0.87-1.05). Incentive-responsive providers were more likely to bill in the highest quartile for unique codes (OR, 1.49; 95% CI, 1.32-1.69) and codes per patient (OR, 1.18; 95% CI, 1.11-1.25) and less likely to have a competing financial interest (OR, 0.76; 95% CI, 0.72-0.81). Responsiveness to financial incentives in cancer care is associated with high market provider density, profit-maximizing billing behavior, and lack of competing financial ownership interests. Identifying physicians and markets responsive to financial incentives may ultimately promote the successful implementation of alternative payment models in cancer care.

  1. Taxonomy of Payments

    DEFF Research Database (Denmark)

    Hedman, Jonas; Tan, Felix B.; Holst, Jacques

    2017-01-01

    that impact payers’ choice of payment instruments. Design/methodology/approach: Through in-depth interviews using the repertory grid technique, the authors explored 15 payers’ perceptions of six payment instruments, including coins, banknotes, debit cards, credit cards, mobile payments, and online banking....... The approach draws heavily on organizational systematics to better understand payers’ choice of payment instruments. Findings: A four-category taxonomy of payments was developed. The authors refer to the taxonomy as the 4Ps: the purchase, the payer, the payment instrument, and the physical technology...... or checks. Research limitations/implications: The findings suggest that payers view payment instruments in a much broader sense, including context, control, or cultural beliefs. Consequently, the authors suggest that researchers try to understand the essence of an innovation before assuming any economic...

  2. Use of Payment Technology

    DEFF Research Database (Denmark)

    Xiao, Xiao; Hedman, Jonas; Runnemark, Emma

    2015-01-01

    Drawing on the theory of consumption value, this research-in-progress strives to provide a theoretical explanation of payment technology use by investigating the relationship between consumers’ perceptions of different consumption values associated with a certain payment technology and their choice...... to use the technology. We conducted the study in the context of Denmark, a Northern European country, with three well established payment technologies: cash, payment cards, and Internet banking. Following a focus group of identifying and defining four types of consumption values associated with each...... payment technology, a survey was then conducted by a national statistics agency in the country. Preliminary results have shown that different consumption values matter for the use of different payment technologies. The findings will potentially contribute to a better understanding of consumer payment...

  3. Public attitudes to financial incentive models for organs

    DEFF Research Database (Denmark)

    Hoeyer, Klaus; Schicktanz, Silke; Deleuran, Ida

    2013-01-01

    Waiting lists for organs have stimulated interest in the use of financial incentives for organ donation (FIs), but the literature does not contain an adequate overview of studies of public attitudes toward this mode of procurement. We conducted a literature review of international peer......-reviewed research published between 2002 and 2012 on how members of the public position themselves toward FIs. We identified and analyzed 23 studies using MEDLINE, PsycINFO, Sociological Abstracts and cross-reference search. The search included whole organs, donation, quantitative and empirical qualitative social...... scientific studies on, public attitudes (excluding professionals and medical students). The review reveals a broad divergence of public opinions on financial incentives. However, quantitative studies showed a low overall level of acceptance of payment for organs in living donation (LD); only a slightly...

  4. Specialty Payment Model Opportunities and Assessment: Gastroenterology and Cardiology Model Design Report.

    Science.gov (United States)

    Mulcahy, Andrew W; Chan, Chris; Hirshman, Samuel; Huckfeldt, Peter J; Kofner, Aaron; Liu, Jodi L; Lovejoy, Susan L; Popescu, Ioana; Timbie, Justin W; Hussey, Peter S

    2015-07-15

    Gastroenterology and cardiology services are common and costly among Medicare beneficiaries. Episode-based payment, which aims to create incentives for high-quality, low-cost care, has been identified as a promising alternative payment model. This article describes research related to the design of episode-based payment models for ambulatory gastroenterology and cardiology services for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare and Medicaid Services (CMS). The authors analyzed Medicare claims data to describe the frequency and characteristics of gastroenterology and cardiology index procedures, the practices that delivered index procedures, and the patients that received index procedures. The results of these analyses can help inform CMS decisions about the definition of episodes in an episode-based payment model; payment adjustments for service setting, multiple procedures, or other factors; and eligibility for the payment model.

  5. Incentives to participate in an international environmental agreement

    International Nuclear Information System (INIS)

    Hoel, M.; Schneider, K.

    1997-01-01

    For international environmental problems involving many countries, such as the climate problem, it is unlikely that all countries will participate in an international environmental agreement. If some countries commit themselves to cooperate, while the remaining countries act independently and in pure self-interest, it appears to be possible to achieve a Pareto improvement if the non-signatory countries reduce their emissions, in exchange for transfers from the countries which sign an agreement. However, the paper shows that the prospect of receiving a transfer for reducing one's emissions provided the country does not commit itself to cooperation, tends to reduce the incentive a country might have to commit itself to cooperation. Moreover, if the disincentive effect of such side payments is strong, total emissions will be higher in a situation with side payments than in a situation in which the signatory countries commit themselves to not give transfers to free riding countries. 4 figs., 2 tabs., 2 appendices, 13 refs

  6. Hospital responses to pay-for-performance incentives.

    Science.gov (United States)

    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.

  7. Network versus Economic Incentives

    DEFF Research Database (Denmark)

    Larsen, Christian Albrekt

    The article supplements the traditional economic line of reasoning with an economic sociological account of the transition from unemployment to employment. The lack of full information is recognised by economic theory while the focus on network within the tradition of economic sociology has...... not been adopted. The article argues that the importance of network actually might be very well understood within recent economic theories that emphasise the lack of full information. The empirical evidence for the importance of network both for employed and unemployed is provided by analysing a best case...... might be an important part of the vicious circles of unemployment. Finally, the article analyse the importance of network versus the importance of economic incentives. The result supports the thesis that economic sociology provides a better account of the transition from unemployment to employment than...

  8. Specialty Payment Model Opportunities and Assessment: Oncology Simulation Report.

    Science.gov (United States)

    White, Chapin; Chan, Chris; Huckfeldt, Peter J; Kofner, Aaron; Mulcahy, Andrew W; Pollak, Julia; Popescu, Ioana; Timbie, Justin W; Hussey, Peter S

    2015-07-15

    This article describes the results of a simulation analysis of a payment model for specialty oncology services that is being developed for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). CMS asked MITRE and RAND to conduct simulation analyses to preview some of the possible impacts of the payment model and to inform design decisions related to the model. The simulation analysis used an episode-level dataset based on Medicare fee-for-service (FFS) claims for historical oncology episodes provided to Medicare FFS beneficiaries in 2010. Under the proposed model, participating practices would continue to receive FFS payments, would also receive per-beneficiary per-month care management payments for episodes lasting up to six months, and would be eligible for performance-based payments based on per-episode spending for attributed episodes relative to a per-episode spending target. The simulation offers several insights into the proposed payment model for oncology: (1) The care management payments used in the simulation analysis-$960 total per six-month episode-represent only 4 percent of projected average total spending per episode (around $27,000 in 2016), but they are large relative to the FFS revenues of participating oncology practices, which are projected to be around $2,000 per oncology episode. By themselves, the care management payments would increase physician practices' Medicare revenues by roughly 50 percent on average. This represents a substantial new outlay for the Medicare program and a substantial new source of revenues for oncology practices. (2) For the Medicare program to break even, participating oncology practices would have to reduce utilization and intensity by roughly 4 percent. (3) The break-even point can be reduced if the care management payments are reduced or if the performance-based payments are reduced.

  9. Achieving health care cost containment through provider payment reform that engages patients and providers.

    Science.gov (United States)

    Ginsburg, Paul B

    2013-05-01

    The best opportunity to pursue cost containment in the next five to ten years is through reforming provider payment to gradually diminish the role of fee-for-service reimbursement. Public and private payers have launched many promising payment reform pilots aimed at blending fee-for-service with payment approaches based on broader units of care, such as an episode or patients' total needs over a period of time, a crucial first step. But meaningful cost containment from payment reform will not be achieved until Medicare and Medicaid establish stronger incentives for providers to contract in this way, with discouragement of nonparticipation increasing over time. In addition, the models need to evolve to engage beneficiaries, perhaps through incentives for patients to enroll in an accountable care organization and to seek care within that organization's network of providers.

  10. Introduction of performance-based financing in burundi was associated with improvements in care and quality.

    Science.gov (United States)

    Bonfrer, Igna; Soeters, Robert; Van de Poel, Ellen; Basenya, Olivier; Longin, Gashubije; van de Looij, Frank; van Doorslaer, Eddy

    2014-12-01

    Several governments in low- and middle-income countries have adopted performance-based financing to increase health care use and improve the quality of health services. We evaluated the effects of performance-based financing in the central African nation of Burundi by exploiting the staggered rollout of this financing across provinces during 2006-10. We found that performance-based financing increased the share of women delivering their babies in an institution by 22 percentage points, which reflects a relative increase of 36 percent, and the share of women using modern family planning services by 5 percentage points, a relative change of 55 percent. The overall quality score for health care facilities increased by 45 percent during the study period, but performance-based financing was found to have no effect on the quality of care as reported by patients. We did not find strong evidence of differential effects of performance-based financing across socioeconomic groups. The performance-based financing effects on the probability of using care when ill were found to be even smaller for the poor. Our findings suggest that a supply-side intervention such as performance-based financing without accompanying access incentives for poor people is unlikely to improve equity. More research into the cost-effectiveness of performance-based financing and how best to target vulnerable populations is warranted. Project HOPE—The People-to-People Health Foundation, Inc.

  11. Investigation of existing financial incentive policies for solar photovoltaic systems in U.S. regions

    Directory of Open Access Journals (Sweden)

    Jian Zhang

    2017-12-01

    Full Text Available This paper analyzes some of the existing incentives for solar photovoltaic (PV energy generation in the U.S. Four types of buildings (e.g., hospitals, large offices, large hotels, and secondary schools located in five different U.S. states, each having their own incentives, are selected and analyzed for the PV incentive policies. The payback period of the PV system is chosen as an indicator to analyze and critique the effectiveness of each incentive by comparing the payback periods before and after taking the incentive into consideration. Then a parametric analysis is conducted to determine the influence of the variation in key parameters, such as PV system capacity, capital cost of PV, sell back ratio and the performance-based incentive rate, on the performance of the PV system. The results show how the existing incentives can be effectively used to promote the PV systems in the U.S. and how variations of the parameters can impact the payback period of the PV systems. Through the evaluation of the existing incentive policies and the parametric study, this paper demonstrates that the type and level of incentives should be carefully determined in policy-making processes to effectively promote the PV systems.

  12. Investigating financial incentives for maternal health: an introduction.

    Science.gov (United States)

    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

  13. U.S. Army Incentive Program: Incentives That Motivate Recruiters

    National Research Council Canada - National Science Library

    Starkey, Benjamin

    1999-01-01

    .... Sixty recruiters and staff personnel at the brigade, battalion and company echelons were randomly selected and interviewed on how the various national and local incentives motivate recruiters to meet...

  14. How effective are biodiversity conservation payments in Mexico?

    OpenAIRE

    Costedoat, Sébastien; Corbera, Esteve; Ezzine de Blas, Driss; Honey-Rosés, Jordi; Baylis, Kathy; Castillo-Santiago, Miguel Angel

    2015-01-01

    We assess the additional forest cover protected by 13 rural communities located in the southern state of Chiapas, Mexico, as a result of the economic incentives received through the country's national program of payments for biodiversity conservation. We use spatially explicit data at the intra-community level to define a credible counterfactual of conservation outcomes.We use covariate-matching specifications associated with spatially explicit variables and difference-in-difference estimator...

  15. Invoicing, Payments Info

    Science.gov (United States)

    Goals Recycling Green Purchasing Pollution Prevention Reusing Water Resources Environmental Management Vendors Invoicing, Payments Info Bidding Opportunities Code of Conduct regarding holiday gifts Business

  16. Coordinating a Service Supply Chain under Arms Offset Program’s Intervention by Performance-Based Contracting

    Directory of Open Access Journals (Sweden)

    Yi-Kuei Lin

    2016-01-01

    Full Text Available This paper investigates a support service supply chain for coordinating with a local third-party logistics provider by arms offset program’s intervention and develops a performance-based contracting framework for the coordinating problem, which remains scarce in the literatures. The performance-based contracting framework evaluates payments and profits for the support service by a game-theoretical approach with principal-agent model. We prove that the proposed framework is an effective tool in acquiring the balance between maximum profit and minimum payment for both parties in the coordinating problem without moral hazard issue. A numerical study consolidates the formulated schemes as contracting preference for both parties’ decision with a higher profit margin at a lower customer’s payment.

  17. Rural Household Preferences for Active Participation in "Payment for Ecosystem Service" Programs: A Case in the Miyun Reservoir Catchment, China.

    Directory of Open Access Journals (Sweden)

    Hao Li

    Full Text Available Many payment for ecosystem services (PES programs, such as the Slope Land Conversion Program (SLCP, are passive and require full participation by impacted households. In contrast, this study considers the alternative of "active and incomplete" participation in PES programs, in which participants are not obliged to contract their own land, and have the right to select into the program or not. This type of program has been popular over the last decade in China; however, there have been few studies on the characteristics of willingness to participate and implementation. As such, this paper uses the Choice Experiment (CE method to explore ways for inducing effective program participation, by analyzing the effects of different regime attributes. The case study used to analyze participation utility was the Jing-Ji Afforestation Program for Ecological and Water Protection (JAPEWP, a typical active-participation forestry PES program, and a key source of water near Beijing in the Miyun Reservoir Catchment (MRC. Analyzing rural household survey data indicated that the program faces a variety of challenges, including long-term maintenance, implementation performance, cost-effectiveness, and monitoring approaches. There are also challenges with one-size-fits-all payment strategies, due to ineffective program participation or imperfect implementation regimes. In response, this study proposes several policies, including providing secure and complete land tenure to the participants, creating more local off-farm employment opportunities, designing performance-based monitoring systems that are integrated with financial incentives, applying differentiated payment strategies, providing capacity building to support forestation activities, and establishing a comprehensive implementation regime that would address these challenges. These policy conclusions provide valuable lessons for other active-participation PES programs as well.

  18. US approaches to physician payment: the deconstruction of primary care.

    Science.gov (United States)

    Berenson, Robert A; Rich, Eugene C

    2010-06-01

    The purpose of this paper is to address why the three dominant alternatives to compensating physicians (fee-for-service, capitation, and salary) fall short of what is needed to support enhanced primary care in the patient-centered medical home, and the relevance of such payment reforms as pay-for-performance and episodes/bundling. The review illustrates why prevalent physician payment mechanisms in the US have failed to adequately support primary care and why innovative approaches to primary care payment play such a prominent role in the PCMH discussion. FFS payment for office visits has never effectively rewarded all the activities that comprise prototypical primary care and may contribute to the "hamster on a treadmill" problems in current medical practice. Capitation payments are associated with risk adjustment challenges and, perhaps, public perceptions of conflict with patients' best interests. Most payers don't employ and therefore cannot generally place physicians on salary; while in theory such salary payments might neutralize incentives, operationally, "time is money;" extra effort devoted to meeting the needs of a more complex patient will likely reduce the services available to others. Fee-for-service, the predominant physician payment scheme, has contributed to both the continuing decline in the primary care workforce and the capability to serve patients well. Yet, the conceptual alternative payment approaches, modified fee-for-service (including fee bundles), capitation, and salary, each have their own problems. Accordingly, new payment models will likely be required to support restoration of primary care to its proper role in the US health care system, and to promote and sustain the development of patient-centered medical homes.

  19. TAP 2: Performance-Based Training Manual

    International Nuclear Information System (INIS)

    1993-08-01

    Cornerstone of safe operation of DOE nuclear facilities is personnel performing day-to-day functions which accomplish the facility mission. Performance-based training is fundamental to the safe operation. This manual has been developed to support the Training Accreditation Program (TAP) and assist contractors in efforts to develop performance-based training programs. It provides contractors with narrative procedures on performance-based training that can be modified and incorporated for facility-specific application. It is divided into sections dealing with analysis, design, development, implementation, and evaluation

  20. Performance-based regulation. Panel Discussion

    International Nuclear Information System (INIS)

    Youngblood, Robert; Bier, Vicki M.; Bukowski, Richard W.; Prasad Kadambi, N.; Koonce, James F.

    2001-01-01

    Full text of publication follows: Performance-based regulation is a part of the NRC's Strategic Plan and is realizing steady progress in conceptual development for actual applications. For example, high-level, conceptual guidelines have been proposed that would apply to reactors, materials, and waste areas. Performance-based approaches are also being applied in other regulated industries such as FAA and OSHA. The discussion will include comments from speakers from different parts of the nuclear industry and other industries regarding benefits and weaknesses of performance-based regulation. (authors)

  1. Tax incentives to promote green electricity. An overview of EU-27 countries

    International Nuclear Information System (INIS)

    Cansino, Jose M.; Pablo-Romero, Maria del P.; Roman, Rocio; Yniguez, Rocio

    2010-01-01

    This paper provides a comprehensive overview of the main tax incentives used in the EU-27 member states (MSs) to promote green electricity. Sixteen MSs use tax incentives to promote green electricity simultaneously with other promotion measures, especially quota obligations and price regulation. However, not all available technologies are promoted. For example, six MSs (Germany, Romania, Slovak Republic, Denmark, Sweden and Poland) have included an exemption on the payments of excise duties for electricity when the electricity is generated from renewable energy sources (RES). This tax incentive is the most widely used. Limited tax incentives in personal income tax are available in Belgium, France, Czech Republic and Luxembourg. In corporate tax, tax incentives consist mainly of a deduction in the taxable profit (Belgium, Greece, Czech Republic and Spain). Lower tax rates in VAT are applied in three MSs, France, Italy and Portugal. Only Spain and Italy use effective tax incentives in property tax. As a great diversity of tax incentives has been used to promote green electricity, this adds another difficulty to the EU objective of providing a renewable energy policy framework, but also it offers a useful set of case studies which can be used to inform EU policy development. (author)

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

    Science.gov (United States)

    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.

  3. Improving response rates using a monetary incentive for patient completion of questionnaires: an observational study

    Directory of Open Access Journals (Sweden)

    Orchard Jo

    2007-02-01

    Full Text Available Abstract Background Poor response rates to postal questionnaires can introduce bias and reduce the statistical power of a study. To improve response rates in our trial in primary care we tested the effect of introducing an unconditional direct payment of £5 for the completion of postal questionnaires. Methods We recruited patients in general practice with knee problems from sites across the United Kingdom. An evidence-based strategy was used to follow-up patients at twelve months with postal questionnaires. This included an unconditional direct payment of £5 to patients for the completion and return of questionnaires. The first 105 patients did not receive the £5 incentive, but the subsequent 442 patients did. We used logistic regression to analyse the effect of introducing a monetary incentive to increase the response to postal questionnaires. Results The response rate following reminders for the historical controls was 78.1% (82 of 105 compared with 88.0% (389 of 442 for those patients who received the £5 payment (diff = 9.9%, 95% CI 2.3% to 19.1%. Direct payments significantly increased the odds of response (adjusted odds ratio = 2.2, 95% CI 1.2 to 4.0, P = 0.009 with only 12 of 442 patients declining the payment. The incentive did not save costs to the trial – the extra cost per additional respondent was almost £50. Conclusion The direct payment of £5 significantly increased the completion of postal questionnaires at negligible increase in cost for an adequately powered study.

  4. Improving response rates using a monetary incentive for patient completion of questionnaires: an observational study

    Science.gov (United States)

    Brealey, Stephen D; Atwell, Christine; Bryan, Stirling; Coulton, Simon; Cox, Helen; Cross, Ben; Fylan, Fiona; Garratt, Andrew; Gilbert, Fiona J; Gillan, Maureen GC; Hendry, Maggie; Hood, Kerenza; Houston, Helen; King, David; Morton, Veronica; Orchard, Jo; Robling, Michael; Russell, Ian T; Torgerson, David; Wadsworth, Valerie; Wilkinson, Clare

    2007-01-01

    Background Poor response rates to postal questionnaires can introduce bias and reduce the statistical power of a study. To improve response rates in our trial in primary care we tested the effect of introducing an unconditional direct payment of £5 for the completion of postal questionnaires. Methods We recruited patients in general practice with knee problems from sites across the United Kingdom. An evidence-based strategy was used to follow-up patients at twelve months with postal questionnaires. This included an unconditional direct payment of £5 to patients for the completion and return of questionnaires. The first 105 patients did not receive the £5 incentive, but the subsequent 442 patients did. We used logistic regression to analyse the effect of introducing a monetary incentive to increase the response to postal questionnaires. Results The response rate following reminders for the historical controls was 78.1% (82 of 105) compared with 88.0% (389 of 442) for those patients who received the £5 payment (diff = 9.9%, 95% CI 2.3% to 19.1%). Direct payments significantly increased the odds of response (adjusted odds ratio = 2.2, 95% CI 1.2 to 4.0, P = 0.009) with only 12 of 442 patients declining the payment. The incentive did not save costs to the trial – the extra cost per additional respondent was almost £50. Conclusion The direct payment of £5 significantly increased the completion of postal questionnaires at negligible increase in cost for an adequately powered study. PMID:17326837

  5. Premier Hospital Quality Incentive Demonstration

    Data.gov (United States)

    U.S. Department of Health & Human Services — CMS is pursuing a vision to improve the quality of health care by expanding the information available about quality of care and through direct incentives to reward...

  6. Performance-based planning and programming guidebook.

    Science.gov (United States)

    2013-09-01

    "Performance-based planning and programming (PBPP) refers to the application of performance management principles within the planning and programming processes of transportation agencies to achieve desired performance outcomes for the multimodal tran...

  7. Incentive contracts and time use

    OpenAIRE

    Tor Viking Eriksson; Jaime Ortega

    2011-01-01

    Empirical studies on incentive contracts have primarily been concerned with the effects on employees’ productivity and earnings. The productivity increases associated with such contracts may, however, come at the expense of quality of life at or outside work. In this paper we study the effect on the employees’ non-work activities, testing whether incentive contracts lead to a change in the allocation of time across work and non-work activities. In doing so, we distinguish between two effects,...

  8. User-centric incentive design for participatory mobile phone sensing

    Science.gov (United States)

    Gao, Wei; Lu, Haoyang

    2014-05-01

    Mobile phone sensing is a critical underpinning of pervasive mobile computing, and is one of the key factors for improving people's quality of life in modern society via collective utilization of the on-board sensing capabilities of people's smartphones. The increasing demands for sensing services and ambient awareness in mobile environments highlight the necessity of active participation of individual mobile users in sensing tasks. User incentives for such participation have been continuously offered from an application-centric perspective, i.e., as payments from the sensing server, to compensate users' sensing costs. These payments, however, are manipulated to maximize the benefits of the sensing server, ignoring the runtime flexibility and benefits of participating users. This paper presents a novel framework of user-centric incentive design, and develops a universal sensing platform which translates heterogenous sensing tasks to a generic sensing plan specifying the task-independent requirements of sensing performance. We use this sensing plan as input to reduce three categories of sensing costs, which together cover the possible sources hindering users' participation in sensing.

  9. Getting value from health spending: going beyond payment reform.

    Science.gov (United States)

    Ho, Sam; Sandy, Lewis G

    2014-05-01

    It is widely held that fee-for-service (FFS) payment systems reward volume and intensity of services, contributing to overall cost inflation, while doing little to reward quality, efficiency, or care coordination. Recently, The National Commission on Physician Payment Reform (sponsored by SGIM) has recommended that payers "should largely eliminate stand-alone fee-for-service payment to medical practices because of its inherent inefficiencies and problematic financial incentives." As the current and former Chief Medical Officers of a large national insurer, we agree that payment reform is a critical component of health care modernization. But calls to transform payment simultaneously go too far, and don't go far enough. Based on our experience, we believe there are several critical ingredients that are either missing or under-emphasized in most payment reform proposals, including: health care is local so no one size fits all; upgrading performance measures; monitoring/overcoming unintended consequences; using a full toolbox to achieve transformation; and ensuring that the necessary components for successful delivery reform are in place. Thinking holistically and remembering that healthcare is a complex adaptive system are crucial to achieving better results for patients and the health system.

  10. Enhancing Incentive Programs with Proximal Goals and Immediate Feedback: Engineered Labor Standards and Technology Enhancements in Stocker Replenishment

    Science.gov (United States)

    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…

  11. Payments to the Lab

    Science.gov (United States)

    Goals Recycling Green Purchasing Pollution Prevention Reusing Water Resources Environmental Management the Lab Make payments for event registrations, sponsorships, insurance, travel, other fees. Contact Treasury Team (505) 667-4090 Email If you need to make a payment to the Lab for an event registration

  12. Hybrid carbon incentive mechanisms and political acceptability

    International Nuclear Information System (INIS)

    Vollebergh, H.R.J.; De Vries, J.L.; Koutstaal, P.R.

    1997-01-01

    In this paper it is analyzed how hybrid systems of carbon taxes and tradeable permits optimize some conflicting dimensions of political acceptability related to the design of these instruments. Pure systems like taxes without exemptions or auctioned tradeable permits cause problems for political acceptability in open economies due to high overall costs (abatement cost plus payments on the tax or auctions) for current polluters. Unfortunately, pure systems based on grandfathering of emission rights across the board do not provide a feasible alternative because of monitoring and enforcement problems. In contrast, consciously designed hybrid systems employ grandfathering of emission rights together with either carbon taxes or auctioned carbon permits in order to overcome acceptability problems of pure systems, while leaving incentives to reduce emissions at the margin untouched. Moreover, monitoring and enforcement costs of the hybrid systems are less due to the lower number of participating agents compared with the pure systems, while opportunities for cost- or burden-sharing exist as well. 3 figs., 4 tabs., 23 refs

  13. Proposed Performance-Based Metrics for the Future Funding of Graduate Medical Education: Starting the Conversation.

    Science.gov (United States)

    Caverzagie, Kelly J; Lane, Susan W; Sharma, Niraj; Donnelly, John; Jaeger, Jeffrey R; Laird-Fick, Heather; Moriarty, John P; Moyer, Darilyn V; Wallach, Sara L; Wardrop, Richard M; Steinmann, Alwin F

    2017-12-12

    Graduate medical education (GME) in the United States is financed by contributions from both federal and state entities that total over $15 billion annually. Within institutions, these funds are distributed with limited transparency to achieve ill-defined outcomes. To address this, the Institute of Medicine convened a committee on the governance and financing of GME to recommend finance reform that would promote a physician training system that meets society's current and future needs. The resulting report provided several recommendations regarding the oversight and mechanisms of GME funding, including implementation of performance-based GME payments, but did not provide specific details about the content and development of metrics for these payments. To initiate a national conversation about performance-based GME funding, the authors asked: What should GME be held accountable for in exchange for public funding? In answer to this question, the authors propose 17 potential performance-based metrics for GME funding that could inform future funding decisions. Eight of the metrics are described as exemplars to add context and to help readers obtain a deeper understanding of the inherent complexities of performance-based GME funding. The authors also describe considerations and precautions for metric implementation.

  14. Payment methods for outpatient care facilities

    Science.gov (United States)

    Yuan, Beibei; He, Li; Meng, Qingyue; Jia, Liying

    2017-01-01

    Background Outpatient care facilities provide a variety of basic healthcare services to individuals who do not require hospitalisation or institutionalisation, and are usually the patient's first contact. The provision of outpatient care contributes to immediate and large gains in health status, and a large portion of total health expenditure goes to outpatient healthcare services. Payment method is one of the most important incentive methods applied by purchasers to guide the performance of outpatient care providers. Objectives To assess the impact of different payment methods on the performance of outpatient care facilities and to analyse the differences in impact of payment methods in different settings. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), 2016, Issue 3, part of the Cochrane Library (searched 8 March 2016); MEDLINE, OvidSP (searched 8 March 2016); Embase, OvidSP (searched 24 April 2014); PubMed (NCBI) (searched 8 March 2016); Dissertations and Theses Database, ProQuest (searched 8 March 2016); Conference Proceedings Citation Index (ISI Web of Science) (searched 8 March 2016); IDEAS (searched 8 March 2016); EconLit, ProQuest (searched 8 March 2016); POPLINE, K4Health (searched 8 March 2016); China National Knowledge Infrastructure (searched 8 March 2016); Chinese Medicine Premier (searched 8 March 2016); OpenGrey (searched 8 March 2016); ClinicalTrials.gov, US National Institutes of Health (NIH) (searched 8 March 2016); World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (searched 8 March 2016); and the website of the World Bank (searched 8 March 2016). In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via ISI Web of Science to find other potentially relevant studies. We also contacted authors of the main included studies regarding any further published or unpublished work. Selection criteria Randomised

  15. 5 CFR 9901.344 - Other performance payments.

    Science.gov (United States)

    2010-01-01

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

  16. Payment methods for outpatient care facilities.

    Science.gov (United States)

    Yuan, Beibei; He, Li; Meng, Qingyue; Jia, Liying

    2017-03-03

    Outpatient care facilities provide a variety of basic healthcare services to individuals who do not require hospitalisation or institutionalisation, and are usually the patient's first contact. The provision of outpatient care contributes to immediate and large gains in health status, and a large portion of total health expenditure goes to outpatient healthcare services. Payment method is one of the most important incentive methods applied by purchasers to guide the performance of outpatient care providers. To assess the impact of different payment methods on the performance of outpatient care facilities and to analyse the differences in impact of payment methods in different settings. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), 2016, Issue 3, part of the Cochrane Library (searched 8 March 2016); MEDLINE, OvidSP (searched 8 March 2016); Embase, OvidSP (searched 24 April 2014); PubMed (NCBI) (searched 8 March 2016); Dissertations and Theses Database, ProQuest (searched 8 March 2016); Conference Proceedings Citation Index (ISI Web of Science) (searched 8 March 2016); IDEAS (searched 8 March 2016); EconLit, ProQuest (searched 8 March 2016); POPLINE, K4Health (searched 8 March 2016); China National Knowledge Infrastructure (searched 8 March 2016); Chinese Medicine Premier (searched 8 March 2016); OpenGrey (searched 8 March 2016); ClinicalTrials.gov, US National Institutes of Health (NIH) (searched 8 March 2016); World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (searched 8 March 2016); and the website of the World Bank (searched 8 March 2016).In addition, we searched the reference lists of included studies and carried out a citation search for the included studies via ISI Web of Science to find other potentially relevant studies. We also contacted authors of the main included studies regarding any further published or unpublished work. Randomised trials, non-randomised trials, controlled before

  17. 42 CFR 413.70 - Payment for services of a CAH.

    Science.gov (United States)

    2010-10-01

    ....70 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... receives an incentive payment for the reasonable costs of purchasing certified EHR technology in a cost... outpatients by a physician or other practitioner who has reassigned his or her rights to bill for those...

  18. The Future of the Mobile Payment as Electronic Payment System

    OpenAIRE

    Bezovski, Zlatko

    2016-01-01

    The development of the Internet and the arrival of e-commerce fostered digitalization in the payment processes by providing a variety of electronic payment options including payment cards (credit and debit), digital and mobile wallets, electronic cash, contactless payment methods etc. Mobile payment services with their increasing popularity are presently under the phase of transition, heading towards a promising future of tentative possibilities along with the innovation in technology. In thi...

  19. Incentives to promote family planning.

    Science.gov (United States)

    Heil, Sarah H; Gaalema, Diann E; Herrmann, Evan S

    2012-11-01

    Over the past 60 years, population control has become an increasingly urgent issue worldwide as a growing population strains already limited resources. The use of financial incentives to promote family planning is an innovative approach that has potential to make a contribution to efforts to better manage population growth. This report reviews eight studies that examined the effect of incentives on family planning. Published studies that tested the impact of incentives to promote some aspect of family planning and included an appropriate control or comparison condition were reviewed. Incentives have been used to promote attendance at contraceptive education sessions, adoption and continuation of contraceptive methods, sterilization, and to limit family size. All but one of the eight studies reviewed reported positive outcomes, but weaknesses in study design and execution limit the strength of the conclusions that can be drawn. Review of this literature suggests that family planning behaviors, like other behaviors, are sensitive to incentives. Given the tremendous need for efficacious interventions in global efforts to manage population growth, further research on this topic using more rigorous experimental methods is warranted. Copyright © 2012 Elsevier Inc. All rights reserved.

  20. Informal Patient Payments and Bought and Brought Goods in the Western Balkans – A Scoping Review

    Directory of Open Access Journals (Sweden)

    Sofie Buch Mejsner

    2017-11-01

    Full Text Available Introduction Informal patient payments for healthcare are common in the Western Balkans, negatively affecting public health and healthcare. Aim To identify literature from the Western Balkans on what is known about informal patient payments and bought and brought goods, to examine their effects on healthcare and to determine what actions can be taken to tackle these payments. Methods After conducting a scoping review that involved searching websites and databases and filtering with eligibility criteria and quality assessment tools, 24 relevant studies were revealed. The data were synthesized using a narrative approach that identified key concepts, types of evidence, and research gaps. Results The number of studies of informal patient payments increased between 2002 and 2015, but evidence regarding the issues of concern is scattered across various countries. Research has reported incidents of informal patient payments on a wide scale and has described various patterns and characteristics of these payments. Although these payments have typically been small – particularly to providers in common areas of specialized medicine – evidence regarding bought and brought goods remains limited, indicating that such practices are likely even more common, of greater magnitude and perhaps more problematic than informal patient payments. Only scant research has examined the measures that are used to tackle informal patient payments. The evidence indicates that legalizing informal patient payments, introducing performance-based payment systems, strengthening reporting, changing mentalities and involving the media and the European Union (EU or religious organizations in anti-corruption campaigns are understood as some of the possible remedies that might help reduce informal patient payments. Conclusion Despite comprehensive evidence regarding informal patient payments, data remain scattered and contradictory, implying that informal patient payments are a

  1. Function-based payment model for inpatient medical rehabilitation: an evaluation.

    Science.gov (United States)

    Sutton, J P; DeJong, G; Wilkerson, D

    1996-07-01

    To describe the components of a function-based prospective payment model for inpatient medical rehabilitation that parallels diagnosis-related groups (DRGs), to evaluate this model in relation to stakeholder objectives, and to detail the components of a quality of care incentive program that, when combined with this payment model, creates an incentive for provides to maximize functional outcomes. This article describes a conceptual model, involving no data collection or data synthesis. The basic payment model described parallels DRGs. Information on the potential impact of this model on medical rehabilitation is gleaned from the literature evaluating the impact of DRGs. The conceptual model described is evaluated against the results of a Delphi Survey of rehabilitation providers, consumers, policymakers, and researchers previously conducted by members of the research team. The major shortcoming of a function-based prospective payment model for inpatient medical rehabilitation is that it contains no inherent incentive to maximize functional outcomes. Linkage of reimbursement to outcomes, however, by withholding a fixed proportion of the standard FRG payment amount, placing that amount in a "quality of care" pool, and distributing that pool annually among providers whose predesignated, facility-level, case-mix-adjusted outcomes are attained, may be one strategy for maximizing outcome goals.

  2. Effect on maternal and child health services in Rwanda of payment to primary health-care providers for performance: an impact evaluation.

    Science.gov (United States)

    Basinga, Paulin; Gertler, Paul J; Binagwaho, Agnes; Soucat, Agnes L B; Sturdy, Jennifer; Vermeersch, Christel M J

    2011-04-23

    Evidence about the best methods with which to accelerate progress towards achieving the Millennium Development Goals is urgently needed. We assessed the effect of performance-based payment of health-care providers (payment for performance; P4P) on use and quality of child and maternal care services in health-care facilities in Rwanda. 166 facilities were randomly assigned at the district level either to begin P4P funding between June, 2006, and October, 2006 (intervention group; n=80), or to continue with the traditional input-based funding until 23 months after study baseline (control group; n=86). Randomisation was done by coin toss. We surveyed facilities and 2158 households at baseline and after 23 months. The main outcome measures were prenatal care visits and institutional deliveries, quality of prenatal care, and child preventive care visits and immunisation. We isolated the incentive effect from the resource effect by increasing comparison facilities' input-based budgets by the average P4P payments made to the treatment facilities. We estimated a multivariate regression specification of the difference-in-difference model in which an individual's outcome is regressed against a dummy variable, indicating whether the facility received P4P that year, a facility-fixed effect, a year indicator, and a series of individual and household characteristics. Our model estimated that facilities in the intervention group had a 23% increase in the number of institutional deliveries and increases in the number of preventive care visits by children aged 23 months or younger (56%) and aged between 24 months and 59 months (132%). No improvements were seen in the number of women completing four prenatal care visits or of children receiving full immunisation schedules. We also estimate an increase of 0·157 standard deviations (95% CI 0·026-0·289) in prenatal quality as measured by compliance with Rwandan prenatal care clinical practice guidelines. The P4P scheme in Rwanda had

  3. Financial incentive increases CPAP acceptance in patients from low socioeconomic background.

    Directory of Open Access Journals (Sweden)

    Ariel Tarasiuk

    Full Text Available OBJECTIVE: We explored whether financial incentives have a role in patients' decisions to accept (purchase a continuous positive airway pressure (CPAP device in a healthcare system that requires cost sharing. DESIGN: Longitudinal interventional study. PATIENTS: The group receiving financial incentive (n = 137, 50.8±10.6 years, apnea/hypopnea index (AHI 38.7±19.9 events/hr and the control group (n = 121, 50.9±10.3 years, AHI 39.9±22 underwent attendant titration and a two-week adaptation to CPAP. Patients in the control group had a co-payment of $330-660; the financial incentive group paid a subsidized price of $55. RESULTS: CPAP acceptance was 43% greater (p = 0.02 in the financial incentive group. CPAP acceptance among the low socioeconomic strata (n = 113 (adjusting for age, gender, BMI, tobacco smoking was enhanced by financial incentive (OR, 95% CI (3.43, 1.09-10.85, age (1.1, 1.03-1.17, AHI (>30 vs. 30 vs. 30 vs. <30 (5.25, 1.34-18.5. CONCLUSIONS: Minimizing cost sharing reduces a barrier for CPAP acceptance among low socioeconomic status patients. Thus, financial incentive should be applied as a policy to encourage CPAP treatment, especially among low socioeconomic strata patients.

  4. Financial incentive increases CPAP acceptance in patients from low socioeconomic background.

    Science.gov (United States)

    Tarasiuk, Ariel; Reznor, Gally; Greenberg-Dotan, Sari; Reuveni, Haim

    2012-01-01

    We explored whether financial incentives have a role in patients' decisions to accept (purchase) a continuous positive airway pressure (CPAP) device in a healthcare system that requires cost sharing. Longitudinal interventional study. The group receiving financial incentive (n = 137, 50.8±10.6 years, apnea/hypopnea index (AHI) 38.7±19.9 events/hr) and the control group (n = 121, 50.9±10.3 years, AHI 39.9±22) underwent attendant titration and a two-week adaptation to CPAP. Patients in the control group had a co-payment of $330-660; the financial incentive group paid a subsidized price of $55. CPAP acceptance was 43% greater (p = 0.02) in the financial incentive group. CPAP acceptance among the low socioeconomic strata (n = 113) (adjusting for age, gender, BMI, tobacco smoking) was enhanced by financial incentive (OR, 95% CI) (3.43, 1.09-10.85), age (1.1, 1.03-1.17), AHI (>30 vs. acceptance was affected by AHI (>30 vs. 30 vs. acceptance among low socioeconomic status patients. Thus, financial incentive should be applied as a policy to encourage CPAP treatment, especially among low socioeconomic strata patients.

  5. Performance-based financing: the same is different.

    Science.gov (United States)

    Renmans, Dimitri; Holvoet, Nathalie; Criel, Bart; Meessen, Bruno

    2017-07-01

    Although it is increasingly acknowledged within the Performance-Based Financing (PBF) research community that PBF is more than just payments based on outputs verified for quality, this narrow definition of PBF is still very present in many studies and evaluations. This leads to missed opportunities, misunderstandings and an unhelpful debate. Therefore, we reinforce the claim that PBF should be viewed as a reform package focused on targeted services with many different aspects that go beyond the health worker level. Failing to acknowledge the importance of the different elements of PBF negatively influences the task of practitioners, researchers and policymakers alike. After making the case for this wider definition, we propose three research pathways (describing, understanding and framing PBF) and give a short and tentative starting point for future research, leaving the floor open for more in-depth discussions. From these three vantage points it appears that when it comes to PBF 'the same is different'. Notwithstanding the increased complexity due to the use of the wider definition, progress on these three different research pathways will strongly improve our knowledge, lead to better adapted PBF programs and create a more nuanced debate on PBF. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  6. Retail payments and economic growth

    OpenAIRE

    Hasan, Iftekhar; De Renzis, Tania; Schmiedel , Heiko

    2012-01-01

    This paper examines the fundamental relationship between retail payments and overall economic growth. Using data from across 27 European markets over the period 1995–2009, the results confirm that migration to efficient electronic retail payments stimulates overall economic growth, consumption and trade. Among different payment instruments, this relationship is strongest for card payments, followed by credit transfers and direct debits. Cheque payments are found to have a relatively low macro...

  7. Performance-Based Evaluation and School Librarians

    Science.gov (United States)

    Church, Audrey P.

    2015-01-01

    Evaluation of instructional personnel is standard procedure in our Pre-K-12 public schools, and its purpose is to document educator effectiveness. With Race to the Top and No Child Left Behind waivers, states are required to implement performance-based evaluations that demonstrate student academic progress. This three-year study describes the…

  8. Overview of Performance Based Practical Design

    Science.gov (United States)

    2018-03-01

    DOI: https://doi.org/10.13023/KTC.RR.2018.03 State transportation agencies (STAs) have increasingly turned to practical design and performance based practical design(PBPD) to inform project development and implementation and to reduce project cos...

  9. Mixed movements/performance-based drawing

    DEFF Research Database (Denmark)

    Brabrand, Helle

    2011-01-01

    Mixed Movements is a research project engaged in performance-based architectural drawing. As one in a series working with architectonic implementation in relation to body and movements, the actual project relates body-movement and dynamic drawing and presents the material as interactive ‘space-time-tables’....

  10. Performance-Based Rewards and Work Stress

    Science.gov (United States)

    Ganster, Daniel C.; Kiersch, Christa E.; Marsh, Rachel E.; Bowen, Angela

    2011-01-01

    Even though reward systems play a central role in the management of organizations, their impact on stress and the well-being of workers is not well understood. We review the literature linking performance-based reward systems to various indicators of employee stress and well-being. Well-controlled experiments in field settings suggest that certain…

  11. Performance-based Pareto optimal design

    NARCIS (Netherlands)

    Sariyildiz, I.S.; Bittermann, M.S.; Ciftcioglu, O.

    2008-01-01

    A novel approach for performance-based design is presented, where Pareto optimality is pursued. Design requirements may contain linguistic information, which is difficult to bring into computation or make consistent their impartial estimations from case to case. Fuzzy logic and soft computing are

  12. Advance Payment ACO Model

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Advance Payment Model is designed for physician-based and rural providers who have come together voluntarily to give coordinated high quality care to the...

  13. NAAG Tobacco Settlement Payments

    Data.gov (United States)

    U.S. Department of Health & Human Services — 1999-2016. National Association of Attorneys General (NAAG). Policy—Tobacco Settlement Payments. The National Association of Attorneys General (NAAG) provides...

  14. NAAG Tobacco Settlement Payments

    Data.gov (United States)

    U.S. Department of Health & Human Services — 1999-2017. National Association of Attorneys General (NAAG). Policy—Tobacco Settlement Payments. The National Association of Attorneys General (NAAG) provides...

  15. Paying for Payments

    DEFF Research Database (Denmark)

    Korsgaard, Søren

    depends only on the relative costs of producing cash and card payments and can be used by regulators to assess privately set interchange fees. When calibrated to cost data, the model implies an optimal fee that is low and may even be negative. The findings are consistent with empirical evidence of high......Do consumers and merchants use the most efficient payment instruments? I examine how interchange fees, which are fees paid from merchants' banks to consumers' banks when card transactions take place, influence the choice between cash and payment cards. I show that when consumers do not pay...... transaction fees to banks - a common feature in bank contracts - card use is declining in interchange fees, and surcharging does not neutralize interchange fees. According to my model, banks set interchange fees at too high a level, resulting in too few card payments. I derive an optimal interchange fee which...

  16. ESRD Payment System

    Data.gov (United States)

    U.S. Department of Health & Human Services — Medicare payment to ESRD facilities for outpatient maintenance dialysis services furnished to Medicare beneficiaries with End-Stage Renal Disease (ESRD) is based on...

  17. A Truthful Incentive Mechanism for Online Recruitment in Mobile Crowd Sensing System

    Directory of Open Access Journals (Sweden)

    Xiao Chen

    2017-01-01

    Full Text Available We investigate emerging mobile crowd sensing (MCS systems, in which new cloud-based platforms sequentially allocate homogenous sensing jobs to dynamically-arriving users with uncertain service qualities. Given that human beings are selfish in nature, it is crucial yet challenging to design an efficient and truthful incentive mechanism to encourage users to participate. To address the challenge, we propose a novel truthful online auction mechanism that can efficiently learn to make irreversible online decisions on winner selections for new MCS systems without requiring previous knowledge of users. Moreover, we theoretically prove that our incentive possesses truthfulness, individual rationality and computational efficiency. Extensive simulation results under both real and synthetic traces demonstrate that our incentive mechanism can reduce the payment of the platform, increase the utility of the platform and social welfare.

  18. A Truthful Incentive Mechanism for Online Recruitment in Mobile Crowd Sensing System.

    Science.gov (United States)

    Chen, Xiao; Liu, Min; Zhou, Yaqin; Li, Zhongcheng; Chen, Shuang; He, Xiangnan

    2017-01-01

    We investigate emerging mobile crowd sensing (MCS) systems, in which new cloud-based platforms sequentially allocate homogenous sensing jobs to dynamically-arriving users with uncertain service qualities. Given that human beings are selfish in nature, it is crucial yet challenging to design an efficient and truthful incentive mechanism to encourage users to participate. To address the challenge, we propose a novel truthful online auction mechanism that can efficiently learn to make irreversible online decisions on winner selections for new MCS systems without requiring previous knowledge of users. Moreover, we theoretically prove that our incentive possesses truthfulness, individual rationality and computational efficiency. Extensive simulation results under both real and synthetic traces demonstrate that our incentive mechanism can reduce the payment of the platform, increase the utility of the platform and social welfare.

  19. Renewable Energy Cost Modeling. A Toolkit for Establishing Cost-Based Incentives in the United States

    Energy Technology Data Exchange (ETDEWEB)

    Gifford, Jason S. [Sustainable Energy Advantage, LLC, Framington, MA (United States); Grace, Robert C. [Sustainable Energy Advantage, LLC, Framington, MA (United States); Rickerson, Wilson H. [Meister Consultants Group, Inc., Boston, MA (United States)

    2011-05-01

    This report serves as a resource for policymakers who wish to learn more about levelized cost of energy (LCOE) calculations, including cost-based incentives. The report identifies key renewable energy cost modeling options, highlights the policy implications of choosing one approach over the other, and presents recommendations on the optimal characteristics of a model to calculate rates for cost-based incentives, FITs, or similar policies. These recommendations shaped the design of NREL's Cost of Renewable Energy Spreadsheet Tool (CREST), which is used by state policymakers, regulators, utilities, developers, and other stakeholders to assist with analyses of policy and renewable energy incentive payment structures. Authored by Jason S. Gifford and Robert C. Grace of Sustainable Energy Advantage LLC and Wilson H. Rickerson of Meister Consultants Group, Inc.

  20. Payment schemes and cost efficiency: evidence from Swiss public hospitals.

    Science.gov (United States)

    Meyer, Stefan

    2015-03-01

    This paper aims at analysing the impact of prospective payment schemes on cost efficiency of acute care hospitals in Switzerland. We study a panel of 121 public hospitals subject to one of four payment schemes. While several hospitals are still reimbursed on a per diem basis for the treatment of patients, most face flat per-case rates-or mixed schemes, which combine both elements of reimbursement. Thus, unlike previous studies, we are able to simultaneously analyse and isolate the cost-efficiency effects of different payment schemes. By means of stochastic frontier analysis, we first estimate a hospital cost frontier. Using the two-stage approach proposed by Battese and Coelli (Empir Econ 20:325-332, 1995), we then analyse the impact of these payment schemes on the cost efficiency of hospitals. Controlling for hospital characteristics, local market conditions in the 26 Swiss states (cantons), and a time trend, we show that, compared to per diem, hospitals which are reimbursed by flat payment schemes perform better in terms of cost efficiency. Our results suggest that mixed schemes create incentives for cost containment as well, although to a lesser extent. In addition, our findings indicate that cost-efficient hospitals are primarily located in cantons with competitive markets, as measured by the Herfindahl-Hirschman index in inpatient care. Furthermore, our econometric model shows that we obtain biased estimates from frontier analysis if we do not account for heteroscedasticity in the inefficiency term.

  1. The effect of financial incentives on the quality of health care provided by primary care physicians.

    Science.gov (United States)

    Scott, Anthony; Sivey, Peter; Ait Ouakrim, Driss; Willenberg, Lisa; Naccarella, Lucio; Furler, John; Young, Doris

    2011-09-07

    The use of blended payment schemes in primary care, including the use of financial incentives to directly reward 'performance' and 'quality' is increasing in a number of countries. There are many examples in the US, and the Quality and Outcomes Framework (QoF) for general practitioners (GPs) in the UK is an example of a major system-wide reform. Despite the popularity of these schemes, there is currently little rigorous evidence of their success in improving the quality of primary health care, or of whether such an approach is cost-effective relative to other ways to improve the quality of care. The aim of this review is to examine the effect of changes in the method and level of payment on the quality of care provided by primary care physicians (PCPs) and to identify:i) the different types of financial incentives that have improved quality;ii) the characteristics of patient populations for whom quality of care has been improved by financial incentives; andiii) the characteristics of PCPs who have responded to financial incentives. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL) and Cochrane Database of Systematic Reviews (CDSR) (The Cochrane Library), MEDLINE, HealthSTAR, EMBASE, CINAHL, PsychLIT, and ECONLIT. Searches of Internet-based economics and health economics working paper collections were also conducted. Finally, studies were identified through the reference lists of retrieved articles, websites of key organisations, and from direct contact with key authors in the field. Articles were included if they were published from 2000 to August 2009. Randomised controlled trials (RCT), controlled before and after studies (CBA), and interrupted time series analyses (ITS) evaluating the impact of different financial interventions on the quality of care delivered by primary healthcare physicians (PCPs). Quality of care was defined as patient reported outcome

  2. Legal incentives for minimizing waste

    International Nuclear Information System (INIS)

    Clearwater, S.W.; Scanlon, J.M.

    1991-01-01

    Waste minimization, or pollution prevention, has become an integral component of federal and state environmental regulation. Minimizing waste offers many economic and public relations benefits. In addition, waste minimization efforts can also dramatically reduce potential criminal requirements. This paper addresses the legal incentives for minimizing waste under current and proposed environmental laws and regulations

  3. Incentives in Supply Function Equilibrium

    DEFF Research Database (Denmark)

    Vetter, Henrik

    2015-01-01

    The author analyses delegation in homogenous duopoly under the assumption that firm-managers compete in supply functions. He reverses earlier findings in that owners give managers incentives to act in an accommodating way. That is, optimal delegation reduces per-firm output and increases profits ...

  4. Incentives and regulation in banking

    NARCIS (Netherlands)

    Martynova, N.

    2015-01-01

    The financial crisis of 2007-2008 has unveiled the hidden flaws in the regulatory framework of the financial sector. The rules of the game established by regulators were not stringent enough and provided bankers with wrong incentives to gamble with depositors’ money. There are two major challenges

  5. Offering Incentives from the Outside

    DEFF Research Database (Denmark)

    Emmanuel, Nikolas G.

    2017-01-01

    Incentives offer a good deal of underexplored opportunities to help manage conflict by encouraging political bargaining. This study has two primary objectives. First, it furthers the discussion of how external third parties can help manage conflicts. Second, it offers a typology of the available ...

  6. Variation in Incentive Effects across Neighbourhoods

    Directory of Open Access Journals (Sweden)

    Mark J Hanly

    2014-03-01

    Full Text Available Small monetary incentives increase survey cooperation rates, however evidence suggests that the appeal of incentives may vary across sample subgroups. Fieldwork budgets can be most effectively distributed by targeting those subgroups where incentives will have the strongest appeal. We examine data from a randomised experiment implemented in the pilot phase of the Irish Longitudinal Study of Ageing, which randomly assigned households to receive a higher (€25 or lower (€10 incentive amount. Using a random effects logistic regression model, we observe a variable effect of the higher incentive across geographic neighbourhoods. The higher incentive has the largest impact in neighbourhoods where baseline cooperation is low, as predicted by Leverage-Saliency theory. Auxiliary neighbourhood-level variables are linked to the sample frame to explore this variation further, however none of these moderate the incentive effect, suggesting that richer information is needed to identify sample subgroups where incentive budgets should be directed.

  7. Incentive mechanism design for the residential building energy efficiency improvement of heating zones in North China

    International Nuclear Information System (INIS)

    Zhong, Y.; Cai, W.G.; Wu, Y.; Ren, H.

    2009-01-01

    Starting with analyzing the investigation results by Ministry of Housing and Urban-Rural Development of China in 2005, more than half of the 10,236 participants are willing to improve the residential building energy efficiency and accept an additional cost of less than 10% of the total cost, the authors illustrate that incenting actions are necessary to improve building energy efficiency and build a central government-local government-market model. As a result of the model analysis, to pursue good execution effects brought by the incentive policies, the executors are required to distinguish the differences of incentive objects' economic activities and strongly respect the incenting on the energy conservation performance. A case study on the incentive policies of existing residential building energy efficiency improvement in heating zones in North China is given as well. Finally, it is strongly recommended to give the first priority to performance-based incentives so that to reduce the lazy behaviors of the incented objects and ensure the targets to be achieved.

  8. A study on the implementation fidelity of the performance-based financing policy in Burkina Faso after 12 months.

    Science.gov (United States)

    Bodson, Oriane; Barro, Ahmed; Turcotte-Tremblay, Anne-Marie; Zanté, Nestor; Somé, Paul-André; Ridde, Valéry

    2018-01-01

    Performance-based financing (PBF) in the health sector has recently gained momentum in low- and middle-income countries (LMICs) as one of the ways forward for achieving Universal Health Coverage. The major principle underlying PBF is that health centers are remunerated based on the quantity and quality of services they provide. PBF has been operating in Burkina Faso since 2011, and as a pilot project since 2014 in 15 health districts randomly assigned into four different models, before an eventual scale-up. Despite the need for expeditious documentation of the impact of PBF, caution is advised to avoid adopting hasty conclusions. Above all, it is crucial to understand why and how an impact is produced or not. Our implementation fidelity study approached this inquiry by comparing, after 12 months of operation, the activities implemented against what was planned initially and will make it possible later to establish links with the policy's impacts. Our study compared, in 21 health centers from three health districts, the implementation of activities that were core to the process in terms of content, coverage, and temporality. Data were collected through document analysis, as well as from individual interviews and focus groups with key informants. In the first year of implementation, solid foundations were put in place for the intervention. Even so, implementation deficiencies and delays were observed with respect to certain performance auditing procedures, as well as in payments of PBF subsidies, which compromised the incentive-based rationale to some extent. Over next months, efforts should be made to adjust the intervention more closely to context and to the original planning.

  9. The Effect of Incentives and Meta-incentives on the Evolution of Cooperation.

    Directory of Open Access Journals (Sweden)

    Isamu Okada

    2015-05-01

    Full Text Available Although positive incentives for cooperators and/or negative incentives for free-riders in social dilemmas play an important role in maintaining cooperation, there is still the outstanding issue of who should pay the cost of incentives. The second-order free-rider problem, in which players who do not provide the incentives dominate in a game, is a well-known academic challenge. In order to meet this challenge, we devise and analyze a meta-incentive game that integrates positive incentives (rewards and negative incentives (punishments with second-order incentives, which are incentives for other players' incentives. The critical assumption of our model is that players who tend to provide incentives to other players for their cooperative or non-cooperative behavior also tend to provide incentives to their incentive behaviors. In this paper, we solve the replicator dynamics for a simple version of the game and analytically categorize the game types into four groups. We find that the second-order free-rider problem is completely resolved without any third-order or higher (meta incentive under the assumption. To do so, a second-order costly incentive, which is given individually (peer-to-peer after playing donation games, is needed. The paper concludes that (1 second-order incentives for first-order reward are necessary for cooperative regimes, (2 a system without first-order rewards cannot maintain a cooperative regime, (3 a system with first-order rewards and no incentives for rewards is the worst because it never reaches cooperation, and (4 a system with rewards for incentives is more likely to be a cooperative regime than a system with punishments for incentives when the cost-effect ratio of incentives is sufficiently large. This solution is general and strong in the sense that the game does not need any centralized institution or proactive system for incentives.

  10. The Effect of Incentives and Meta-incentives on the Evolution of Cooperation.

    Science.gov (United States)

    Okada, Isamu; Yamamoto, Hitoshi; Toriumi, Fujio; Sasaki, Tatsuya

    2015-05-01

    Although positive incentives for cooperators and/or negative incentives for free-riders in social dilemmas play an important role in maintaining cooperation, there is still the outstanding issue of who should pay the cost of incentives. The second-order free-rider problem, in which players who do not provide the incentives dominate in a game, is a well-known academic challenge. In order to meet this challenge, we devise and analyze a meta-incentive game that integrates positive incentives (rewards) and negative incentives (punishments) with second-order incentives, which are incentives for other players' incentives. The critical assumption of our model is that players who tend to provide incentives to other players for their cooperative or non-cooperative behavior also tend to provide incentives to their incentive behaviors. In this paper, we solve the replicator dynamics for a simple version of the game and analytically categorize the game types into four groups. We find that the second-order free-rider problem is completely resolved without any third-order or higher (meta) incentive under the assumption. To do so, a second-order costly incentive, which is given individually (peer-to-peer) after playing donation games, is needed. The paper concludes that (1) second-order incentives for first-order reward are necessary for cooperative regimes, (2) a system without first-order rewards cannot maintain a cooperative regime, (3) a system with first-order rewards and no incentives for rewards is the worst because it never reaches cooperation, and (4) a system with rewards for incentives is more likely to be a cooperative regime than a system with punishments for incentives when the cost-effect ratio of incentives is sufficiently large. This solution is general and strong in the sense that the game does not need any centralized institution or proactive system for incentives.

  11. Merger incentives and the failing firm defense

    NARCIS (Netherlands)

    Bouckaert, J.M.C.; Kort, P.M.

    2014-01-01

    The merger incentives between profitable firms differ fundamentally from the incentives of a profitable firm to merge with a failing firm. We investigate these incentives under different modes of price competition and Cournot behavior. Our main finding is that firms strictly prefer exit of the

  12. Effort and Selection Effects of Incentive Contracts

    NARCIS (Netherlands)

    Bouwens, J.F.M.G.; van Lent, L.A.G.M.

    2003-01-01

    We show that the improved effort of employees associated with incentive contracts depends on the properties of the performance measures used in the contract.We also find that the power of incentives in the contract is only indirectly related to any improved employee effort.High powered incentive

  13. Earnings progression, human capital and incentives

    DEFF Research Database (Denmark)

    Frederiksen, Anders

    progression by investigating the effects of on-the-job human capital acquisition, explicit short-run incentives and career concern incentives on earnings progression. The model leads to predictions about the incentive structure and the progression in both cross-sectional and individual earnings which...

  14. The Independent Payment Advisory Board.

    Science.gov (United States)

    Manchikanti, Laxmaiah; Falco, Frank J E; Singh, Vijay; Benyamin, Ramsin M; Hirsch, Joshua A

    2011-01-01

    The Independent Payment Advisory Board (IPAB) is a vastly powerful component of the president's health care reform law, with authority to issue recommendations to reduce the growth in Medicare spending, providing recommendations to be considered by Congress and implemented by the administration on a fast track basis. Ever since its inception, IPAB has been one of the most controversial issues of the Patient Protection and Affordable Care Act (ACA), even though the powers of IPAB are restricted and multiple sectors of health care have been protected in the law. IPAB works by recommending policies to Congress to help Medicare provide better care at a lower cost, which would include ideas on coordinating care, getting rid of waste in the system, providing incentives for best practices, and prioritizing primary care. Congress then has the power to accept or reject these recommendations. However, Congress faces extreme limitations, either to enact policies that achieve equivalent savings, or let the Secretary of Health and Human Services (HHS) follow IPAB's recommendations. IPAB has strong supporters and opponents, leading to arguments in favor of or against to the extreme of introducing legislation to repeal IPAB. The origins of IPAB are found in the ideology of the National Institute for Health and Clinical Excellence (NICE) and the impetus of exploring health care costs, even though IPAB's authority seems to be limited to Medicare only. The structure and operation of IPAB differs from Medicare and has been called the Medicare Payment Advisory Commission (MedPAC) on steroids. The board membership consists of 15 full-time members appointed by the president and confirmed by the Senate with options for recess appointments. The IPAB statute sets target growth rates for Medicare spending. The applicable percent for maximum savings appears to be 0.5% for year 2015, 1% for 2016, 1.25% for 2017, and 1.5% for 2018 and later. The IPAB Medicare proposal process involves

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

    Directory of Open Access Journals (Sweden)

    Bärnighausen Till

    2009-06-01

    Full Text Available Abstract 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

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

    Science.gov (United States)

    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

  17. The effective use of property tax incentives for economic development

    OpenAIRE

    Daphne A. Kenyon; Adam H. Langley; Bethany P. Paquin

    2013-01-01

    To make property-tax incentives for business more effective, do not approve every incentive request, target use of incentives, avoid incentive wars, cooperate with surrounding localities, and conduct regular evaluations.

  18. New payment model for rural health services in Mongolia.

    Science.gov (United States)

    Hindle, Don; Khulan, Buyankhishig

    2006-01-01

    This article describes experiences in Mongolia in designing and implementing a new method of payment for rural health services. The new method involves using a formula that allocates 65% of available funding on the basis of risk-adjusted capitation, 20% on the basis of asset costs, 10% on the basis of variations in distance-related costs, and 5% on the basis of satisfactory attainment of quality of care targets. Rural populations have inferior health services in most countries, whether rich or poor. Their situation has deteriorated in most transition economies, including Mongolia since 1990. One factor has been the use of inappropriate methods of payment of care providers. Changes in payment methods have therefore been made in most transition economies with mixed success. One factor has been a tendency to over-simplify, for example, to introduce capitation without risk adjustment or to make per case payments that ignored casemix. In 2002, the Mongolian government decided that its crude funding formula for rural health services should be replaced. It had two main components. The first was payment of an annual grant by the local government from its general revenue on the basis of estimated service population, number of inpatient beds, and number of clinical staff. The second was an output-based payment per inpatient day from the National Health Insurance Fund. The model was administratively complicated, and widely believed to be unfair. The two funding agencies were giving conflicting types of financial incentives. Most important, the funding methods gave few incentives or rewards for service improvement. In some respects, the incentives were perverse (such as the encouragement of hospital admission by the National Health Insurance Fund). A new funding model was developed through statistical analysis of data from routine service reports and opinions questionnaires. As noted above, there are components relating to per capita needs for care, capital assets, distance

  19. Payment card rewards programs and consumer payment choice

    OpenAIRE

    Andrew Ching; Fumiko Hayashi

    2006-01-01

    Card payments have been growing very rapidly. To continue the growth, payment card networks keep adding new merchants and card issuers try to stimulate their existing customers’ card usage by providing rewards. This paper seeks to analyze the effects of payment card rewards programs on consumer payment choice, by using consumer survey data. Specifically, we examine whether credit/debit reward receivers use credit/debit cards relatively more often than other consumers, if so how much more ofte...

  20. Payment reform to finance a medical home: comment on "Achieving cost control, care coordination, and quality improvement through incremental payment system reform".

    Science.gov (United States)

    McGuire, Thomas G

    2010-01-01

    This commentary on R. F. Averill et al. (2010) addresses their idea of risk and quality adjusting fee-for-service payments to primary care physicians in order to improve the efficiency of primary care and take a step toward financing a "medical home"for patients. I show how their idea can create incentives for efficient practice styles. Pairing this with an active beneficiary choice of primary care physician with an enrollment fee would make the idea easier to implement and provide an incentive and the financing for elements of service not covered by procedure-based fees.

  1. Performance-based inspection and maintenance strategies

    International Nuclear Information System (INIS)

    Vesely, W.E.

    1995-01-01

    Performance-based inspection and maintenance strategies utilize measures of equipment performance to help guide inspection and maintenance activities. A relevant measure of performance for safety system components is component unavailability. The component unavailability can also be input into a plant risk model such as a Probabilistic Risk Assessment (PRA) to determine the associated plant risk performance. Based on the present and projected unavailability performance, or the present and projected risk performance, the effectiveness of current maintenance activities can be evaluated and this information can be used to plan future maintenance activities. A significant amount of information other than downtimes or failure times is collected or can be collected when an inspection or maintenance is conducted which can be used to estimate the component unavailability. This information generally involves observations on the condition or state of the component or component piecepart. The information can be detailed such as the amount of corrosion buildup or can be general such as the general state of the component described as ' high degradation', ' moderate degradation', or ' low degradation'. Much of the information collected in maintenance logs is qualitative and fuzzy. As part of an NRC Research program on performance-based engineering modeling, approaches have been developed to apply Fuzzy Set Theory to information collected on the state of the component to determine the implied component or component piecepart unavailability. Demonstrations of the applications of Fuzzy Set Theory are presented utilizing information from plant maintenance logs. The demonstrations show the power of Fuzzy Set Theory in translating engineering information to reliability and risk implications

  2. Cash and Payments Management Data

    Data.gov (United States)

    General Services Administration — The Prompt Payment Act, along with the Debt Collection Improvement Act of 1996, requires the timely payment of commercial obligations for supplies and services using...

  3. Medicaid Disproportionate Share Hospital Payments

    Data.gov (United States)

    U.S. Department of Health & Human Services — Medicaid Disproportionate Share Hospital (DSH) Payments This link provides you with information about Medicaid DSH Payments. You can find information on DSH Audit...

  4. Incentives – Effectiveness and efficiency

    Directory of Open Access Journals (Sweden)

    Björn Hinderlich

    2014-03-01

    Full Text Available This paper covers the question if and how incentive schemes work evaluated by their impact on company performance (market capitalization and profit before tax. Based on a unique data set for German executive directors of DAX companies it can be proved that neither short (STI nor long term incentives (LTI plans necessarily support the company success. It rather depends on the efficiency of each plan, i. e. on its design. Special attention has to be paid on target setting. Short term focused objectives often miss their targets, whereas long term oriented objectives significantly support the company success. To solve the prisoner’s dilemma between employers and employees by a quasi-endless game, additional measures may be helpful, such as share ownership guidelines.

  5. Doing More for More: Unintended Consequences of Financial Incentives for Oncology Specialty Care.

    Science.gov (United States)

    O'Neil, Brock; Graves, Amy J; Barocas, Daniel A; Chang, Sam S; Penson, David F; Resnick, Matthew J

    2016-02-01

    Specialty care remains a significant contributor to health care spending but largely unaddressed in novel payment models aimed at promoting value-based delivery. Bladder cancer, chiefly managed by subspecialists, is among the most costly. In 2005, Centers for Medicare and Medicaid Services (CMS) dramatically increased physician payment for office-based interventions for bladder cancer to shift care from higher cost facilities, but the impact is unknown. This study evaluated the effect of financial incentives on patterns of fee-for-service (FFS) bladder cancer care. Data from a 5% sample of Medicare beneficiaries from 2001-2013 were evaluated using interrupted time-series analysis with segmented regression. Primary outcomes were the effects of CMS fee modifications on utilization and site of service for procedures associated with the diagnosis and treatment of bladder cancer. Rates of related bladder cancer procedures that were not affected by the fee change were concurrent controls. Finally, the effect of payment changes on both diagnostic yield and need for redundant procedures were studied. All statistical tests were two-sided. Utilization of clinic-based procedures increased by 644% (95% confidence interval [CI] = 584% to 704%) after the fee change, but without reciprocal decline in facility-based procedures. Procedures unaffected by the fee incentive remained unchanged throughout the study period. Diagnostic yield decreased by 17.0% (95% CI = 12.7% to 21.3%), and use of redundant office-based procedures increased by 76.0% (95% CI = 59% to 93%). Financial incentives in bladder cancer care have unintended and costly consequences in the current FFS environment. The observed price sensitivity is likely to remain a major issue in novel payment models failing to incorporate procedure-based specialty physicians. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  6. Public acceptability of financial incentives for smoking cessation in pregnancy and breast feeding: a survey of the British public

    Science.gov (United States)

    Hoddinott, Pat; Morgan, Heather; MacLennan, Graeme; Sewel, Kate; Thomson, Gill; Bauld, Linda; Yi, Deokhee; Ludbrook, Anne; Campbell, Marion K

    2014-01-01

    Objective To survey public attitudes about incentives for smoking cessation in pregnancy and for breast feeding to inform trial design. Design Cross-sectional survey. Setting and participants British general public. Methods Seven promising incentive strategies had been identified from evidence syntheses and qualitative interview data from service users and providers. These were shopping vouchers for: (1) validated smoking cessation in pregnancy and (2) after birth; (3) for a smoke-free home; (4) for proven breast feeding; (5) a free breast pump; (6) payments to health services for reaching smoking cessation in pregnancy targets and (7) breastfeeding targets. Ipsos MORI used area quota sampling and home-administered computer-assisted questionnaires, with randomised question order to assess agreement with different incentives (measured on a five-point scale). Demographic data and target behaviour experience were recorded. Analysis used multivariable ordered logit models. Results Agreement with incentives was mixed (ranging from 34% to 46%) among a representative sample of 1144 British adults. Mean agreement score was highest for a free breast pump, and lowest for incentives for smoking abstinence after birth. More women disagreed with shopping vouchers than men. Those with lower levels of education disagreed more with smoking cessation incentives and a breast pump. Those aged 44 or under agreed more with all incentive strategies compared with those aged 65 and over, particularly provider targets for smoking cessation. Non-white ethnic groups agreed particularly with breastfeeding incentives. Current smokers with previous stop attempts and respondents who had breast fed children agreed with providing vouchers for the respective behaviours. Up to £40/month vouchers for behaviour change were acceptable (>85%). Conclusions Women and the less educated were more likely to disagree, but men and women of childbearing age to agree, with incentives designed for their benefit

  7. Extrinsic incentives and tax compliance

    OpenAIRE

    Sour, Laura; Gutiérrez Andrade, Miguel Ángel

    2011-01-01

    This paper models the impact of extrinsic incentives in a tax compliance model. It also provides experimental evidence that confirms the existence of a positive relationship between rewards and tax compliance. If individuals are audited, rewards for honest taxpayers are effective in increasing the level of tax compliance. These results are particularly relevant in countries where there is little respect for tax law since rewards can contribute to crowding in the intrinsic motivation to comply.

  8. Accounting Conservatism and Managerial Incentives

    OpenAIRE

    Young K. Kwon

    2005-01-01

    There are two sources of agency costs under moral hazard: (1) distortions in incentive contracts and (2) implementation of suboptimal decisions. In the accounting literature, the relation between conservative accounting and agency costs of type (1) has received considerable attention (cf. Watts 2002). However, little appears to be known about the effects of accounting conservatism on agency costs of type (2) or trade-offs between agency costs of types (1) and (2). The purpose of this study is...

  9. An Incentive Theory of Matching

    OpenAIRE

    Brown, Alessio J. G.; Merkl, Christian; Snower, Dennis J.

    2010-01-01

    This paper examines the labour market matching process by distinguishing its two component stages: the contact stage, in which job searchers make contact with employers and the selection stage, in which they decide whether to match. We construct a theoretical model explaining two-sided selection through microeconomic incentives. Firms face adjustment costs in responding to heterogeneous variations in the characteristics of workers and jobs. Matches and separations are described through firms'...

  10. Analytical perspectives on performance-based management

    DEFF Research Database (Denmark)

    Wadmann, Sarah; Johansen, Sarah; Lind, Ane

    2013-01-01

    Performance-based management (PBM) has become a dominant form of governance in health care and there is a need for careful assessment of its function and effects. This article contains a cross-disciplinary literature synthesis of current studies of PBM. Literature was retrieved by database search...... perspectives allows appreciation of otherwise implicit assumptions and potential implications of PBM. Reflections on such differences are important to ensure vigilant appropriation of shifting management tools in health quality governance.......Performance-based management (PBM) has become a dominant form of governance in health care and there is a need for careful assessment of its function and effects. This article contains a cross-disciplinary literature synthesis of current studies of PBM. Literature was retrieved by database searches....... In the functionalist perspective, PBM is perceived as a management tool aimed at improving health care services by means of market-based mechanisms. In the interpretive perspective, the adoption of PBM is understood as consequence of institutional and individual agents striving for public legitimacy. In the post...

  11. Incentives for reporting disease outbreaks.

    Directory of Open Access Journals (Sweden)

    Ramanan Laxminarayan

    Full Text Available BACKGROUND: Countries face conflicting incentives to report infectious disease outbreaks. Reports of outbreaks can prompt other countries to impose trade and travel restrictions, which has the potential to discourage reporting. However, reports can also bring medical assistance to contain the outbreak, including access to vaccines. METHODS: We compiled data on reports of meningococcal meningitis to the World Health Organization (WHO from 54 African countries between 1966 and 2002, a period is marked by two events: first, a large outbreak reported from many countries in 1987 associated with the Hajj that resulted in more stringent requirements for meningitis vaccination among pilgrims; and second, another large outbreak in Sub-Saharan Africa in 1996 that led to a new international mechanism to supply vaccines to countries reporting a meningitis outbreak. We used fixed-effects regression modeling to statistically estimate the effect of external forcing events on the number of countries reporting cases of meningitis to WHO. FINDINGS: We find that the Hajj vaccination requirements started in 1988 were associated with reduced reporting, especially among countries with relatively fewer cases reported between 1966 and 1979. After the vaccine provision mechanism was in place in 1996, reporting among countries that had previously not reported meningitis outbreaks increased. INTERPRETATION: These results indicate that countries may respond to changing incentives to report outbreaks when they can do so. In the long term, these incentives are likely to be more important than surveillance assistance in prompt reporting of outbreaks.

  12. Long-Term Effects of Payments for Environmental Services: Combining Insights from Communication and Economics

    Directory of Open Access Journals (Sweden)

    John M. Kerr

    2017-09-01

    Full Text Available Interdisciplinary analytical perspectives can bring important insights to address complex sustainability problems. In this paper we present and apply a model that integrates perspectives from economics and communication sciences to address the question of what happens to pro-environmental behavior after the introduction and then the withdrawal of payment for environmental services (PES. In particular, we discuss the effects of financial incentives on social norms and the effects of norms on subsequent behavior after incentives have ended. This is important because the dominant literature on PES lacks a sophisticated understanding of social norms and fails to address what will happen to behavior once payments end. That literature addresses the potential problem that payments can crowd out or possibly crowd in intrinsic sources of motivation for pro-social behavior, but it lacks the sophisticated understanding of social norms that has the potential to help explain and address this phenomenon. We summarize experimental evidence based on our model showing that introducing a financial incentive for behavior change can change social norms around that behavior. These norms, in turn, can continue to influence behavior even after incentives have ended. PES programs can address this situation by actively evoking existing social norms in favor of conservation.

  13. Incentive Schemes for Participatory Sensing

    OpenAIRE

    Radanovic, Goran; Faltings, Boi

    2015-01-01

    We consider a participatory sensing scenario where a group of private sensors observes the same phenomenon, such as air pollution. Since sensors need to be installed and maintained, owners of sensors are inclined to provide inaccurate or random data. We design a novel payment mechanism that incentivizes honest behavior by scoring sensors based on the quality of their reports. The basic principle follows the standard Bayesian Truth Serum (BTS) paradigm, where highest rewards are obtained for r...

  14. Financial incentives to increase Canadian organ donation: quick fix or fallacy?

    Science.gov (United States)

    Gill, John S; Klarenbach, Scott; Barnieh, Lianne; Caulfield, Timothy; Knoll, Greg; Levin, Adeera; Cole, Edward H

    2014-01-01

    Unlike the United States, the potential to increase organ donation in Canada may be sufficient to meet the need for transplantation. However, there has been no national coordinated effort to increase organ donation. Strategies that do not involve payment for organs, such as investment in health care resources to support deceased donor organ donation and introduction of a remuneration framework for the work of deceased organ donation, should be prioritized for implementation. Financial incentives that may be permitted under existing legislation and that pose little risk to existing donation sources should be advanced, including the following: payment of funeral expenses for potential donors who register their decision on organ donation during life (irrespective of the decision to donate or actual organ donation) and removal of disincentives for directed and paired exchange living donation, such as payment of wages, payment for pain and suffering related to the donor surgery, and payment of directed living kidney donors for participation in Canada's paired exchange program. In contrast, it would be premature to contemplate a regulated system of organ sales that would require a paradigm shift in the current approach to organ donation and legislative change to implement. Copyright © 2013 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    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

  16. Financial Incentive Increases CPAP Acceptance in Patients from Low Socioeconomic Background

    Science.gov (United States)

    Tarasiuk, Ariel; Reznor, Gally; Greenberg-Dotan, Sari; Reuveni, Haim

    2012-01-01

    Objective We explored whether financial incentives have a role in patients′ decisions to accept (purchase) a continuous positive airway pressure (CPAP) device in a healthcare system that requires cost sharing. Design Longitudinal interventional study. Patients The group receiving financial incentive (n = 137, 50.8±10.6 years, apnea/hypopnea index (AHI) 38.7±19.9 events/hr) and the control group (n = 121, 50.9±10.3 years, AHI 39.9±22) underwent attendant titration and a two-week adaptation to CPAP. Patients in the control group had a co-payment of $330–660; the financial incentive group paid a subsidized price of $55. Results CPAP acceptance was 43% greater (p = 0.02) in the financial incentive group. CPAP acceptance among the low socioeconomic strata (n = 113) (adjusting for age, gender, BMI, tobacco smoking) was enhanced by financial incentive (OR, 95% CI) (3.43, 1.09–10.85), age (1.1, 1.03–1.17), AHI (>30 vs. CPAP (4.29, 1.05–17.51). Among average/high-income patients (n = 145) CPAP acceptance was affected by AHI (>30 vs. CPAP adherence was similar in the financial incentive and control groups, 35% and 39%, respectively (p = 0.82). Adherence rate was sensitive to education (+yr) (1.28, 1.06–1.55) and AHI (>30 vs. CPAP acceptance among low socioeconomic status patients. Thus, financial incentive should be applied as a policy to encourage CPAP treatment, especially among low socioeconomic strata patients. PMID:22479368

  17. Approach to performance based regulation development

    International Nuclear Information System (INIS)

    Spogen, L.R.; Cleland, L.L.

    1977-06-01

    An approach to the development of performance based regulations (PBR's) is described. Initially, a framework is constructed that consists of a function hierarchy and associated measures. The function at the top of the hierarchy is described in terms of societal objectives. Decomposition of this function into subordinate functions and their subsequent decompositions yield the function hierarchy. ''Bottom'' functions describe the roles of system components. When measures are identified for the performance of each function and means of aggregating performances to higher levels are established, the framework may be employed for developing PBR's. Consideration of system flexibility and performance uncertainty guide in determining the hierarchical level at which regulations are formulated. Ease of testing compliance is also a factor. To show the viability of the approach, the framework developed by Lawrence Livermore Laboratory for the Nuclear Regulatory Commission for evaluation of material control systems at fixed facilities is presented

  18. Mixed Movements/performance-based drawing

    DEFF Research Database (Denmark)

    Brabrand, Helle

    2010-01-01

    Mixed Movements is a research project engaged in performance-based architectural drawing. The project experiments with drawing-series as montages of materials and forces, making the drawing appear in its changing character. The moving components are conditioned by different circumstances...... that question each other, working as well with space-time motives as with expressions and techniques. A series poses questions both to the kind of forces it raises as well as to the kind of sensual affects it produces – to how the body resonates with the rhythms and tensions that appear in the drawing....... A drawing-series is then both a machine, a diagram, and an appearance, what we call a resonance-model, creating links between tectonic and drawing constructions, kinaesthetic competences and actual body-movements....

  19. How effective are biodiversity conservation payments in Mexico?

    Science.gov (United States)

    Costedoat, Sébastien; Corbera, Esteve; Ezzine-de-Blas, Driss; Honey-Rosés, Jordi; Baylis, Kathy; Castillo-Santiago, Miguel Angel

    2015-01-01

    We assess the additional forest cover protected by 13 rural communities located in the southern state of Chiapas, Mexico, as a result of the economic incentives received through the country's national program of payments for biodiversity conservation. We use spatially explicit data at the intra-community level to define a credible counterfactual of conservation outcomes. We use covariate-matching specifications associated with spatially explicit variables and difference-in-difference estimators to determine the treatment effect. We estimate that the additional conservation represents between 12 and 14.7 percent of forest area enrolled in the program in comparison to control areas. Despite this high degree of additionality, we also observe lack of compliance in some plots participating in the PES program. This lack of compliance casts doubt on the ability of payments alone to guarantee long-term additionality in context of high deforestation rates, even with an augmented program budget or extension of participation to communities not yet enrolled.

  20. Specialty Payment Model Opportunities and Assessment: Oncology Model Design Report.

    Science.gov (United States)

    Huckfeldt, Peter J; Chan, Chris; Hirshman, Samuel; Kofner, Aaron; Liu, Jodi L; Mulcahy, Andrew W; Popescu, Ioana; Stevens, Clare; Timbie, Justin W; Hussey, Peter S

    2015-07-15

    This article describes research related to the design of a payment model for specialty oncology services for possible testing by the Center for Medicare and Medicaid Innovation at the Centers for Medicare & Medicaid Services (CMS). Cancer is a common and costly condition. Episode-based payment, which aims to create incentives for high-quality, low-cost care, has been identified as a promising alternative payment model for oncology care. Episode-based payment systems can provide flexibility to health care providers to select among the most effective and efficient treatment alternatives, including activities that are not currently reimbursed under Medicare payment policies. However, the model design also needs to ensure that high-quality care is delivered and that beneficial treatments are not withheld from patients. CMS asked MITRE and RAND to conduct analyses to inform design decisions related to an episode-based oncology model for Medicare beneficiaries undergoing chemotherapy treatment for cancer. In particular, this study focuses on analyses of Medicare claims data related to the definition of the initiation of an episode of chemotherapy, patterns of spending during and surrounding episodes of chemotherapy, and attribution of episodes of chemotherapy to physician practices. We found that the time between the primary cancer diagnosis and chemotherapy initiation varied widely across patients, ranging from one day to over seven years, with a median of 2.4 months. The average level of total monthly payments varied considerably across cancers, with the highest spending peak of $9,972 for lymphoma, and peaks of $3,109 for breast cancer and $2,135 for prostate cancer.

  1. Home Dialysis in the Prospective Payment System Era.

    Science.gov (United States)

    Lin, Eugene; Cheng, Xingxing S; Chin, Kuo-Kai; Zubair, Talhah; Chertow, Glenn M; Bendavid, Eran; Bhattacharya, Jayanta

    2017-10-01

    The ESRD Prospective Payment System introduced two incentives to increase home dialysis use: bundling injectable medications into a single payment for treatment and paying for home dialysis training. We evaluated the effects of the ESRD Prospective Payment System on home dialysis use by patients starting dialysis in the United States from January 1, 2006 to August 31, 2013. We analyzed data on dialysis modality, insurance type, and comorbidities from the United States Renal Data System. We estimated the effect of the policy on home dialysis use with multivariable logistic regression and compared the effect on Medicare Parts A/B beneficiaries with the effect on patients with other types of insurance. The ESRD Prospective Payment System associated with a 5.0% (95% confidence interval [95% CI], 4.0% to 6.0%) increase in home dialysis use by the end of the study period. Home dialysis use increased by 5.8% (95% CI, 4.3% to 6.9%) among Medicare beneficiaries and 4.1% (95% CI, 2.3% to 5.4%) among patients covered by other forms of health insurance. The difference between these groups was not statistically significant (1.8%; 95% CI, -0.2% to 3.8%). Conversely, in both populations, the training add-on did not associate with increases in home dialysis use beyond the effect of the policy. The ESRD Prospective Payment System bundling, but not the training add-on, associated with substantial increases in home dialysis, which were identical for both Medicare and non-Medicare patients. These spill-over effects suggest that major payment changes in Medicare can affect all patients with ESRD. Copyright © 2017 by the American Society of Nephrology.

  2. Risk-adjusted payment and performance assessment for primary care.

    Science.gov (United States)

    Ash, Arlene S; Ellis, Randall P

    2012-08-01

    Many wish to change incentives for primary care practices through bundled population-based payments and substantial performance feedback and bonus payments. Recognizing patient differences in costs and outcomes is crucial, but customized risk adjustment for such purposes is underdeveloped. Using MarketScan's claims-based data on 17.4 million commercially insured lives, we modeled bundled payment to support expected primary care activity levels (PCAL) and 9 patient outcomes for performance assessment. We evaluated models using 457,000 people assigned to 436 primary care physician panels, and among 13,000 people in a distinct multipayer medical home implementation with commercially insured, Medicare, and Medicaid patients. Each outcome is separately predicted from age, sex, and diagnoses. We define the PCAL outcome as a subset of all costs that proxies the bundled payment needed for comprehensive primary care. Other expected outcomes are used to establish targets against which actual performance can be fairly judged. We evaluate model performance using R(2)'s at patient and practice levels, and within policy-relevant subgroups. The PCAL model explains 67% of variation in its outcome, performing well across diverse patient ages, payers, plan types, and provider specialties; it explains 72% of practice-level variation. In 9 performance measures, the outcome-specific models explain 17%-86% of variation at the practice level, often substantially outperforming a generic score like the one used for full capitation payments in Medicare: for example, with grouped R(2)'s of 47% versus 5% for predicting "prescriptions for antibiotics of concern." Existing data can support the risk-adjusted bundled payment calculations and performance assessments needed to encourage desired transformations in primary care.

  3. Community oncology in an era of payment reform.

    Science.gov (United States)

    Cox, John V; Ward, Jeffery C; Hornberger, John C; Temel, Jennifer S; McAneny, Barbara L

    2014-01-01

    Patients and payers (government and private) are frustrated with the fee-for-service system (FFS) of payment for outpatient health services. FFS rewards volume and highly valued services, including expensive diagnostics and therapeutics, over lesser valued cognitive services. Proposed payment schemes would incent collaboration and coordination of care among providers and reward quality. In oncology, new payment schemes must address the high costs of all services, particularly drugs, while preserving the robust distribution of sites of service available to patients in the United States. Information technology and personalized cancer care are changing the practice of oncology. Twenty-first century oncology will require increasing cognitive work and shared decision making, both of which are not well regarded in the FFS model. A high proportion of health care dollars are consumed in the final months of life. Effective delivery of palliative and end-of-life care must be addressed by practice and by new models of payment. Value-based reimbursement schemes will require oncology practices to change how they are structured. Lessons drawn from the principles of primary care's Patient Centered Medical Home (PCMH) will help oncology practice to prepare for new schemes. PCMH principles place a premium on proactively addressing toxicities of therapies, coordinating care with other providers, and engaging patients in shared decision making, supporting the ideal of value defined in the triple aim-to measurably improve patient experience and quality of care at less cost. Payment reform will be disruptive to all. Oncology must be engaged in policy discussions and guide rational shifts in priorities defined by new payment models.

  4. Framework for Mobile Payments Integration

    DEFF Research Database (Denmark)

    Carton, Fergal; Hedman, Jonas; Damsgaard, Jan

    2012-01-01

    consumers and merchants. These instruments are centralised, costly and lack decision support functionality. The ubiquity of the mobile phone has provided a decentralised platform for managing payment processes in a new way, but the value proposition for customers has yet to be elaborated clearly....... This inertia has stalled the design of sustainable revenue models for a mobile payments ecosystem. Merchants and consumers in the meantime are being seduced by the convenience of on‑line and mobile payment solutions. Adopting the purchase and payment process as the unit of analysis, the current mobile payment...

  5. 4. Payment Schemes

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 6; Issue 2. Electronic Commerce - Payment Schemes. V Rajaraman. Series Article Volume 6 Issue 2 February 2001 pp 6-13. Fulltext. Click here to view fulltext PDF. Permanent link: https://www.ias.ac.in/article/fulltext/reso/006/02/0006-0013 ...

  6. Permissible Delay in Payments

    Directory of Open Access Journals (Sweden)

    Yung-Fu Huang

    2007-01-01

    Full Text Available The main purpose of this paper wants to investigate the optimal retailer's lot-sizing policy with two warehouses under partially permissible delay in payments within the economic order quantity (EOQ framework. In this paper, we want to extend that fully permissible delay in payments to the supplier would offer the retailer partially permissible delay in payments. That is, the retailer must make a partial payment to the supplier when the order is received. Then the retailer must pay off the remaining balance at the end of the permissible delay period. In addition, we want to add the assumption that the retailer's storage space is limited. That is, the retailer will rent the warehouse to store these exceeding items when the order quantity is larger than retailer's storage space. Under these conditions, we model the retailer's inventory system as a cost minimization problem to determine the retailer's optimal cycle time and optimal order quantity. Three theorems are developed to efficiently determine the optimal replenishment policy for the retailer. Finally, numerical examples are given to illustrate these theorems and obtained a lot of managerial insights.

  7. Structuring payment to medical homes after the affordable care act.

    Science.gov (United States)

    Edwards, Samuel T; Abrams, Melinda K; Baron, Richard J; Berenson, Robert A; Rich, Eugene C; Rosenthal, Gary E; Rosenthal, Meredith B; Landon, Bruce E

    2014-10-01

    The Patient-Centered Medical Home (PCMH) is a leading model of primary care reform, a critical element of which is payment reform for primary care services. With the passage of the Affordable Care Act, the Accountable Care Organization (ACO) has emerged as a model of delivery system reform, and while there is theoretical alignment between the PCMH and ACOs, the discussion of physician payment within each model has remained distinct. Here we compare payment for medical homes with that for accountable care organizations, consider opportunities for integration, and discuss implications for policy makers and payers considering ACO models. The PCMH and ACO are complementary approaches to reformed care delivery: the PCMH ultimately requires strong integration with specialists and hospitals as seen under ACOs, and ACOs likely will require a high functioning primary care system as embodied by the PCMH. Aligning payment incentives within the ACO will be critical to achieving this integration and enhancing the care coordination role of primary care in these settings.

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

    Directory of Open Access Journals (Sweden)

    Enisha eSarin

    2016-03-01

    Full Text Available 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 Gurdarspur 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

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

    Science.gov (United States)

    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

  10. The Effect of Incentives and Meta-incentives on the Evolution of Cooperation

    OpenAIRE

    Okada, Isamu; Yamamoto, Hitoshi; Toriumi, Fujio; Sasaki, Tatsuya

    2015-01-01

    Although positive incentives for cooperators and/or negative incentives for free-riders in social dilemmas play an important role in maintaining cooperation, there is still the outstanding issue of who should pay the cost of incentives. The second-order free-rider problem, in which players who do not provide the incentives dominate in a game, is a well-known academic challenge. In order to meet this challenge, we devise and analyze a meta-incentive game that integrates positive incentives (re...

  11. Effects of payments for ecosystem services on wildlife habitat recovery.

    Science.gov (United States)

    Tuanmu, Mao-Ning; Viña, Andrés; Yang, Wu; Chen, Xiaodong; Shortridge, Ashton M; Liu, Jianguo

    2016-08-01

    Conflicts between local people's livelihoods and conservation have led to many unsuccessful conservation efforts and have stimulated debates on policies that might simultaneously promote sustainable management of protected areas and improve the living conditions of local people. Many government-sponsored payments-for-ecosystem-services (PES) schemes have been implemented around the world. However, few empirical assessments of their effectiveness have been conducted, and even fewer assessments have directly measured their effects on ecosystem services. We conducted an empirical and spatially explicit assessment of the conservation effectiveness of one of the world's largest PES programs through the use of a long-term empirical data set, a satellite-based habitat model, and spatial autoregressive analyses on direct measures of change in an ecosystem service (i.e., the provision of wildlife species habitat). Giant panda (Ailuropoda melanoleuca) habitat improved in Wolong Nature Reserve of China after the implementation of the Natural Forest Conservation Program. The improvement was more pronounced in areas monitored by local residents than those monitored by the local government, but only when a higher payment was provided. Our results suggest that the effectiveness of a PES program depends on who receives the payment and on whether the payment provides sufficient incentives. As engagement of local residents has not been incorporated in many conservation strategies elsewhere in China or around the world, our results also suggest that using an incentive-based strategy as a complement to command-and-control, community- and norm-based strategies may help achieve greater conservation effectiveness and provide a potential solution for the park versus people conflict. © 2016 Society for Conservation Biology.

  12. Reliability payments to generation capacity in electricity markets

    International Nuclear Information System (INIS)

    Olsina, Fernando; Pringles, Rolando; Larisson, Carlos; Garcés, Francisco

    2014-01-01

    Electric power is a critical input to modern economies. Generation adequacy and security of supply in power systems running under competition are currently topics of high concern for consumers, regulators and governments. In a market setting, generation investments and adequacy can only be achieved by an appropriate regulatory framework that sets efficient remuneration to power capacity. Theoretically, energy-only electricity markets are efficient and no additional mechanism is needed. Nonetheless, the energy-only market design suffers from serious drawbacks. Therefore, jointly with the evolution of electricity markets, many remunerating mechanisms for generation capacity have been proposed. Explicit capacity payment was the first remunerating approach implemented and perhaps still the most applied. However, this price-based regulation has been applied no without severe difficulties and criticism. In this paper, a new reliability payment mechanism is envisioned. Capacity of each generating unit is paid according to its effective contribution to overall system reliability. The proposed scheme has many attractive features and preserves the theoretical efficiency properties of energy-only markets. Fairness, incentive compatibility, market power mitigation and settlement rules are investigated in this work. The article also examines the requirements for system data and models in order to implement the proposed capacity mechanism. A numerical example on a real hydrothermal system serves for illustrating the practicability of the proposed approach and the resulting reliability payments to the generation units. - Highlights: • A new approach for remunerating supply reliability provided by generation units is proposed. • The contribution of each generating unit to lessen power shortfalls is determined by simulations. • Efficiency, fairness and incentive compatibility of the proposed reliability payment are assessed

  13. A Capacity Payment Model for the Italian Electricity Market. Why It is Needed and How Can It Be Designed?

    Energy Technology Data Exchange (ETDEWEB)

    Gelmini, A.; Benini, M.; Gallanti, M [CESI RICERCA S.p.A(Italy)

    2007-06-15

    The capacity payment model proposed by the Regulatory Authority for the Italian electricity market has been described and its impact has been assessed by means of long-term dynamic simulations. By comparing the simulation results of scenarios with and without the proposed capacity payment models, as well as with a scenario characterized by a fixed-payment model, the following conclusions can be drawn: 1. the proposed capacity payment model is able to sufficiently incentivize investments, so that a satisfactory amount of generation capacity results available over time, keeping the reserve margin substantially over the reference lower limit; 2. the proposed capacity payment model allows to substantially reduce price peaks, thus reducing both the average electricity prices and their volatility; 3. specific costs of the proposed capacity payment model are in the range between 2.5 to 5.5 Euro/MWh along the simulation period; 4. savings in buying energy from the power exchange due to price reductions substantially compensate the 'premium' related costs in the long term: this means that, with the proposed capacity payment model, it is possible to guarantee a better adequacy of the electric system without additional costs; 5. the simulations confirmed that the dynamic behavior of the proposed capacity payment model results in a better timing in providing incentive to investments in new generation capacity when needed, w.r.t. a simple conventional fixed-payment model.

  14. A Capacity Payment Model for the Italian Electricity Market. Why It is Needed and How Can It Be Designed?

    International Nuclear Information System (INIS)

    Gelmini, A.; Benini, M.; Gallanti, M

    2007-06-01

    The capacity payment model proposed by the Regulatory Authority for the Italian electricity market has been described and its impact has been assessed by means of long-term dynamic simulations. By comparing the simulation results of scenarios with and without the proposed capacity payment models, as well as with a scenario characterized by a fixed-payment model, the following conclusions can be drawn: 1. the proposed capacity payment model is able to sufficiently incentivize investments, so that a satisfactory amount of generation capacity results available over time, keeping the reserve margin substantially over the reference lower limit; 2. the proposed capacity payment model allows to substantially reduce price peaks, thus reducing both the average electricity prices and their volatility; 3. specific costs of the proposed capacity payment model are in the range between 2.5 to 5.5 Euro/MWh along the simulation period; 4. savings in buying energy from the power exchange due to price reductions substantially compensate the 'premium' related costs in the long term: this means that, with the proposed capacity payment model, it is possible to guarantee a better adequacy of the electric system without additional costs; 5. the simulations confirmed that the dynamic behavior of the proposed capacity payment model results in a better timing in providing incentive to investments in new generation capacity when needed, w.r.t. a simple conventional fixed-payment model.

  15. Performance-Based Regulation In A High Distributed Energy Resources Future

    Energy Technology Data Exchange (ETDEWEB)

    Newton Lowry, Mark [Pacific Economics Group Research LLC, Madison, WI (United States); Woolf, Tim [Synapse Energy Economics, Cambridge, MA (United States); Schwartz, Lisa C. [Lawrence Berkeley National Lab. (LBNL), Berkeley, CA (United States)

    2018-03-07

    Performance-based regulation (PBR) of utilities has emerged as an important ratemaking option in the last 25 years. It has been implemented in numerous jurisdictions across the United States and is common in many other advanced industrialized countries. PBR’s appeal lies chiefly in its ability to strengthen utility performance incentives relative to traditional cost-of-service regulation (COSR). Some forms of PBR can streamline regulation and provide utilities with greater operating flexibility. Ideally, the benefits of better performance are shared by the utility and its customers. The shortcomings of traditional COSR in providing electric utilities with incentives that are aligned with certain regulatory goals are becoming increasingly clear. In particular, COSR can provide strong incentives to increase electricity sales and utility rate base. Further, some parties express concern that traditional COSR does not provide utilities with appropriate financial incentives to address evolving industry challenges such as changing customer demands for electricity services, increased levels of distributed energy resources (DERs), and growing pressure to mitigate carbon dioxide emissions. In addition, attention to potential new regulatory models to support the “utility of the future” has renewed interest in PBR. This report describes key elements of PBR and explains some of the advantages and disadvantages of various PBR options. We present pertinent issues from the perspectives of utilities and customers. In practice, these different perspectives are not diametrically opposed. Nonetheless, this framework is useful for illustrating how various aspects of PBR may be viewed by those key groups. Regulators have a unique perspective, in that they must balance consumer, utility, and other interests with the goal of achieving a result that is in the overall public interest.

  16. Payments for carbon sequestration to alleviate development pressure in a rapidly urbanizing region

    Science.gov (United States)

    Smith, Jordan W.; Dorning, Monica; Shoemaker, Douglas A.; Méley, Andréanne; Dupey, Lauren; Meentemeyer, Ross K.

    2017-01-01

    The purpose of this study was to determine individuals' willingness to enroll in voluntary payments for carbon sequestration programs through the use of a discrete choice experiment delivered to forest owners living in the rapidly urbanizing region surrounding Charlotte, North Carolina. We examined forest owners' willingness to enroll in payments for carbon sequestration policies under different levels of financial incentives (annual revenue), different contract lengths, and different program administrators (e.g., private companies versus a state or federal agency). We also examined the influence forest owners' sense of place had on their willingness to enroll in hypothetical programs. Our results showed a high level of ambivalence toward participating in payments for carbon sequestration programs. However, both financial incentives and contract lengths significantly influenced forest owners' intent to enroll. Neither program administration nor forest owners' sense of place influenced intent to enroll. Although our analyses indicated that payments from carbon sequestration programs are not currently competitive with the monetary returns expected from timber harvest or property sales, certain forest owners might see payments for carbon sequestration programs as a viable option for offsetting increasing tax costs as development encroaches and property values rise.

  17. Effects of payment changes on trends in post-acute care.

    Science.gov (United States)

    Buntin, Melinda Beeuwkes; Colla, Carrie Hoverman; Escarce, José J

    2009-08-01

    To test how the implementation of new Medicare post-acute payment systems affected the use of inpatient rehabilitation facilities (IRFs), skilled nursing facilities (SNFs), and home health agencies. Medicare acute hospital, IRF, and SNF claims; provider of services file; enrollment file; and Area Resource File data. We used multinomial logit models to measure realized access to post-acute care and to predict how access to alternative sites of care changed in response to prospective payment systems. A file was constructed linking data for elderly Medicare patients discharged from acute care facilities between 1996 and 2003 with a diagnosis of hip fracture, stroke, or lower extremity joint replacement. Although the effects of the payment systems on the use of post-acute care varied, most reduced the use of the site of care they directly affected and boosted the use of alternative sites of care. Payment system changes do not appear to have differentially affected the severely ill. Payment system incentives play a significant role in determining where Medicare beneficiaries receive their post-acute care. Changing these incentives results in shifting of patients between post-acute sites.

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

    Science.gov (United States)

    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.

  19. Michigan's fee-for-value physician incentive program reduces spending and improves quality in primary care.

    Science.gov (United States)

    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.

  20. Participation determinants in the DRG payment system of obstetrics and gynecology clinics in South Korea.

    Science.gov (United States)

    Song, Jung-Kook; Kim, Chang-yup

    2010-03-01

    The Diagnosis Related Group (DRG) payment system, which has been implemented in Korea since 1997, is based on voluntary participation. Hence, the positive impact of this system depends on the participation of physicians. This study examined the factors determining participation of Korean obstetrics & gynecology (OBGYN) clinics in the DRG-based payment system. The demographic information, practice-related variables of OBGYN clinics and participation information in the DRG-based payment system were acquired from the nationwide data from 2002 to 2007 produced by the National Health Insurance Corporation and the Health Insurance Review & Assessment Service. The subjects were 336 OBGYN clinics consisting of 43 DRG clinics that had maintained their participation in 2003-2007 and 293 no-DRG (fee-for-service) clinics that had never been a DRG clinic during the same period. Logistic regression analysis was carried out to determine the factors associated with the participation of OBGYN clinics in the DRG-based payment system. The factors affecting participation of OBGYN clinics in the DRG-based payment system were as follows (psystem are more likely to participate in the DRG-based payment system. Therefore, to ensure adequate participation of physicians, a payment system with a stronger financial incentive might be more suitable in Korea.

  1. Water Conservation and Economic Incentives

    Science.gov (United States)

    Narayanan, M.

    2016-12-01

    Water has played a vital role in the progress of human civilization throughout history. Both agriculture based economics as well as industry based economics totally rely upon water for survival and prosperity. Water could be a limiting factor in dictating day-to-day human activities and as such one should learn to live within the limits of available natural resources. Most of the water on this earth is either salty or undrinkable. Only one percent of world's water is available for all the needs of human civilization. This includes human personal household needs, community activities, agriculture, industry, plant and animal life sustenance. The supply of usable fresh water is finite and the per capita consumption of fresh water needs to be reduced in particularly in some selected regions of this world. The United States consumes about 450 billion gallons of water every day. The U.S. daily average of water pumped by public water supply systems is 185 gallons per person. The biggest water gobbler in a household is the lawn. Typically, at least 50% of water consumed by households is used outdoors. Even inside a house, bathroom facilities claim nearly 75% of the water used. Here is a short list of economic Incentives that may help water conservation. (1) Providing rebates, refunds or other economic incentives to those consumers that are willing to change to modern technological methods. Examples include, but not limited to energy efficient washing machines, low-flush toilets and improved shower head designs. (2) Communities should provide economic incentives to limit the type and size of landscaping. (3) Need, necessity and nature of outdoor water use could be restricted whenever possible. (4) Sprinkler ban may be deemed appropriate in extreme cases. (5) Set up hotlines that can help penalize those that ignore water conservation guidelines. (6) Incorporating water conservation monitors. References: http://www.nrdc.org/water/http://www.ecy.wa.gov/programs/wr/ws/wtrcnsv.htmlhttp://www.sscwd.org/tips.html

  2. Incentive Ratios of Fisher Markets

    DEFF Research Database (Denmark)

    Chen, Ning; Deng, Xuaitue; Zhang, Hongyang

    2012-01-01

    In a Fisher market, a market maker sells m items to n potential buyers. The buyers submit their utility functions and money endowments to the market maker, who, upon receiving submitted information, derives market equilibrium prices and allocations of its items. While agents may benefit...... by misreporting their private information, we show that the percentage of improvement by a unilateral strategic play, called incentive ratio, is rather limited—it is less than 2 for linear markets and at most $e^{1/e}\\thickapprox 1.445$ for Cobb-Douglas markets. We further prove that both ratios are tight....

  3. Incentives for improvement of CANDU

    International Nuclear Information System (INIS)

    Hart, R.S.; Dunn, J.T.; Finlay, R.B.

    1988-12-01

    CANDU is a relatively young technology which has demonstrated many achievements as an electrical power generation system. These achievements include an unsurpassed safety record, high annual and lifetime capacity factors, low electricity cost and a broad range of other performance strengths which together indicate that the CANDU technology is fundamentally sound. Known capabilities not yet fully exploited, such as advanced fuel cycle options, indicate that CANDU technology will continue to pay strong dividends on research, development and design investment. This provides a strong incentive for the improvement of CANDU on a continuing basis

  4. Market incentives and pharmaceutical innovation.

    Science.gov (United States)

    Yin, Wesley

    2008-07-01

    I study the impact of the Orphan Drug Act (ODA), which established tax incentives for rare disease drug development. I examine the flow of new clinical drug trials for a large set of rare diseases. Among more prevalent rare diseases, the ODA led to a significant and sustained increase in new trials. The impact for less prevalent rare diseases was limited to an increase in the stock of drugs. Tax credits can stimulate R & D; yet because they leave revenue margins unaffected, tax credits appear to have a more limited impact on private innovation in markets with smaller revenue potential.

  5. Incentives in Supply Function Equilibrium

    DEFF Research Database (Denmark)

    Vetter, Henrik

    2014-01-01

    The author analyses delegation in homogenous duopoly under the assumption that the firm-managers compete in supply functions. In supply function equilibrium, managers’ decisions are strategic complements. This reverses earlier findings in that the author finds that owners give managers incentives...... to act in an accommodating way. As a result, optimal delegation reduces per-firm output and increases profits to above-Cournot profits. Moreover, in supply function equilibrium the mode of competition is endogenous. This means that the author avoids results that are sensitive with respect to assuming...

  6. The voluntary fulfillment of the taxes payment as reformative institution of Venezuelan tax system

    Directory of Open Access Journals (Sweden)

    Jose Guillermo Garcia

    2007-07-01

    Full Text Available A consensus between the reformers of the public administration exists on a matter that changes are not decreed, but that these require, for their effective fulfillment of certain conditions, like stimulation of actors affected by the reforms, to recognize the new scenario like favorable and therefore, to act in its name. Under this premise, this paper analyzes the voluntary fulfillment of the taxes payment as reformative institution of the Venezuelan tax system, which has implied the development of a formal incentives structure promoting the initiative of conscious tax payment.

  7. On incentives for assurance of petroleum supply

    International Nuclear Information System (INIS)

    Osmundsen, Petter; Aven, Terje; Tomasgard, Asgeir

    2010-01-01

    Assurance of supply is a crucial objective for producers and consumers of oil and gas. A basic requirement to meet this objective is that producers and transmitters have sufficient economic incentives and capabilities to assure a desired degree of supply. The topic of this paper is to evaluate these incentives from a broad perspective. We examine economic trade-offs inherent in a delay of production, including reputational issues, as well as contract incentives for gas sellers, drilling companies, and oil service companies.

  8. Incentives for reducing emissions in Krakow

    International Nuclear Information System (INIS)

    Uberman, R.; Pierce, B.; Lazecki, A.

    1994-01-01

    This effort is identifying, specific incentives that may be used by Krakow city officials to encourage, residents to change the way they heat their homes and businesses in order to reduce pollution. This paper describes the incentives study for converting small coal or coke-fired boilers to gas in the Old Town area. A similar study looked at incentives for expanding the district heating system and future analyses will be performed for home stove options

  9. Incentives and cooperation in firms: Field evidence

    OpenAIRE

    Berger, Johannes; Herbertz, Claus; Sliwka, Dirk

    2011-01-01

    We empirically investigate the impact of incentive scheme structure on the degree of cooperation in firms using a unique and representative data set. Combining employee survey data with detailed firm level information on the relative importance of individual, team, and company performance for compensation, we find a significant positive relation between the intensity of team incentives and several survey measures of cooperation. Moreover, higher powered team incentives are associated with low...

  10. TAP 2, Performance-Based Training Manual

    Energy Technology Data Exchange (ETDEWEB)

    1991-07-01

    Training programs at DOE nuclear facilities should provide well- trained, qualified personnel to safely and efficiently operate the facilities in accordance with DOE requirements. A need has been identified for guidance regarding analysis, design, development, implementation, and evaluation of consistent and reliable performance-based training programs. Accreditation of training programs at Category A reactors and high-hazard and selected moderate-hazard nonreactor facilities will assure consistent, appropriate, and cost-effective training of personnel responsible for the operation, maintenance, and technical support of these facilities. Training programs that are designed and based on systematically job requirements, instead of subjective estimation of trainee needs, yield training activities that are consistent and develop or improve knowledge, skills, and abilities that can be directly related to the work setting. Because the training is job-related, the content of these programs more efficiently and effectively meets the needs of the employee. Besides a better trained work force, a greater level of operational reactor safety can be realized. This manual is intended to provide an overview of the accreditation process and a brief description of the elements necessary to construct and maintain training programs that are based on the requirements of the job. Two comparison manuals provide additional information to assist contractors in their efforts to accredit training programs.

  11. TAP 2, Performance-Based Training Manual

    International Nuclear Information System (INIS)

    1991-07-01

    Training programs at DOE nuclear facilities should provide well- trained, qualified personnel to safely and efficiently operate the facilities in accordance with DOE requirements. A need has been identified for guidance regarding analysis, design, development, implementation, and evaluation of consistent and reliable performance-based training programs. Accreditation of training programs at Category A reactors and high-hazard and selected moderate-hazard nonreactor facilities will assure consistent, appropriate, and cost-effective training of personnel responsible for the operation, maintenance, and technical support of these facilities. Training programs that are designed and based on systematically job requirements, instead of subjective estimation of trainee needs, yield training activities that are consistent and develop or improve knowledge, skills, and abilities that can be directly related to the work setting. Because the training is job-related, the content of these programs more efficiently and effectively meets the needs of the employee. Besides a better trained work force, a greater level of operational reactor safety can be realized. This manual is intended to provide an overview of the accreditation process and a brief description of the elements necessary to construct and maintain training programs that are based on the requirements of the job. Two comparison manuals provide additional information to assist contractors in their efforts to accredit training programs

  12. INEQUALITY, INCENTIVES AND THE INTERPERSONAL TEST

    DEFF Research Database (Denmark)

    Lippert-Rasmussen, Kasper

    2008-01-01

    ABSTRACT This article defends three claims: (1) even if Rawls' difference principle permits incentives to induce talented people to be more productive, it does not follow that it permits inequalities; (2) the difference principle, when adequately specified, may in some circumstances permit incent...... incentives and allow that the worst off are not made as well off as they could be; and (3) an argument for incentives might pass Cohen's interpersonal test even if it is unsound and might not pass it even if it is sound. 1...

  13. Pattern of the rational worker incentive system

    Directory of Open Access Journals (Sweden)

    Kopytova A.V.

    2017-01-01

    Full Text Available The article presents a model of rational incentive system with the structure consisting of three blocks. The first block (financial incentives provides monetary compensation to a worker. The second block (stimulating by comfortable living conditions is aimed to regulate the quality of a worker’s life in and outside the place he works. The third block (non-financial incentives takes into account cultural and social worker’s needs. The proposed structure of incentive system provides the most comprehensive coverage to the employee’s needs and organizes them in the way accessible both for specialists of labor economics and human resource management and for ordinary workers.

  14. Incentives and intrinsic motivation in healthcare

    Directory of Open Access Journals (Sweden)

    Mikel Berdud

    2016-11-01

    Conclusions: The conclusions could act as a guide to support the optimal design of incentive policies and schemes within health organisations when healthcare professionals are intrinsically motivated.

  15. Do Tax Incentives Affect Business Location? Evidence from State Film Incentives

    OpenAIRE

    Patrick Button

    2015-01-01

    I provide the first estimates of the impacts of recently-popular U.S. state film incentives on filming location, establishment location, and employment in the film industry. Filming in this industry is relatively insensitive to locational characteristics, and these incentives are numerous and strong, so this is a good case study to bound the effects of tax incentives on business location. I compile a detailed database of incentives across U.S. states, matching this with TV series and feature ...

  16. Financial incentive approaches for reducing peak electricity demand, experience from pilot trials with a UK energy provider

    International Nuclear Information System (INIS)

    Bradley, Peter; Coke, Alexia; Leach, Matthew

    2016-01-01

    Whilst tariff-based approaches to load-shifting are common in the residential sector, incentive-based approaches are rare. This is so, even though providing customers incentives to shape their power consumption patterns has substantial potential. This paper presents findings from an exploratory UK pilot study that trials financial payments and detailed energy feedback to incentivise load-shifting of residential electricity consumption. An intervention study was implemented measuring actual energy use by individual households as well as conducting surveys and interviews. From the trials it was found that the approaches resulted in reductions in peak time energy use. Evidence from the study found that the incentives-based approaches were able to overcome some of the barriers to response experienced in Time-of-Use studies, though less good on others. Interestingly, the height of the barriers varied by the electricity-using practice and the incentivising approach applied. The height of the barriers also varied by participant. The study concludes by identifying that broad participation in demand response is likely to require a suite of incentivising approaches that appeal to different people, a key policy finding of interest to international agencies, government, public and private sector entities. - Highlights: • Novel study of financial incentive approaches for shifting residential energy. • First academic paper comprehensively identifying barriers to time of use tariffs. • First study reporting barriers to financial incentive approaches for demand response. • Incentive study design can be applied by government and energy companies.

  17. 24 CFR 206.19 - Payment options.

    Science.gov (United States)

    2010-04-01

    ... 24 Housing and Urban Development 2 2010-04-01 2010-04-01 false Payment options. 206.19 Section 206... CONVERSION MORTGAGE INSURANCE Eligibility; Endorsement Eligible Mortgages § 206.19 Payment options. (a) Term payment option. Under the term payment option, equal monthly payments are made by the mortgagee to the...

  18. 24 CFR 983.352 - Vacancy payment.

    Science.gov (United States)

    2010-04-01

    ... PROJECT-BASED VOUCHER (PBV) PROGRAM Payment to Owner § 983.352 Vacancy payment. (a) Payment for move-out month. If an assisted family moves out of the unit, the owner may keep the housing assistance payment... 24 Housing and Urban Development 4 2010-04-01 2010-04-01 false Vacancy payment. 983.352 Section...

  19. Higher Magnitude Cash Payments Improve Research Follow-up Rates Without Increasing Drug Use or Perceived Coercion

    Science.gov (United States)

    Festinger, David S.; Marlowe, Douglas B.; Dugosh, Karen L.; Croft, Jason R.; Arabia, Patricia L.

    2008-01-01

    In a prior study (Festinger et al., 2005) we found that neither the mode (cash vs. gift card) nor magnitude ($10, $40, or $70) of research follow-up payments increased rates of new drug use or perceptions of coercion. However, higher payments and payments in cash were associated with better follow-up attendance, reduced tracking efforts, and improved participant satisfaction with the study. The present study extended those findings to higher payment magnitudes. Participants from an urban outpatient substance abuse treatment program were randomly assigned to receive $70, $100, $130, or $160 in either cash or a gift card for completing a follow-up assessment at 6 months post-admission (n ≅ 50 per cell). Apart from the payment incentives, all participants received a standardized, minimal platform of follow-up efforts. Findings revealed that neither the magnitude nor mode of payment had a significant effect on new drug use or perceived coercion. Consistent with our previous findings, higher payments and cash payments resulted in significantly higher follow-up rates and fewer tracking calls. In addition participants receiving cash vs. gift cards were more likely to use their payments for essential, non-luxury purchases. Follow-up rates for participants receiving cash payments of $100, $130, and $160 approached or exceeded the FDA required minimum of 70% for studies to be considered in evaluations of new medications. This suggests that the use of higher magnitude payments and cash payments may be effective strategies for obtaining more representative follow-up samples without increasing new drug use or perceptions of coercion. PMID:18395365

  20. Incentive-based approaches in marine conservation: Applications for sea turtles

    Directory of Open Access Journals (Sweden)

    Gjertsen Heidi

    2010-01-01

    Full Text Available Conservation practitioners are increasingly turning to incentive-based approaches to encourage local resource users to change behaviors that impact biodiversity and natural habitat. We assess the design and performance of marine conservation interventions with varying types of incentives through an analysis of case studies from around the world. Here we focus on seven examples that are particularly relevant to designing incentives for sea turtle conservation. Four of the cases are focused on sea turtle conservation, and the others contain elements that may be applied to turtle projects. Many more opportunities exist for interventions that combine the strengths of these approaches, such as performance-based agreements that provide funds for education or alternative livelihood development, and leasing fishing rights to reduce bycatch.

  1. Understanding informal payments in health care: motivation of health workers in Tanzania.

    Science.gov (United States)

    Stringhini, Silvia; Thomas, Steve; Bidwell, Posy; Mtui, Tina; Mwisongo, Aziza

    2009-06-30

    There is growing evidence that informal payments for health care are fairly common in many low- and middle-income countries. Informal payments are reported to have a negative consequence on equity and quality of care; it has been suggested, however, that they may contribute to health worker motivation and retention. Given the significance of motivation and retention issues in human resources for health, a better understanding of the relationships between the two phenomena is needed. This study attempts to assess whether and in what ways informal payments occur in Kibaha, Tanzania. Moreover, it aims to assess how informal earnings might help boost health worker motivation and retention. Nine focus groups were conducted in three health facilities of different levels in the health system. In total, 64 health workers participated in the focus group discussions (81% female, 19% male) and where possible, focus groups were divided by cadre. All data were processed and analysed by means of the NVivo software package. The use of informal payments in the study area was confirmed by this study. Furthermore, a negative relationship between informal payments and job satisfaction and better motivation is suggested. Participants mentioned that they felt enslaved by patients as a result of being bribed and this resulted in loss of self-esteem. Furthermore, fear of detection was a main demotivating factor. These factors seem to counterbalance the positive effect of financial incentives. Moreover, informal payments were not found to be related to retention of health workers in the public health system. Other factors such as job security seemed to be more relevant for retention. This study suggests that the practice of informal payments contributes to the general demotivation of health workers and negatively affects access to health care services and quality of the health system. Policy action is needed that not only provides better financial incentives for individuals but also

  2. Understanding informal payments in health care: motivation of health workers in Tanzania

    Directory of Open Access Journals (Sweden)

    Bidwell Posy

    2009-06-01

    Full Text Available Abstract Background There is growing evidence that informal payments for health care are fairly common in many low- and middle-income countries. Informal payments are reported to have a negative consequence on equity and quality of care; it has been suggested, however, that they may contribute to health worker motivation and retention. Given the significance of motivation and retention issues in human resources for health, a better understanding of the relationships between the two phenomena is needed. This study attempts to assess whether and in what ways informal payments occur in Kibaha, Tanzania. Moreover, it aims to assess how informal earnings might help boost health worker motivation and retention. Methods Nine focus groups were conducted in three health facilities of different levels in the health system. In total, 64 health workers participated in the focus group discussions (81% female, 19% male and where possible, focus groups were divided by cadre. All data were processed and analysed by means of the NVivo software package. Results The use of informal payments in the study area was confirmed by this study. Furthermore, a negative relationship between informal payments and job satisfaction and better motivation is suggested. Participants mentioned that they felt enslaved by patients as a result of being bribed and this resulted in loss of self-esteem. Furthermore, fear of detection was a main demotivating factor. These factors seem to counterbalance the positive effect of financial incentives. Moreover, informal payments were not found to be related to retention of health workers in the public health system. Other factors such as job security seemed to be more relevant for retention. Conclusion This study suggests that the practice of informal payments contributes to the general demotivation of health workers and negatively affects access to health care services and quality of the health system. Policy action is needed that not only

  3. PAYMENT CAPACITY SENSITIVITY FACTORS

    OpenAIRE

    Daniel BRÎNDESCU – OLARIU

    2014-01-01

    The current study focuses on the sensitivity of the corporate payment capacity. Through the nature of the subject, the research is based on simulating variations of the forecasted cash-flows of the companies included in the sample. The study employs 391 forecasted yearly cash-flows statements collected from 50 companies from Timis County (Romania), as well as the detailed hypotheses of the forecasts. The results of the study facilitate the determination and classification of the main se...

  4. Variation in Payment Rates under Medicare's Inpatient Prospective Payment System.

    Science.gov (United States)

    Krinsky, Sam; Ryan, Andrew M; Mijanovich, Tod; Blustein, Jan

    2017-04-01

    To measure variation in payment rates under Medicare's Inpatient Prospective Payment System (IPPS) and identify the main payment adjustments that drive variation. Medicare cost reports for all Medicare-certified hospitals, 1987-2013, and Dartmouth Atlas geographic files. We measure the Medicare payment rate as a hospital's total acute inpatient Medicare Part A payment, divided by the standard IPPS payment for its geographic area. We assess variation using several measures, both within local markets and nationally. We perform a factor decomposition to identify the share of variation attributable to specific adjustments. We also describe the characteristics of hospitals receiving different payment rates and evaluate changes in the magnitude of the main adjustments over time. Data downloaded from the Centers for Medicare and Medicaid Services, the National Bureau of Economic Research, and the Dartmouth Atlas. In 2013, Medicare paid for acute inpatient discharges at a rate 31 percent above the IPPS base. For the top 10 percent of discharges, the mean rate was double the IPPS base. Variations were driven by adjustments for medical education and care to low-income populations. The magnitude of variation has increased over time. Adjustments are a large and growing share of Medicare hospital payments, and they create significant variation in payment rates. © Health Research and Educational Trust.

  5. 20 CFR 411.525 - What payments are available under each of the EN payment systems?

    Science.gov (United States)

    2010-04-01

    ... EN payment systems? 411.525 Section 411.525 Employees' Benefits SOCIAL SECURITY ADMINISTRATION THE TICKET TO WORK AND SELF-SUFFICIENCY PROGRAM Employment Network Payment Systems § 411.525 What payments are available under each of the EN payment systems? (a) For payments for outcome payment months, both...

  6. Adoption of Mobile Payment Platforms

    DEFF Research Database (Denmark)

    Staykova, Kalina Stefanova; Damsgaard, Jan

    2016-01-01

    Numerous mobile payment solutions, which rely on new disruptive technologies, have been launched on the payment market in recent years. But despite the growing number of mobile payment apps, very few solutions have turned to be successful as the majority of them fail to gain a critical mass...... of users. In this paper, we investigate successful platform adoption strategies by using the Reach and Range Framework for Multi-Sided Platforms as a strategic tool to which mobile payment providers can adhere in order to tackle some of the main challenges they face throughout the evolution...... of their platforms. The analysis indicates that successful mobile payment solutions tend to be launched as one-sided platforms and then gradually be expanded into being two-sided. Our study showcases that the success of mobile payment platforms lies with the ability of the platform to balance the reach (number...

  7. Impact of the Japanese Diagnosis Procedure Combination-based Payment System on cardiovascular medicine-related costs.

    Science.gov (United States)

    Yasunaga, Hideo; Ide, Hiroo; Imamura, Tomoaki; Ohe, Kazuhiko

    2005-09-01

    In 2003, a lump-sum payment system based on Diagnosis Procedure Combinations (DPC) was introduced to 82 specific function hospitals in Japan. While the US DRG/PPS system is a "per case payment" system, the DPC based payment system adopts a "per day payment." It is generally believed that the Japanese system provides as much of an incentive as the DRG/PPS system to shorten the average length of stay (LOS). We performed an empirical analysis of the effect of LOS shortening on hospital revenue and expenditure under the DPC-based payment system, particularly in cardiovascular diseases. We also point out fundamentally controversial aspects of the current system. A total 109 cases were selected from patients hospitalized at the University of Tokyo Hospital from May to July, 2003 and classified into one of three categories: (1) cardiac catheter interventions, (2) cardiac catheter examinations, and (3) other conservative treatments. We analyzed the changes in profit per day in cases of a reduction in average LOS and an increase in the number of cases. In category (1) profit increased significantly in conjunction with reduced LOS. In category (2) profit increased only minimally. In category (3), profit increased rarely and sometimes decreased. In cases of conservative treatment, profits sometimes decreased because an increase in material costs exceeded the increase in revenue. It therefore became clear that the DPC-based payment system does not decisively provide an economic incentive to reduce LOS in cardiovascular medicine.

  8. Program evaluation and incentives for administrators of energy efficiency programs: can evaluation solve the principal/agent problem?

    Energy Technology Data Exchange (ETDEWEB)

    Blumstein, Carl (Univ. of California, Energy Institute (United States))

    2009-07-01

    This paper addresses the nexus between the evaluation of energy-efficiency programs and incentive payments based on performance for program administrators in California. The paper describes problems that arise when evaluators are asked to measure program performance by answering the counterfactual question, what would have happened in the absence of the program? Then some ways of addressing these problems are examined. Key conclusions are that 1) program evaluation cannot precisely and accurately determine the counterfactual, there will always be substantial uncertainty, 2) given the current state of knowledge, the decision to tie all of the incentive to program outcomes is misguided, and 3) incentive programs should be regularly reviewed and revised so that they can be adapted to new conditions.

  9. Program evaluation and incentives for administrators of energy-efficiency programs: Can evaluation solve the principal/agent problem?

    Energy Technology Data Exchange (ETDEWEB)

    Blumstein, Carl, E-mail: blumstei@berkeley.ed [University of California Energy Institute, 2547 Channing Way, Berkeley, CA 94720 (United States)

    2010-10-15

    This paper addresses the nexus between evaluation of energy-efficiency programs and incentive payments based on performance for program administrators in California. The paper describes the problems that arise when evaluators are asked to measure program performance by answering the counterfactual question-what would have happened in the absence of the program? Then the paper examines some ways of addressing these problems. Key conclusions are (1) program evaluation cannot precisely and accurately determine the counterfactual, there will always be substantial uncertainty, (2) given the current state of knowledge, the decision to tie all incentives to program outcomes is misguided, and (3) incentive programs should be regularly reviewed and revised so that they can be adapted to new conditions.

  10. Program evaluation and incentives for administrators of energy-efficiency programs. Can evaluation solve the principal/agent problem?

    Energy Technology Data Exchange (ETDEWEB)

    Blumstein, Carl [University of California Energy Institute, 2547 Channing Way, Berkeley, CA 94720 (United States)

    2010-10-15

    This paper addresses the nexus between evaluation of energy-efficiency programs and incentive payments based on performance for program administrators in California. The paper describes the problems that arise when evaluators are asked to measure program performance by answering the counterfactual question - what would have happened in the absence of the program? Then the paper examines some ways of addressing these problems. Key conclusions are (1) program evaluation cannot precisely and accurately determine the counterfactual, there will always be substantial uncertainty, (2) given the current state of knowledge, the decision to tie all incentives to program outcomes is misguided, and (3) incentive programs should be regularly reviewed and revised so that they can be adapted to new conditions. (author)

  11. Program evaluation and incentives for administrators of energy-efficiency programs: Can evaluation solve the principal/agent problem?

    International Nuclear Information System (INIS)

    Blumstein, Carl

    2010-01-01

    This paper addresses the nexus between evaluation of energy-efficiency programs and incentive payments based on performance for program administrators in California. The paper describes the problems that arise when evaluators are asked to measure program performance by answering the counterfactual question-what would have happened in the absence of the program? Then the paper examines some ways of addressing these problems. Key conclusions are (1) program evaluation cannot precisely and accurately determine the counterfactual, there will always be substantial uncertainty, (2) given the current state of knowledge, the decision to tie all incentives to program outcomes is misguided, and (3) incentive programs should be regularly reviewed and revised so that they can be adapted to new conditions.

  12. Renewable Energy Cost Modeling: A Toolkit for Establishing Cost-Based Incentives in the United States; March 2010 -- March 2011

    Energy Technology Data Exchange (ETDEWEB)

    Gifford, J. S.; Grace, R. C.; Rickerson, W. H.

    2011-05-01

    This report is intended to serve as a resource for policymakers who wish to learn more about establishing cost-based incentives. The report will identify key renewable energy cost modeling options, highlight the policy implications of choosing one approach over the other, and present recommendations on the optimal characteristics of a model to calculate rates for cost-based incentives, feed-in tariffs (FITs), or similar policies. These recommendations will be utilized in designing the Cost of Renewable Energy Spreadsheet Tool (CREST). Three CREST models will be publicly available and capable of analyzing the cost of energy associated with solar, wind, and geothermal electricity generators. The CREST models will be developed for use by state policymakers, regulators, utilities, developers, and other stakeholders to assist them in current and future rate-setting processes for both FIT and other renewable energy incentive payment structures and policy analyses.

  13. A Qualitative Study on Incentives and Disincentives for Care of Common Mental Disorders in Ontario Family Health Teams

    Science.gov (United States)

    Silveira, Jose; Mckenzie, Kwame

    2016-01-01

    Background: An opportunity to address the needs of patients with common mental disorders (CMDs) resides in primary care. Barriers are restricting availability of treatment for CMDs in primary care. By understanding the incentives that promote and the disincentives that deter treatment for CMDs in a collaborative primary care context, this study aims to help contribute to goals of greater access to mental healthcare. Method: A qualitative pilot study using semi-structured interviews with thematic analysis. Results: Participants identified 10 themes of incentives and disincentives influencing quality treatment of CMDs in a collaborative primary care setting: high service demands, clinical presentation, patient-centred care, patient attributes, education, physician attributes, organizational, access to mental health resources, psychiatry and physician payment model. Conclusion: An understanding of the incentives and disincentives influencing care is essential to achieve greater integration and capacity for care for the treatment of CMDs in primary care. PMID:27585029

  14. The Government Incentive Regulation Model and Pricing Mechanism in Power Transmission and Distribution Market

    Directory of Open Access Journals (Sweden)

    Huan Zhang

    2016-01-01

    Full Text Available The power transmission and distribution (T&D market’s natural monopoly and individual information have been the impediment to improving the energy efficiency in the whole T&D market. In order to improve the whole social welfare, T&D market should be controlled by government. An incentive regulation model with the target of maximizing social welfare has been studied. A list of contracts with transferring payment and quantity of T&D are given to motivate the corporation to reveal the true technical parameter and input the optimal investment. The corporate revenue, optimal investment, and effort are proved to depend on its own technical parameter. The part of incentive regulation model ends with the optimal pricing mechanism of T&D market. At the end of this paper, we give a numerical example to explain our research and confirm its function graphically.

  15. Mandatory high-risk pooling: an approach to reducing incentives for cream skimming.

    Science.gov (United States)

    van Barneveld, E M; van Vliet, R C; van de Ven, W P

    1996-01-01

    Risk-adjusted capitation payments (RACPs) to competing health insurers are an essential element of market-oriented health care reforms in The Netherlands. Crude RACPs are inadequate, especially because they encourage insurers to select against people expected to be unprofitable--a practice called cream skimming. However, implementing improved RACPs does not appear to be straightforward. This paper analyzes an approach that, given a system of crude RACPs, reduces insurers' incentives for cream skimming in the market for individual health insurance, while preserving incentives for efficiency and cost containment. Under the proposed system of Mandatory High-Risk Pooling (MHRP), each insurer would be allowed to periodically predetermine a small fraction of its members whose costs would be (partially) pooled. The pool would be financed with mandatory, flat-rate contributions. The results suggest that MHRP is a promising supplement to RACPs.

  16. Incentive Compatible and Globally Efficient Position Based Routing for Selfish Reverse Multicast in Wireless Sensor Networks

    Directory of Open Access Journals (Sweden)

    Sarvesh Varatharajan

    2009-10-01

    Full Text Available We consider the problem of all-to-one selfish routing in the absence of a payment scheme in wireless sensor networks, where a natural model for cost is the power required to forward, referring to the resulting game as a Locally Minimum Cost Forwarding (LMCF. Our objective is to characterize equilibria and their global costs in terms of stretch and diameter, in particular finding incentive compatible algorithms that are also close to globally optimal. We find that although social costs for equilibria of LMCF exhibit arbitrarily bad worst-case bounds and computational infeasibility of reaching optimal equilibria, there exist greedy and local incentive compatible heuristics achieving near-optimal global costs.

  17. Characteristics of Mobile Payment Procedures

    OpenAIRE

    Kreyer, Nina; Pousttchi, Key; Turowski, Klaus

    2002-01-01

    Companies are not going to invest into the development of innovative applications or services unless these can be charged for appropriately. Thus, the existence of standardized and widely accepted mobile payment procedures is crucial for successful business-to-customer mobile commerce. The acceptance of mobile payment procedures depends on costs, security and convenience issues. For the latter, it is important that a procedure can be used over the different payment scenarios mobile commerce, ...

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

    Science.gov (United States)

    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…

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

    Science.gov (United States)

    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…

  20. Payments for ecosystem services and rural development: Landowners' preferences and potential participation in western Mexico

    OpenAIRE

    MacMillan, Douglas C.

    2013-01-01

    Incentive-based mechanisms cancontribute to rural development and deliver environmental services, but need to be attractive to landowners and communities to ensure their participation.Here we study the views of landowners and agrarian communities(ejidos)from central Jalisco in Mexico to identify characteristics that payment for environmental services (PES)programs conserving/enhancing forest cover could include in their design. A choice experiment was applied to 161 landowners and ejido-lando...

  1. 7 CFR 3560.656 - Incentives offers.

    Science.gov (United States)

    2010-01-01

    ... 7 Agriculture 15 2010-01-01 2010-01-01 false Incentives offers. 3560.656 Section 3560.656... AGRICULTURE DIRECT MULTI-FAMILY HOUSING LOANS AND GRANTS Housing Preservation § 3560.656 Incentives offers. (a) The Agency will offer a borrower, who submits a prepayment request meeting the conditions of § 3560...

  2. Changes in Incentives, Rewards and Sanctions.

    Science.gov (United States)

    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)

  3. Behavioural economics: Cash incentives avert deforestation

    Science.gov (United States)

    Cárdenas, Juan Camilo

    2017-10-01

    There is tension in developing countries between financial incentives to clear forests and climate regulation benefits of preserving trees. Now research shows that paying private forest owners in Uganda reduced deforestation, adding to the debate on the use of monetary incentives in forest conservation.

  4. Incentive theory: IV. Magnitude of reward

    OpenAIRE

    Killeen, Peter R.

    1985-01-01

    Incentive theory is successfully applied to data from experiments in which the amount of food reward is varied. This is accomplished by assuming that incentive value is a negatively accelerated function of reward duration. The interaction of the magnitude of a reward with its delay is confirmed, and the causes and implications of this interaction are discussed.

  5. Design of capacity incentive and energy compensation for demand response programs

    Science.gov (United States)

    Liu, Zhoubin; Cui, Wenqi; Shen, Ran; Hu, Yishuang; Wu, Hui; Ye, Chengjin

    2018-02-01

    Variability and Uncertainties caused by renewable energy sources have called for large amount of balancing services. Demand side resources (DSRs) can be a good alternative of traditional generating units to provide balancing service. In the areas where the electricity market has not been fully established, e.g., China, DSRs can help balance the power system with incentive-based demand response programs. However, there is a lack of information about the interruption cost of consumers in these areas, making it hard to determine the rational amount of capacity incentive and energy compensation for the participants of demand response programs. This paper proposes an algorithm to calculate the amount of capacity incentive and energy compensation for demand response programs when there lacks the information about interruption cost. Available statistical information of interruption cost in referenced areas is selected as the referenced data. Interruption cost of the targeted area is converted from the referenced area by product per electricity consumption. On this basis, capacity incentive and energy compensation are obtained to minimize the payment to consumers. Moreover, the loss of consumers is guaranteed to be covered by the revenue they earned from load serving entities.

  6. Incentive contracts for development projects

    Science.gov (United States)

    Finley, David T.; Smith, Byron; DeGroff, B.

    2012-09-01

    Finding a contract vehicle that balances the concerns of the customer and the contractor in a development project can be difficult. The customer wants a low price and an early delivery, with as few surprises as possible as the project progresses. The contractor wants sufficient cost and schedule to cover risk. Both want to clearly define what each party will provide. Many program offices do not want to award cost plus contracts because their funding sources will not allow it, their boards do not want an open ended commitment, and they feel like they lose financial control of the project. A fixed price incentive contract, with a mutually agreed upon target cost, provides the owner with visibility into the project and input into the execution of the project, encourages both parties to save costs, and stimulates a collaborative atmosphere by aligning the respective interests of customers and contractors.

  7. Policy and Validity Prospects for Performance-Based Assessment.

    Science.gov (United States)

    Baker, Eva L.; And Others

    1994-01-01

    This article describes performance-based assessment as expounded by its proponents, comments on these conceptions, reviews evidence regarding the technical quality of performance-based assessment, and considers its validity under various policy options. (JDD)

  8. The cost-effectiveness of using financial incentives to improve provider quality: a framework and application

    DEFF Research Database (Denmark)

    Meacock, R.; Kristensen, Søren Rud; Sutton, M.

    2014-01-01

    Despite growing adoption of pay-for-performance (P4P) programmes in health care, there is remarkably little evidence on the cost-effectiveness of such schemes. We review the limited number of previous studies and critique the frameworks adopted and the narrow range of costs and outcomes considered......, and whether performance improvement is a transitory or investment activity. Our application to the Advancing Quality initiative demonstrates that the incentive payments represented less than half of the 13m pound total programme costs. By generating approximately 5200 quality-adjusted life years and 4.4m...

  9. Customer response on price incentives

    International Nuclear Information System (INIS)

    Naesje, Paal C.; Andersen, Thale K.; Saele, Hanne

    2005-01-01

    This paper analyses the relation between end-users energy attitudes and their corresponding energy behaviour. It presents empirical findings from analyses of the effects of two-way communication between consumers and power companies. Two-way communication has made available high quality data on energy consumption. In the build-up to the analysis in this paper the a number of aspects thought to influence energy consumption has been looked at; including standard of housing, number and age of residents, as well as socio-economic factors, behaviour and preferences. Here we choose to focus specifically on attitudes and behaviour. These aspects are controlled for price incentives. The combination of very tight peak power balance in the Nordic power system and few investments in extension of power networks has turned the focus towards manual or automatic demand-response which requires hourly metering for documentation. The data are two-fold: Hourly recordings of meter-data of electric consumption of 10,894 customers (nearly half of these had installed technology for remote load control) in two different network areas and survey-data from a questionnaire distributed to consumers that resulted in nearly 550 answers. During the winter 2003/2004 these customers were offered different price incentives. The analyses showed a net reduction in electricity consumption of 1,0 kWh/h at the most in peak load hours. The paper is based on two connected studies, 'End-user flexibility by efficient use of ICT' and 'Improving end-user knowledge for managing energy loads end consumption' conducted in Norway by the SINTEF group

  10. Medicare Provider Payment Data - Home Health Agencies

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Home Health Agency PUF contains information on utilization, payment (Medicare payment and standard payment), and submitted charges organized by CMS Certification...

  11. The Impact of Lottery Incentives on Student Survey Response Rates.

    Science.gov (United States)

    Porter, Stephen R.; Whitcomb, Michael E.

    2003-01-01

    A controlled experiment tested the effects of lottery incentives using a prospective college applicant Web survey, with emails sent to more than 9,000 high school students. Found minimal effect of postpaid incentives for increasing levels of incentive. (EV)

  12. Tradeoffs in the design of health plan payment systems: Fit, power and balance.

    Science.gov (United States)

    Geruso, Michael; McGuire, Thomas G

    2016-05-01

    In many markets, including the new U.S. Marketplaces, health insurance plans are paid by risk-adjusted capitation, sometimes combined with reinsurance and other payment mechanisms. This paper proposes a framework for evaluating the de facto insurer incentives embedded in these complex payment systems. We discuss fit, power and balance, each of which addresses a distinct market failure in health insurance. We implement empirical metrics of fit, power, and balance in a study of Marketplace payment systems. Using data similar to that used to develop the Marketplace risk adjustment scheme, we quantify tradeoffs among the three classes of incentives. We show that an essential tradeoff arises between the goals of limiting costs and limiting cream skimming because risk adjustment, which is aimed at discouraging cream-skimming, weakens cost control incentives in practice. A simple reinsurance system scores better on our measures of fit, power and balance than the risk adjustment scheme in use in the Marketplaces. Copyright © 2016 Elsevier B.V. All rights reserved.

  13. Fingerprint start the next generation of payment method : Fingerprint payment: a new mode of mobile payment

    OpenAIRE

    Wu, Chong

    2016-01-01

    In the generation of mobile internet, fingerprint payment is one of the most popular topics at the moment. China has a big market and many users are using the mobile payment methods. There are a large number of mobile phones equipped with fingerprint recognition technology. As we know, fingerprint payment brings us more convenience and safety. We do not need to use many bankcards, and fingerprint also eliminates the users from the trouble of queuing to pay. However, users send traditional dig...

  14. A contingent payment model of smoking cessation: effects on abstinence and withdrawal.

    Science.gov (United States)

    Heil, Sarah H; Tidey, Jennifer W; Holmes, Heather W; Badger, Gary J; Higgins, Stephen T

    2003-04-01

    The present study was designed to characterize nicotine withdrawal during a 5-day period in which smokers who were not trying to quit were offered monetary incentives to abstain while residing in their usual environments. Participants were randomly assigned to one of three groups. In two groups, monetary payment was delivered contingent on breath carbon monoxide levels (CO< or =8 ppm) indicating recent smoking abstinence, with the amount of payment differing between the two groups. The third group was a control group in which payment was delivered independent of smoking status. Participants provided CO samples three times per day (morning, afternoon- and evening) for 5 days (Monday-Friday). At each evening visit, all participants completed a nicotine withdrawal questionnaire and other questionnaires. Contingent payment significantly decreased expired-air CO and salivary cotinine levels as compared with the control group. No significant differences in abstinence were noted as a function of the amount paid. Participants in both contingent payment groups reported significantly more withdrawal symptoms than those in the noncontingent control group, including increases in anxiety and nervousness, impatience and restlessness, hunger, and desire to smoke. Such contingent payment procedures may provide an effective method for studying nicotine withdrawal in smokers that does not require the costly and inconvenient practice of housing research participants on a closed ward to prevent smoking.

  15. Managing bundled payments.

    Science.gov (United States)

    Draper, Andrew

    2011-04-01

    Results of Medicare's ACE demonstration project and Geisinger Health System's ProvenCare initiative provide insight into the challenges hospitals will face as bundled payment proliferates. An early analysis of these results suggests that hospitals would benefit from bringing full automation using clinical IT tools to bear in their efforts to meet these challenges. Other important factors contributing to success include board and physician leadership, organizational structure, pricing methodology for bidding, evidence-based medical practice guidelines, supply cost management, process efficiency management, proactive and aggressive case management, business development and marketing strategy, and the financial management system.

  16. Empirical Studies on Cash Payments

    NARCIS (Netherlands)

    J. Kippers (Jeanine)

    2004-01-01

    textabstractCash is still the most common means of daily payments. The large number of cash payments is supported by a costly distribution system in which retailers, banks and central banks participate. Currency is issued in a range of bank note and coin denominations to facilitate efficiency

  17. Build Your Own Payment Model.

    Science.gov (United States)

    Berlin, Joey

    2017-07-01

    Physicians participating in MACRA have a unique opportunity to create and submit their own alternative payment models to the government and take command of their own future payments. At least one Texas physician is taking a crack at developing his own model.

  18. A comprehensive payment model for short- and long-stay psychiatric patients.

    Science.gov (United States)

    Fries, B E; Durance, P W; Nerenz, D R; Ashcraft, M L

    1993-01-01

    In this article, a payment model is developed for a hospital system with both acute- and chronic-stay psychiatric patients. "Transition pricing" provides a balance between the incentives of an episode-based system and the necessity of per diem long-term payments. Payment is dependent on two new psychiatric resident classification systems for short- and long-term stays. Data on per diem cost of inpatient care, by day of stay, was computed from a sample of 2,968 patients from 100 psychiatric units in 51 Department of Veterans Affairs (VA) Medical Centers. Using a 9-month cohort of all VA psychiatric discharges nationwide (79,337 with non-chronic stays), profits and losses were simulated.

  19. Incentives of Health Care Expenditure

    Directory of Open Access Journals (Sweden)

    Eero Siljander

    2012-12-01

    Full Text Available The incentives of health care expenditure (HCE have been a topic of discussion in the USA (Obama reforms and in Europe (adjustment to debt crisis. There are competing views of institutional versus GDP (unit income elasticity and productivity related factors of growth of expenditure. However ageing of populations, technology change and economic incentives related to institutions are also key drivers of growth according to the OECD and EU’s AWG committee. Simulation models have been developed to forecast the growth of social expenditure (including HCEs to 2050. In this article we take a historical perspective to look at the institutional structures and their relationship to HCE growth. When controlling for age structure, price developments, doctor density and in-patient and public shares of expenditures, we find that fee-for-service in primary care, is according to the results, in at least 20 percent more costly than capitation or salary remuneration. Capitation and salary (or wage remuneration are at same cost levels in primary care. However we did not find the cost lowering effect for gatekeeping which could have been expected based on previous literature. Global budgeting 30 (partly DRG based percent less costly in specialized care than other reimbursement schemes like open contracting or volume based reimbursement. However the public integration of purchaser and provider cost seems to result to about 20 higher than public reimbursement or public contracting. Increasing the number of doctors or public financing share results in increased HCEs. Therefore expanding public reimbursement share of health services seems to lead to higher HCE. On the contrary, the in-patient share reduced expenditures. Compared to the previous literature, the finding on institutional dummies is in line with similar modeling papers. However the results for public expansion of services is a contrary one to previous works on the subject. The median lag length of

  20. Impact of payment system change from per-case to per-diem on high severity patient's length of stay.

    Science.gov (United States)

    Jang, Sung-In; Nam, Chung Mo; Lee, Sang Gyu; Kim, Tae Hyun; Park, Sohee; Park, Eun-Cheol

    2016-09-01

    A new payment system, the diagnosis-related group (DRG) system, and Korean diagnosis procedure combination (KDPC, per-diem) payment system were officially introduced in 2002 and in 2012, respectively. We evaluated the impact of payment system change from per-case to per-diem on high severity patient's length of stay (LOS).Claim data was used. A total of 36,240 case admissions and 72,480 control admissions were included in the analysis. Segmented regression analysis of interrupted time series between cases and controls was conducted. Hospitals that consistently participated in the DRG payment system and changed to the KDPC payment system were defined as case hospitals. Hospitals that consistently participated in the DRG payment system were defined as control hospitals.LOS increased by 0.025 days per month (P = 0.0055) for 3 surgical diagnosis-related admissions due to the bundled payment system change. LOS among emergency admissions also increased and showed an increasing tendency under the KDPC. The LOS increase was observed specifically for complex procedure admissions and high severity cases (CCI 0, 1: 0.022, P = 0.0142; CCI 2, 3: 0.026, P = 0.0288; CCI ≥ 4: 0.055, P = 0.0003).Although both payment systems are optimized to decrease LOS, incentives to reduce LOS are stronger under the DRG system than under the KDPC system. It is worth noting that too strong incentive for reducing LOS is suitable to high severity cases.

  1. Behavioral Therapy, Incentives Enhance Addiction Treatment

    Science.gov (United States)

    ... Research News From NIH Behavioral Therapy, Incentives Enhance Addiction Treatment Past Issues / Summer 2006 Table of Contents ... that people who are trying to end their addiction to marijuana can benefit from a treatment program ...

  2. Marketing to Nurses through an Incentive Program.

    Science.gov (United States)

    Campbell, Jeanne Phillips; Williams, Trudy

    1983-01-01

    Describes the Incentive Career Mobility Plan, a program for improving employee morale and retention by rewarding self-improvement. Discusses its use by nurse administrators for marketing their institutions to current and potential employees. (JOW)

  3. Chinese Academic Assessment and Incentive System.

    Science.gov (United States)

    Suo, Qinghui

    2016-02-01

    The Chinese academic assessment and incentive system drew mixed responses from academia. In the essay the author tried to explain why the current assessment system is appropriate in China and an opportunistic behavior in Chinese academia is exposed.

  4. Incentive mechanisms for Opportunistic Cloud Computing Services

    DEFF Research Database (Denmark)

    Kuada, Eric; Olesen, Henning

    2012-01-01

    to the OCCS platform as well as the efficient usage of these resources. We employ game theory and mechanism design to model and design the incentive schemes. We present two game models and show the existence of a pure strategy Nash equilibrium for both the cooperative and non-cooperative games. Three base...... ever contributing resources. It may also suffer from resource wastage from members or external entities trying to attack the system so that genuine users are deprived of valuable resources. The purpose of this paper is to design incentive schemes that will encourage the contribution of resources...... incentive schemes are presented and two advanced schemes one based on discount factor and the other a stochastic scheme are also presented. We perform analytical evaluation of our incentive schemes and conclude that the schemes meet the desired properties of budget-balance, ex-post individual rationality...

  5. Survey of electronic payment methods and systems

    NARCIS (Netherlands)

    Havinga, Paul J.M.; Smit, Gerardus Johannes Maria; Helme, A.; Verbraeck, A.

    1996-01-01

    In this paper an overview of electronic payment methods and systems is given. This survey is done as part of the Moby Dick project. Electronic payment systems can be grouped into three broad classes: traditional money transactions, digital currency and creditdebit payments. Such payment systems have

  6. 32 CFR 751.13 - Partial payments.

    Science.gov (United States)

    2010-07-01

    ... voucher and all other information related to the partial payment shall be placed in the claim file. Action... 32 National Defense 5 2010-07-01 2010-07-01 false Partial payments. 751.13 Section 751.13 National... Claims Against the United States § 751.13 Partial payments. (a) Partial payments when hardship exists...

  7. 32 CFR 750.9 - Claims: Payments.

    Science.gov (United States)

    2010-07-01

    ... requires submission of the payment voucher to the General Accounting Office. All other field authorized payment vouchers are submitted directly to the servicing disbursing office for payment. ... 32 National Defense 5 2010-07-01 2010-07-01 false Claims: Payments. 750.9 Section 750.9 National...

  8. 12 CFR 412.11 - Payment guidelines.

    Science.gov (United States)

    2010-01-01

    ... 12 Banks and Banking 4 2010-01-01 2010-01-01 false Payment guidelines. 412.11 Section 412.11 Banks and Banking EXPORT-IMPORT BANK OF THE UNITED STATES ACCEPTANCE OF PAYMENT FROM A NON-FEDERAL SOURCE FOR TRAVEL EXPENSES § 412.11 Payment guidelines. (a) Payments from a non-Federal source, other than...

  9. 10 CFR 603.805 - Payment methods.

    Science.gov (United States)

    2010-01-01

    ... 10 Energy 4 2010-01-01 2010-01-01 false Payment methods. 603.805 Section 603.805 Energy DEPARTMENT... Other Administrative Matters Payments § 603.805 Payment methods. A TIA may provide for: (a... progress. A fixed-support TIA must use this payment method (this does not preclude use of an initial...

  10. Marketable Incentive Contracts and Capital Structure Relevance.

    OpenAIRE

    Garvey, Gerald T

    1997-01-01

    This article investigates the claim that debt finance can increase firm value by curtailing managers' access to 'free cash flow.' The author first shows that incentive contracts that tie the managers' pay to stockholder wealth are often a superior solution to the free cash flow problem. He then considers the possibility that the manager can trade on secondary capital markets. Liquid secondary markets are shown to undermine management incentive schemes and, in many cases, to restore the value ...

  11. Financial Incentives to Promote Active Travel

    OpenAIRE

    Martin, Adam; Suhrcke, Marc; Ogilvie, David

    2012-01-01

    Context Financial incentives, including taxes and subsidies, can be used to encourage behavior change. They are common in transport policy for tackling externalities associated with use of motor vehicles, and in public health for influencing alcohol consumption and smoking behaviors. Financial incentives also offer policymakers a compromise between ?nudging,? which may be insufficient for changing habitual behavior, and regulations that restrict individual choice. Evidence acquisition The lit...

  12. Hermann agreement updates IRS guidelines for incentives.

    Science.gov (United States)

    Broccolo, B M; Peregrine, M W

    1995-01-01

    The October 1994 agreement between the Internal Revenue Service (IRS) and Hermann Hospital of Houston, Texas, elucidates current IRS policy on physician recruitment incentives. The IRS distinguishes between the recruiting and the retention of physicians and perimts incentives beyond reasonable compensation in the former but not the latter circumstance. This new agreement, while not legally precedential, nevertheless provides guidance for healthcare organizations seeking safe harbor protection.

  13. Altruism, Conformism, and Incentives in the Workplace

    OpenAIRE

    Tichem, Jan

    2014-01-01

    markdownabstractPerformance pay can motivate employees, but money is not the only motivation in the workplace. Altruism, which means that someone enjoys the well-being of someone else, can also provide a powerful motivation. The first part of this thesis studies theoretically how altruism between an employee and his superior affects the optimal use of monetary incentives. Among others, the analysis reveals how altruism influences the credibility of monetary incentive schemes, and how altruist...

  14. Incentive Effects of Peer Pressure in Organizations

    OpenAIRE

    Kohei Daido

    2006-01-01

    This paper studies the effects of peer pressure on incentives. We assume that, in addition to the material payoff, each agent's utility includes the psychological payoff from peer pressure generated by a comparison of effort costs. We show that the optimal incentive schemes depend mainly on the degree of peer pressure and of the heterogeneity of agents. Furthermore, we examine the optimal organizational forms in terms of the principal''s intention to make use of the effects of peer pressure.

  15. 48 CFR 1552.216-77 - Award term incentive.

    Science.gov (United States)

    2010-10-01

    ... award term incentive periods] years. (c) Right not to grant or cancel the award term incentive. (1) The Government has the unilateral right not to grant or to cancel award term incentive periods and the associated... the award term incentive is cancelled, a unilateral modification will cite this clause as the...

  16. Payment by Results

    Directory of Open Access Journals (Sweden)

    Brendan A. Rapple

    1994-01-01

    Full Text Available Today the public is demanding that it exercise more control over how tax dollars are spent in the educational sphere, with multitudes also canvassing that education become closely aligned to the marketplace's economic forces. In this paper I examine an historical precedent for such demands, i.e. the comprehensive 19th century system of accountability, "Payment by Results," which endured in English and Welsh elementary schools from 1862 until 1897. Particular emphasis is focused on the economic market-driven aspect of the system whereby every pupil was examined annually by an Inspector, the amount of the governmental grant being largely dependent on the answering. I argue that this was a narrow, restrictive system of educational accountability though one totally in keeping with the age's pervasive utilitarian belief in laissez-faire. I conclude by observing that this Victorian system might be suggestive to us today when calls for analogous schemes of educational accountability are shrill.

  17. 42 CFR 412.521 - Basis of payment.

    Science.gov (United States)

    2010-10-01

    ... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.521 Basis of payment. (a) Method of payment. (1) Under the prospective payment system, long... furnished to Medicare beneficiaries. (2) The amount of payment under the prospective payment system is based...

  18. Patient casemix classification for medicare psychiatric prospective payment.

    Science.gov (United States)

    Drozd, Edward M; Cromwell, Jerry; Gage, Barbara; Maier, Jan; Greenwald, Leslie M; Goldman, Howard H

    2006-04-01

    For a proposed Medicare prospective payment system for inpatient psychiatric facility treatment, the authors developed a casemix classification to capture differences in patients' real daily resource use. Primary data on patient characteristics and daily time spent in various activities were collected in a survey of 696 patients from 40 inpatient psychiatric facilities. Survey data were combined with Medicare claims data to estimate intensity-adjusted daily cost. Classification and Regression Trees (CART) analysis of average daily routine and ancillary costs yielded several hierarchical classification groupings. Regression analysis was used to control for facility and day-of-stay effects in order to compare hierarchical models with models based on the recently proposed payment system of the Centers for Medicare & Medicaid Services. CART analysis identified a small set of patient characteristics strongly associated with higher daily costs, including age, psychiatric diagnosis, deficits in daily living activities, and detox or ECT use. A parsimonious, 16-group, fully interactive model that used five major DSM-IV categories and stratified by age, illness severity, deficits in daily living activities, dangerousness, and use of ECT explained 40% (out of a possible 76%) of daily cost variation not attributable to idiosyncratic daily changes within patients. A noninteractive model based on diagnosis-related groups, age, and medical comorbidity had explanatory power of only 32%. A regression model with 16 casemix groups restricted to using "appropriate" payment variables (i.e., those with clinical face validity and low administrative burden that are easily validated and provide proper care incentives) produced more efficient and equitable payments than did a noninteractive system based on diagnosis-related groups.

  19. The impact of financial constraints and incentives on professional autonomy.

    Science.gov (United States)

    Lewis, Jenny M; Marjoribanks, Tim

    2003-01-01

    General practice has been the subject of extensive reforms over the 1990s in Australia as elsewhere. Reforms have attempted to improve quality and contain the overall cost of health care, and have often been seen as reducing the autonomy of medical professionals. This paper examines the impact of financial constraints and incentives introduced during the 1990s on Australian GPs' perceptions of autonomy. An existing seven component definition of autonomy and six themes that emerged from reviewing publications were used to construct focus group questions. A total of 25 GPs participated in four focus groups. Those who participated believe that their financial autonomy has been diminished by policy changes and consumer expectations. They also perceive that their ability to control clinical decisions, which they regard as the most important aspect of professional autonomy, has been reduced along with financial autonomy. Organized medicine in Australia sees financial accountability and clinical decision making as polar opposites, and has continued to argue that fee-for-service payment is the only appropriate method of remuneration, despite increasing evidence that this does not guarantee clinical autonomy. Major changes to the financing of general practice in Australia are required to address the concerns of GPs, governments and patients.

  20. Paying for payments: free payments and optimal interchange fees

    OpenAIRE

    Korsgaard, Søren

    2014-01-01

    Do consumers and merchants use the most efficient payment instruments? I examine how inter- change fees, which are fees paid from merchants' banks to consumers' banks when card transactions take place, influence the choice between cash and payment cards. I show that when consumers do not pay transaction fees to banks - a common feature in bank contracts - card use is declining in interchange fees, and surcharging does not neutralize interchange fees. According to my model, banks set interchan...

  1. Retail payments and the real economy

    OpenAIRE

    Hasan, Iftekhar; De Renzis, Tania; Schmiedel, Heiko

    2013-01-01

    This paper examines the fundamental relationship between retail payments and the real economy. Using data from across 27 European markets over the period 1995-2009, the results confirm that migration to efficient electronic retail payments stimulates the overall economy, consumption and trade. Among different payment instruments, this relationship is strongest for card payments, followed by credit transfers. Cheque payments are found to have a relatively low macroeconomic impact. Retail payme...

  2. Study on payments through mobile phones

    Directory of Open Access Journals (Sweden)

    Anca Ioana ANDREESCU

    2006-01-01

    Full Text Available The evolution of information and communications technology, together with the increasing use of electronic commerce, phones and mobile applications, have facilitated mobile payments to become an alternative payment method for buyers and vendors. Mobile payments offer various opportunities to business environment and became a starting point in the transition from electronic to mobile. This paper aims to analyze the present situation of the mobile payment methods and to identify the effects that mobile payment systems have on electronic commerce.

  3. Preparing for budget-based payment methodologies: global payment and episode-based payment.

    Science.gov (United States)

    Hudson, Mark E

    2015-10-01

    Use of budget-based payment methodologies (capitation and episode-based bundled payment) has been demonstrated to drive value in healthcare delivery. With a focus on high-volume, high-cost surgical procedures, inclusion of anaesthesiology services in these methodologies is likely. This review provides a summary of budget-based payment methodologies and practical information necessary for anaesthesiologists to prepare for participation in these programmes. Although few examples of anaesthesiologists' participation in these models exist, an understanding of the structure of these programmes and opportunities for participation are available. Prospective preparation in developing anaesthesiology-specific bundled payment profiles and early participation in pathway development associated with selected episodes of care are essential for successful participation as a gainsharing partner. With significant opportunity to contribute to care coordination and cost management, anaesthesiology can play an important role in budget-based payment programmes and should expect to participate as full gainsharing partners. Precise costing methodologies and accurate economic modelling, along with identification of quality management and cost control opportunities, will help identify participation opportunities and appropriate payment and gainsharing agreements. Anaesthesiology-specific examples with budget-based payment models are needed to help guide increased participation in these programmes.

  4. Uses of Multiple Measures for Performance-Based Compensation

    Science.gov (United States)

    Burnett, Alyson; Cushing, Ellen; Bivona, Lauren

    2012-01-01

    Across the nation, states and local school districts are seeking to redesign their educator-evaluation systems. Newly funded initiatives from the U.S. Department of Education--such as Race to the Top, School Improvement Grants, and the Teacher Incentive Fund--call for innovative teacher and principal evaluation models. These new evaluation models…

  5. The LUGPA Alternative Payment Model for Initial Therapy of Newly Diagnosed Patients With Organ-confined Prostate Cancer: Rationale and Development.

    Science.gov (United States)

    Kapoor, Deepak A; Shore, Neal D; Kirsh, Gary M; Henderson, Jonathan; Cohen, Todd D; Latino, Kathleen

    2017-01-01

    Over the past several decades, rapid expansion in healthcare expenditures has exposed the utilization incentives inherent in fee-for-service payment models. The passage of Medicare Access and CHIP Reauthorization Act of 2015 heralded a transition toward value-based care, creating incentives for practitioners to accept bidirectional risk linked to outcome and utilization metrics. At present, the limited availability of these vehicles excludes all but a handful of providers from participation in alternative payment models (APMs). The LUGPA APM supports the goals of the triple aim in improving the patient experience, enhancing population health and reducing expenditures. By requiring utilization of certified electronic health record technologies, tying payment to quality metrics, and requiring practices to bear more than nominal risk, the LUGPA APM qualifies as an advanced APM, thereby easing the reporting burden and creating opportunities for participating practices.

  6. 42 CFR 413.350 - Periodic interim payments for skilled nursing facilities receiving payment under the skilled...

    Science.gov (United States)

    2010-10-01

    ... facilities receiving payment under the skilled nursing facility prospective payment system for Part A... nursing facilities receiving payment under the skilled nursing facility prospective payment system for... SNF receiving payment under the prospective payment system may receive periodic interim payments (PIP...

  7. The incentive sensitization theory of addiction: some current issues

    OpenAIRE

    Robinson, Terry E; Berridge, Kent C

    2008-01-01

    We present a brief overview of the incentive sensitization theory of addiction. This posits that addiction is caused primarily by drug-induced sensitization in the brain mesocorticolimbic systems that attribute incentive salience to reward-associated stimuli. If rendered hypersensitive, these systems cause pathological incentive motivation (‘wanting’) for drugs. We address some current questions including: what is the role of learning in incentive sensitization and addiction? Does incentive s...

  8. Electronic Payments Profitability Extent Model

    Directory of Open Access Journals (Sweden)

    Rudolf Vohnout

    2016-12-01

    Full Text Available Cashless payments are recent phenomena, which even increased with the introduction of contactless means like NFC, PayPass or payWave. Such new methods speed-up the entire payment process and in comparison to cash transactions are much simpler and faster. But on the other hand the key question for merchant is if it is worth to have such device, which accept these new payment means or not to have the terminal at all. What is the amount of cash flow, which delimits the cash holdings to be still profitable? This paper tries to give answers to such question by presenting general profitability model, which will address defining the cash threshold amount. The aim is to show that cash holdings could be profitable up to certain amount, but after the threshold is met, cashless payment methods are fairly superior despite their additional costs.

  9. Game Theoretic Analysis of Carbon Emission Abatement in Fashion Supply Chains Considering Vertical Incentives and Channel Structures

    Directory of Open Access Journals (Sweden)

    Longfei He

    2015-04-01

    Full Text Available We study an emission-dependent dyadic fashion supply chain made up of a supplier and a manufacturer, both of which can reduce their own component/product emissions to serve the carbon-footprint sensitive consumers. With Carbon Tax regulation, we consider four scenarios resulting from two ways in form of adopting transfer price contract and/or introducing third-party emission-reduction service (TPERS to enhance the efficiency of systematic emission reductions. We refine four models from these corresponding scenarios, which in turn constitute a decision-making framework composed of determining vertical incentives and choosing supply chain structures. By exploiting Stackelberg games in all models, we compare their emission reduction efficiencies and profitability for each pair of settings. Theoretic analysis and numerical studies show that adopting vertical transfer payment schemes can definitely benefit channel carbon footprint reduction and Pareto improvement of supply chain profitability, regardless of whether the emission-reduction service exists or not. However, whether introducing TPERS or not is heavily depending on systematic parameters when the transfer payment incentive is adopted there. We also provide insights on the sensitivity of carbon tax parameters with respect to the supply chain performance, overall carbon emission reduction, vertical incentive and TPERS adopting decision-makings.

  10. Payment changes require integrating records.

    Science.gov (United States)

    Palley, M A

    1990-06-01

    The greatest challenges for healthcare organizations facing radical changes in their payment and reporting structures lie in finding ways to integrate various forms of patient information. An analysis of how three New York City hospitals dealt with their state's switch to an all-payer diagnosis related group-based payment system reveals strengths and weaknesses in their existing information systems and in steps taken to adapt to the change.

  11. Public acceptability of financial incentives for smoking cessation in pregnancy and breast feeding: a survey of the British public.

    Science.gov (United States)

    Hoddinott, Pat; Morgan, Heather; MacLennan, Graeme; Sewel, Kate; Thomson, Gill; Bauld, Linda; Yi, Deokhee; Ludbrook, Anne; Campbell, Marion K

    2014-07-18

    To survey public attitudes about incentives for smoking cessation in pregnancy and for breast feeding to inform trial design. Cross-sectional survey. British general public. Seven promising incentive strategies had been identified from evidence syntheses and qualitative interview data from service users and providers. These were shopping vouchers for: (1) validated smoking cessation in pregnancy and (2) after birth; (3) for a smoke-free home; (4) for proven breast feeding; (5) a free breast pump; (6) payments to health services for reaching smoking cessation in pregnancy targets and (7) breastfeeding targets. Ipsos MORI used area quota sampling and home-administered computer-assisted questionnaires, with randomised question order to assess agreement with different incentives (measured on a five-point scale). Demographic data and target behaviour experience were recorded. Analysis used multivariable ordered logit models. Agreement with incentives was mixed (ranging from 34% to 46%) among a representative sample of 1144 British adults. Mean agreement score was highest for a free breast pump, and lowest for incentives for smoking abstinence after birth. More women disagreed with shopping vouchers than men. Those with lower levels of education disagreed more with smoking cessation incentives and a breast pump. Those aged 44 or under agreed more with all incentive strategies compared with those aged 65 and over, particularly provider targets for smoking cessation. Non-white ethnic groups agreed particularly with breastfeeding incentives. Current smokers with previous stop attempts and respondents who had breast fed children agreed with providing vouchers for the respective behaviours. Up to £40/month vouchers for behaviour change were acceptable (>85%). Women and the less educated were more likely to disagree, but men and women of childbearing age to agree, with incentives designed for their benefit. Trials evaluating reach, impact on health inequalities and ethnic

  12. Economic incentives for evidence generation: promoting an efficient path to personalized medicine.

    Science.gov (United States)

    Towse, Adrian; Garrison, Louis P

    2013-01-01

    The preceding articles in this volume have identified and discussed a wide range of methodological and practical issues in the development of personalized medicine. This concluding article uses the resulting insights to identify implications for the economic incentives for evidence generation. It argues that promoting an efficient path to personalized medicine is going to require appropriate incentives for evidence generation including: 1) a greater willingness on the part of payers to accept prices that reflect value; 2) consideration of some form of intellectual property protection (e.g., data exclusivity) for diagnostics to incentivize generation of evidence of clinical utility; 3) realistic expectations around the standards for evidence; and 4) public investment in evidence collection to complement the efforts of payers and manufacturers. It concludes that such incentives could build and maintain a balance among: 1) realistic thresholds for evidence and the need for payers to have confidence in the clinical utility of the drugs and tests they use; 2) payment for value, with prices that ensure cost-effectiveness for health systems; and 3) levels of intellectual property protection for evidence generation that provide a return for those financing research and development, while encouraging competition to produce both better and more efficient tests. Copyright © 2013, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc.

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

    Science.gov (United States)

    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…

  14. Reducing Potentially Avoidable Complications in Patients with Chronic Diseases: The Prometheus Payment Approach

    Science.gov (United States)

    de Brantes, Francois; Rastogi, Amita; Painter, Michael

    2010-01-01

    Objective (or Study Question) To determine whether a new payment model can reduce current incidence of potentially avoidable complications (PACs) in patients with a chronic illness. Data Sources/Study Setting A claims database of 3.5 million commercially insured members under age 65. Study Design We analyzed the database using the Prometheus Payment model's analytical software for six chronic conditions to quantify total costs, proportion spent on PACs, and their variability across the United States. We conducted a literature review to determine the feasibility of reducing PACs. We estimated the financial impact on a prototypical practice if that practice received payments based on the Prometheus Payment model. Principal Findings We find that (1) PACs consume an average of 28.6 percent of costs for the six chronic conditions studied and vary significantly; (2) reducing PACs to the second decile level would save U.S.$116.7 million in this population; (3) current literature suggests that practices in certain settings could decrease PACs; and (4) using the Prometheus model could create a large potential incentive for a prototypical practice to reduce PACs. Conclusions By extrapolating these findings we conclude that costs might be reduced through payment reform efforts. A full extrapolation of these results, while speculative, suggests that total costs associated to the six chronic conditions studied could decrease by 3.8 percent. PMID:20662949

  15. The Impact of New Payment Models on Quality of Diabetes Care and Outcomes.

    Science.gov (United States)

    McGinley, Erin L; Gabbay, Robert A

    2016-06-01

    Historic changes in healthcare reimbursement and payment models due to the Affordable Care Act in the United States have the potential to transform how providers care for chronic diseases such as diabetes. Payment experimentation has provided insights into how changing incentives for primary care providers can yield improvements in the triple aim: improving patient experience, improving the health of populations, and reducing costs of healthcare. Much of this has involved leveraging widespread adoption of the patient-centered medical home (PCMH) with diabetes often the focus. While evidence is mounting that the PCMH can improve diabetes outcomes, some PCMH demonstrations have displayed mixed results. One of the first large-scale PCMH demonstrations developed around diabetes was conducted by the Commonwealth of Pennsylvania. Different payment models were employed across a series of staggered regional rollouts that provided a case study for the influence of innovative payment models. These learning laboratories provide insights into the role of reimbursement models and changes in how practice transformation is implemented. Ultimately, evolving payment systems focused on the total cost of care, such as Accountable Care Organizations, hold promise to transform diabetes care and produce significant cost savings through the prevention of complications.

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

    Science.gov (United States)

    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.

  17. R&D Incentives for Neglected Diseases

    Science.gov (United States)

    Dimitri, Nicola

    2012-01-01

    Neglected diseases are typically characterized as those for which adequate drug treatment is lacking, and the potential return on effort in research and development (R&D), to produce new therapies, is too small for companies to invest significant resources in the field. In recent years various incentives schemes to stimulate R&D by pharmaceutical firms have been considered. Broadly speaking, these can be classified either as ‘push’ or ‘pull’ programs. Hybrid options, that include push and pull incentives, have also become increasingly popular. Supporters and critics of these various incentive schemes have argued in favor of their relative merits and limitations, although the view that no mechanism is a perfect fit for all situations appears to be widely held. For this reason, the debate on the advantages and disadvantages of different approaches has been important for policy decisions, but is dispersed in a variety of sources. With this in mind, the aim of this paper is to contribute to the understanding of the economic determinants behind R&D investments for neglected diseases by comparing the relative strength of different incentive schemes within a simple economic model, based on the assumption of profit maximizing firms. The analysis suggests that co-funded push programs are generally more efficient than pure pull programs. However, by setting appropriate intermediate goals hybrid incentive schemes could further improve efficiency. PMID:23284648

  18. R&D incentives for neglected diseases.

    Directory of Open Access Journals (Sweden)

    Nicola Dimitri

    Full Text Available Neglected diseases are typically characterized as those for which adequate drug treatment is lacking, and the potential return on effort in research and development (R&D, to produce new therapies, is too small for companies to invest significant resources in the field. In recent years various incentives schemes to stimulate R&D by pharmaceutical firms have been considered. Broadly speaking, these can be classified either as 'push' or 'pull' programs. Hybrid options, that include push and pull incentives, have also become increasingly popular. Supporters and critics of these various incentive schemes have argued in favor of their relative merits and limitations, although the view that no mechanism is a perfect fit for all situations appears to be widely held. For this reason, the debate on the advantages and disadvantages of different approaches has been important for policy decisions, but is dispersed in a variety of sources. With this in mind, the aim of this paper is to contribute to the understanding of the economic determinants behind R&D investments for neglected diseases by comparing the relative strength of different incentive schemes within a simple economic model, based on the assumption of profit maximizing firms. The analysis suggests that co-funded push programs are generally more efficient than pure pull programs. However, by setting appropriate intermediate goals hybrid incentive schemes could further improve efficiency.

  19. R&D incentives for neglected diseases.

    Science.gov (United States)

    Dimitri, Nicola

    2012-01-01

    Neglected diseases are typically characterized as those for which adequate drug treatment is lacking, and the potential return on effort in research and development (R&D), to produce new therapies, is too small for companies to invest significant resources in the field. In recent years various incentives schemes to stimulate R&D by pharmaceutical firms have been considered. Broadly speaking, these can be classified either as 'push' or 'pull' programs. Hybrid options, that include push and pull incentives, have also become increasingly popular. Supporters and critics of these various incentive schemes have argued in favor of their relative merits and limitations, although the view that no mechanism is a perfect fit for all situations appears to be widely held. For this reason, the debate on the advantages and disadvantages of different approaches has been important for policy decisions, but is dispersed in a variety of sources. With this in mind, the aim of this paper is to contribute to the understanding of the economic determinants behind R&D investments for neglected diseases by comparing the relative strength of different incentive schemes within a simple economic model, based on the assumption of profit maximizing firms. The analysis suggests that co-funded push programs are generally more efficient than pure pull programs. However, by setting appropriate intermediate goals hybrid incentive schemes could further improve efficiency.

  20. Incentives and intrinsic motivation in healthcare.

    Science.gov (United States)

    Berdud, Mikel; Cabasés, Juan M; Nieto, Jorge

    It has been established in the literature that workers within public organisations are intrinsically motivated. This paper is an empirical study of the healthcare sector using methods of qualitative analysis research, which aims to answer the following hypotheses: 1) doctors are intrinsically motivated; 2) economic incentives and control policies may undermine doctors' intrinsic motivation; and 3) well-designed incentives may encourage doctors' intrinsic motivation. We conducted semi-structured interviews à-la-Bewley with 16 doctors from Navarre's Healthcare Service (Servicio Navarro de Salud-Osasunbidea), Spain. The questions were based on current theories of intrinsic motivation and incentives to test the hypotheses. Interviewees were allowed to respond openly without time constraints. Relevant information was selected, quantified and analysed by using the qualitative concepts of saturation and codification. The results seem to confirm the hypotheses. Evidence supporting hypotheses 1 and 2 was gathered from all interviewees, as well as indications of the validity of hypothesis 3 based on interviewees' proposals of incentives. The conclusions could act as a guide to support the optimal design of incentive policies and schemes within health organisations when healthcare professionals are intrinsically motivated. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

  1. CROSS-CULTURAL INCENTIVES FOR THE FDI

    Directory of Open Access Journals (Sweden)

    Dumitru ZAIȚ

    2014-06-01

    Full Text Available In order to invest there are some incentives needed, including among them, certainly, the ones discussed and analysed in the scientific literature such as: specific earning chances (expectations of each participant (wage, profit, dividend, budget revenue, etc., potential investor’s general or current state, etc.. Less visible incentives from complex areas not obviously related to the investment are, however, less considered. Among these could be incentives arising from inherited or education and culture transmitted philosophy, generally regarding earnings, business and investment. We notice these incentives in case of FDI in different shades and intensities.Investor’s decision to acquire, sell or to carry out projects in a particular area, region or country is not only due to purely economic, commercial or financial reasoning. In such operations, meeting among businessmen, managers and other professionals in the field is, first of all, meeting in specific circumstances, among more or less different cultures.Both theory and practice must be concerned in what way and to what extent these factors influence the investment intention, outcome and yield. Our study proposes a list of the most important cultural type incentives for investment (mainly FDI, based on a set of cases, through a logical and empirical research, using some of the most relevant and recent studies and several real situations to which we got access. These are early data and analysis that will allow us to draw attention to the problem and to develop further research to reach generalizable results

  2. MACRA, MIPS, and the New Medicare Quality Payment Program: An Update for Radiologists.

    Science.gov (United States)

    Rosenkrantz, Andrew B; Nicola, Gregory N; Allen, Bibb; Hughes, Danny R; Hirsch, Joshua A

    2017-03-01

    The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 advances the goal of tying Medicare payments to quality and value. In April 2016, CMS published an initial proposed rule for MACRA, renaming it the Quality Payment Program (QPP). Under QPP, clinicians receive payments through either advanced alternative payment models or the Merit-Based Incentive Payment System (MIPS), a consolidation of existing federal performance programs that applies positive or negative adjustments to fee-for-service payments. Most physicians will participate in MIPS. This review highlights implications of the QPP and MIPS for radiologists. Although MIPS incorporates radiology-specific quality measures, radiologists will also be required to participate in other practice improvement activities, including patient engagement. Recognizing physicians' unique practice patterns, MIPS will provide special considerations in performance evaluation for physicians with limited face-to-face patient interaction. Although such considerations will affect radiologists' likelihood of success under QPP, many practitioners will be ineligible for the considerations under currently proposed criteria. Reporting using qualified clinical data registries will benefit radiologists' performance by allowing expanded arrays of MIPS and non-MIPS specialty-specific measures. A group practice reporting option will substantially reduce administrative burden but introduce new challenges by requiring uniform determination of patient-facing status and performance measurement for all of the group's physicians (diagnostic radiologists, interventional radiologists, and nonradiologists) under the same taxpayer identification number. Given that the initial MIPS performance period begins in 2017, radiologists must begin preparing for QPP and taking actions to ensure their future success under this new quality-based payment system. Copyright © 2016 American College of Radiology. Published by Elsevier Inc. All rights

  3. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes

    Science.gov (United States)

    Flodgren, Gerd; Eccles, Martin P; Shepperd, Sasha; Scott, Anthony; Parmelli, Elena; Beyer, Fiona R

    2014-01-01

    review according to the AMSTAR criteria. We included systematic reviews of studies evaluating the effectiveness of any type of financial incentive. We grouped financial incentives into five groups: payment for working for a specified time period; payment for each service, episode or visit; payment for providing care for a patient or specific population; payment for providing a pre-specified level or providing a change in activity or quality of care; and mixed or other systems. We summarised data using vote counting. Main results We identified four reviews reporting on 32 studies. Two reviews scored 7 on the AMSTAR criteria (moderate, score 5 to 7, quality) and two scored 9 (high, score 8 to 11, quality). The reported quality of the included studies was, by a variety of methods, low to moderate. Payment for working for a specified time period was generally ineffective, improving 3/11 outcomes from one study reported in one review. Payment for each service, episode or visit was generally effective, improving 7/10 outcomes from five studies reported in three reviews; payment for providing care for a patient or specific population was generally effective, improving 48/69 outcomes from 13 studies reported in two reviews; payment for providing a pre-specified level or providing a change in activity or quality of care was generally effective, improving 17/20 reported outcomes from 10 studies reported in two reviews; and mixed and other systems were of mixed effectiveness, improving 20/31 reported outcomes from seven studies reported in three reviews. When looking at the effect of financial incentives overall across categories of outcomes, they were of mixed effectiveness on consultation or visit rates (improving 10/17 outcomes from three studies in two reviews); generally effective in improving processes of care (improving 41/57 outcomes from 19 studies in three reviews); generally effective in improving referrals and admissions (improving 11/16 outcomes from 11 studies in four

  4. Capacity payments in imperfect electricity markets: Need and design

    International Nuclear Information System (INIS)

    Joskow, Paul L.

    2008-01-01

    This paper argues that a variety of imperfections in wholesale 'energy-only' electricity markets lead to generators earning net revenues that are inadequate to support investment in a least cost portfolio of generating capacity and to satisfy consumer preferences for reliability. Theoretical and numerical examples are used to illustrate the sources of this 'missing money' problem. Improvements in 'energy-only' wholesale electricity markets, especially those that improve pricing when capacity is fully utilized, can reduce the magnitude of the missing money problem. However, these improvements are unlikely to fully ameliorate it. Forward capacity obligations and associated auction mechanisms to determine capacity prices are necessary to restore appropriate wholesale market prices and associated investment incentives to support the optimal portfolio of generating investments. The deficiencies of the original capacity payment mechanisms adopted in the US are discussed and the necessary improvements identified. (author)

  5. Do family physicians need more payment for working better? Financial incentives in primary care

    Directory of Open Access Journals (Sweden)

    László Róbert Kolozsvári

    2014-05-01

    Conclusions: The implementations of these schemes should be critically evaluated with continuous monitoring at national or regional level; comparison is required between targets and their achievements, health gains and use of resources as well.

  6. 46 CFR 310.7 - Federal student subsistence allowances and student incentive payments.

    Science.gov (United States)

    2010-10-01

    ... employed afloat that is at least equal to the median number of days of seafaring employment under articles... Internet system at https://mscs.marad.dot.gov. Reports may also be mailed to: Compliance Specialist, Office... Superintendent's recommendation for approval or disapproval and an evaluation of the applicant's academic and...

  7. 78 FR 40835 - Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program...

    Science.gov (United States)

    2013-07-08

    ... and Labor- related Share for ESRD Facilities for CY 2014 c. Proposed Productivity Adjustment d. Calculation of the ESRDB Market Basket Update, Adjusted for Multifactor Productivity for CY 2014 4. The... Facility Performance on Clinical Measures Based on Improvement c. Proposals for Calculating Facility...

  8. 77 FR 67449 - Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program...

    Science.gov (United States)

    2012-11-09

    .... Thirty-Day Hospital Readmissions b. Efficiency c. Population/Community Health 6. Scoring Background and... Statistics BMI Body Mass Index BSA Body Surface Area CAH Critical Access Hospital CBSA Core-Based Statistical....89, Bad debts, charity, and courtesy allowances. Additionally, this rule will remove the cap on bad...

  9. 77 FR 40951 - Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program...

    Science.gov (United States)

    2012-07-11

    .... Thirty-Day Hospital Readmissions b. Efficiency c. Population/Community Health 6. Proposed Scoring for the...-96) by revising 42 CFR 413.89, Bad debts, charity, and courtesy allowances. B. Summary of the Major... current hospital wage data to account for differing wage levels in areas in which ESRD facilities are...

  10. 78 FR 72155 - Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program...

    Science.gov (United States)

    2013-12-02

    ... and casts, and IOLs inserted in a physician's office. SUPPLEMENTARY INFORMATION: Electronic Access... rule, we did not readily have access to the 2007 utilization data for the ESRD facilities located in... the amount of the adjustment. We solicited comments on the proposal to include data on the utilization...

  11. Paperless Transaction for Publication Incentive System

    Science.gov (United States)

    Ibrahim, Rosziati; Madon, Hamiza Diana; Nazri, Nurul Hashida Amira Mohd; Saarani, Norhafizah; Mustapha, Aida

    2017-08-01

    Within the Malaysian context, incentive system in scientific publishing rewards authors for publishing journal articles or conference papers that are indexed by Scopus. At Universiti Tun Hussein Onn Malaysia, the incentive system is going into its third year in operational. The main challenge lies in preparing the evidences as required by the application guideline. This paper presents an online module for publication incentive within the University Publication Information System (SMPU). The module was developed using the Scrum methodology based on the existing workflow of paper-based application. The module is hoped to increase the quality of the system deliverables of SMPU as well as having the ability to cope with change of university requirements in the future.

  12. Are Delegation and Incentives Complementary Instruments ?

    DEFF Research Database (Denmark)

    Lando, Henrik

    2004-01-01

    It is natural to suppose that delegation and incentives are complementaryboth in the sense that when more decisions are delegated toa lower level of an organizational hierarchy, more use should be madeof incentives at that level, and in the sense that more use of incentivesshould be accompanied...... by more delegation. This issue is analyzedwithin a Principal-Agent framework in which there are two decisionsto be made: an effort decision which can only be made by the Agent,and some other decision which can be made by either the Principal(i.e. be centralized) or by the Agent (i.e. be delegated). Within...... thisframework it is shown that delegation and incentives are not necessarilycomplementary instruments; some decisions should be centralized whenincentives are introduced....

  13. Economic barriers and incentives for biodiversity restoration

    International Nuclear Information System (INIS)

    Garcia Frapolli, Eduardo; Lindigcisneros, Roberto

    2011-01-01

    Costs related with restoration efforts, as well as the economic incentives, are fundamental issues that have not been fully considered from a formal standpoint. Through the analysis of restoration trials in collaboration with an indigenous community in western Mexico, we analyzed economic issues related with the restoration trials themselves, and with the economic context that gives incentives for ecological restoration. We reach to the conclusion that the cost-benefit relationship of the restoration process by itself can be straightforward calculated in some cases, calculating economic benefits accrued from the diversity restored to ecosystem is more difficult. In terms of the incentives for biodiversity restoration, we concluded that in many cases, economic variables out of the control of those involved in restoration are determinant.

  14. Generic host state incentive report. Draft

    International Nuclear Information System (INIS)

    1985-01-01

    Even the most carefully designed and operated low-level radioactive waste management facility will present potential risks and costs to nearby residents. Individuals who live near these facilities may receive some benefits, but they also bear the brunt of any adverse impacts. It is with this in mind that various siting techniques have been developed. Before any ''extra'' compensation or incentive can be discussed, however, it must first be clearly demonstrated that these facilities protect public health and the environment. This report addresses five distinct areas as follows: mitigation measure to prevent or reduce the impact of the facility; incentives and compensation techniques that might make a facility more acceptable; the use of agreement building in order to develop an arrangement between the host community and a facility proponent; the importance of economics resulting from a typical regional low-level radioactive waste facility; and the role of state government in promoting and legitimizing the use of incentives. 6 tabs

  15. Incentive relativity in middle aged rats.

    Science.gov (United States)

    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.

  16. The safety-incentive theory of liability

    International Nuclear Information System (INIS)

    Marshall, J.M.

    1977-11-01

    The use of liability law to improve incentives for safety is supported by certain recent theoretical results. The main ideas and the key argumants are summarized. Basic weaknesses of the theory are discussed, namely: (1) the simple model of Calabresi does not generalize; (2) the more complex systems of J.P. Brown, P. Diamond, and J. Green require that courts possess a great deal of information and use it to set appropriate standards of due care; (3) in practice safety incentives also depend upon fear of criminal penalties and the sense of social responsibility. The questions whether and when liability rules can significantly affect incentives are addressed. It is concluded that the theory in its present state can hardly serve as a basis for altering liability rules

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

    Science.gov (United States)

    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

  18. Incentive and insurance effects of income taxation

    DEFF Research Database (Denmark)

    Andersen, Torben M.

    2015-01-01

    the sensitivity of labour supply to taxes, which tends to reduce tax distortions and lower the marginal costs of public funds. The relation between incentives and insurance and thus efficiency and equity is flattened by the insurance effect and it may even be non-monotone. However, the optimal utilitarian policy......Tax distortions cause a trade-off between efficiency and equity. However, taxes not only affect incentives; they also provide implicit insurance, and this may critically affect the efficiency–equity relationship. For a standard labour supply problem it is shown that the insurance effect mutes...

  19. On the Effectiveness of Incentive Pay

    DEFF Research Database (Denmark)

    Friis, Ivar; Hansen, Allan; Vámosi, Tamás S.

    2015-01-01

    research addressing the need to better understand how interdependencies arise among management control system elements and how they affect organisational effectiveness. Based on an in-depth case study on the implementation of a new incentive system in a manufacturing firm, we seek to provide more research...... and insight into how incentive pay features in complementary and substitutional relationships in an individual organisational setting. Greater insight can help illustrate how complementary and substitutional relationships unfold in even more complex ways than current research indicates, as well as how...

  20. Incentives and performance governance of research organizations

    CERN Document Server

    Wollersheim, Jutta; Ringelhan, Stefanie; Osterloh, Margit

    2015-01-01

    ​This book contributes to the current discussion in society, politics and higher education on innovation capacity and the financial and non-financial incentives for researchers. The expert contributions in the book deal with implementation of incentive systems at higher education institutions in order to foster innovation. On the other hand, the book also discusses the extent to which governance structures from economy can be transferred to universities and how scientific performance can be measured and evaluated. This book is essential for decision-makers in knowledge-intensive organizations and higher-educational institutions dealing with the topic of performance management.

  1. Incentive Design and Mis-Allocated Effort

    OpenAIRE

    Schnedler, Wendelin

    2013-01-01

    Incentives often distort behavior: they induce agents to exert effort but this effort is not employed optimally. This paper proposes a theory of incentive design allowing for such distorted behavior. At the heart of the theory is a trade-off between getting the agent to exert effort and ensuring that this effort is used well. The theory covers various moral-hazard models, ranging from traditional single-task to multi-task models. It also provides -for the first time- a formalization and proof...

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

    Science.gov (United States)

    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

  3. A dynamic simulation model for assessing the overall impact of incentive policies on power system reliability, costs and environment

    International Nuclear Information System (INIS)

    Ibanez-Lopez, A.S.; Martinez-Val, J.M.; Moratilla-Soria, B.Y.

    2017-01-01

    The liberalization of power markets has entailed dramatic changes in power system planning worldwide. The inception of new alternative technologies, smart grids and distributed generation and storage is expected to make system planning even more challenging. Government policies still play a major role in the evolution of a country's power generation mix, even in those countries with liberalized markets. This paper presents a System Dynamics model aimed at assessing the overall technical, economic and environmental impact of renewable energy incentives and capacity payment policies. The model has been used to simulate Spain's power industry in order to assess the impact of electric power policies with the goal of getting insights regarding how to achieve an optimum power generation mix. The main conclusions of the present paper are (i) the necessity of specific regulatory actions in Spain in order to keep adequate reliability levels, avoid price spikes and boom and bust investment cycles as well as to deploy specific technologies, (ii) the fact that capacity payments are a better instrument for keeping adequate reserve margins and avoiding power price spikes than renewable energy incentives and (iii) the evidence that both instruments entail additional system costs over the base case scenario. - Highlights: • A System Dynamics model of Spain's power generation mix is proposed. • The overall policy impact on system costs, environment and reliability is assessed. • Current policies are not enough to keep adequate reliability levels. • Capacity payments are an adequate instrument for guaranteeing system reliability. • RES incentives do not solve reliability issues and entail greater system costs.

  4. Performance Based Logistics... What’s Stopping Us

    Science.gov (United States)

    2016-03-01

    performance-based life cycle product support, where outcomes are acquired through performance-based arrangements that deliver Warfighter requirements and...correlates to the acquisition life cycle framework: spend the time and effort to identify and lock in the PBL requirements; conduct an analysis to...studies and reports on PBLs over the past 15 or more years. Much like fashion styles, the af- finity for PBLs has ebbed and flowed during this time

  5. 77 FR 4638 - Defense Federal Acquisition Regulation Supplement; Performance-Based Payments (DFARS Case 2011-D045)

    Science.gov (United States)

    2012-01-30

    ... tool. The PBP analysis tool is a cash-flow model for evaluating alternative financing arrangements, and..., public health and safety effects, distributive impacts, and equity). E.O. 13563 emphasizes the importance... PBP analysis tool is a cash-flow model for evaluating alternative financing arrangements, and is...

  6. CMS announces new payment model

    Directory of Open Access Journals (Sweden)

    Robbins RA

    2018-01-01

    Full Text Available No abstract available. Article truncated after 150 words. On Tuesday, 1/9/18, the Centers for Medicare and Medicaid (CMS announced a new voluntary bundled-payment model that will be considered an advanced alternative payment model under Medicare Access and CHIP Reauthorization Act of 2015 (MACRA (1. The new model is the first advanced Alternative Payment Model (APM to be introduced by the Trump administration. The Trump administration has been a vocal advocate of reducing administrative burden for clinicians and has touted voluntary models as a solution (2. The new, voluntary model comes less than two months after the CMS officially decided to eliminate two mandatory bundled-payment models created during the Obama administration. Under the model, clinician payment will be based on quality measures during a 90-day episode of care. Participants must select at least one of the 32 clinical episodes to apply to the model. The inpatient clinical episodes are listed in Table 1 (3. Table 1. Clinical inpatient episodes under …

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

    Science.gov (United States)

    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…

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

    Science.gov (United States)

    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…

  9. Changing physician incentives for cancer care to reward better patient outcomes instead of use of more costly drugs.

    Science.gov (United States)

    Newcomer, Lee N

    2012-04-01

    More-sophisticated chemotherapy regimens have improved the outlook for cancer patients since the 1970s, but the payment system for cancer chemotherapy has not changed during that time span. The "buy and bill" approach for reimbursement provides incentives for medical oncologists to use expensive medications when less costly alternatives that deliver similar results are available. Furthermore, the system does nothing to assess how much value society derives from high-price drugs. This paper reviews the historical context of "buy and bill" reimbursement and considers the use of clinical pathways and bundled payments, two alternative strategies that are being tried to reward physicians for improving outcomes and reducing the total cost of cancer care.

  10. 20 CFR 411.550 - How are the outcome payments calculated under the outcome payment system?

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false How are the outcome payments calculated under the outcome payment system? 411.550 Section 411.550 Employees' Benefits SOCIAL SECURITY ADMINISTRATION... the outcome payments calculated under the outcome payment system? The amount of each monthly outcome...

  11. Proof of payment for all reimbursement claims

    CERN Multimedia

    HR Department

    2006-01-01

    Members of the personnel are kindly requested to note that only documents proving that a payment has been made are accepted as proof of payment for any claims for reimbursement, including specifically the reimbursement of education fees. In particular, the following will be accepted as proof of payment: bank or post office bank statements indicating the name of the institution to which the payment was made; photocopies of cheques made out to the institution to which the payments were made together with bank statements showing the numbers of the relevant cheques; proof of payment in the form of discharged payment slips; invoices with acknowledgement of settlement, receipts, bank statements detailing operations crediting another account or similar documents. As a result, the following documents in particular will no longer be accepted as proof of payment: photocopies of cheques that are not submitted together with bank or post office bank statements showing the numbers of the relevant cheques; details of ...

  12. Equal Access to Justice Act Payments

    Data.gov (United States)

    Social Security Administration — A dataset containing payment amounts made by the Social Security Administration for court-approved Equal Access to Justice Act (EAJA) payments for fiscal year 2010...

  13. 32 CFR 756.7 - Payment.

    Science.gov (United States)

    2010-07-01

    ... payment is possible under another statute. In some cases, neither the NAFI nor its insurer may be legally responsible. In those instances when there is no negligence, and payment is authorized under some other...

  14. Payment Reform: Unprecedented and Evolving Impact on Gynecologic Oncology.

    Science.gov (United States)

    Apte, Sachin M; Patel, Kavita

    2016-01-01

    With the signing of the Medicare Access and CHIP Reauthorization Act in April 2015, the Centers for Medicare and Medicaid Services (CMS) is now positioned to drive the development and implementation of sweeping changes to how physicians and hospitals are paid for the provision of oncology-related services. These changes will have a long-lasting impact on the sub-specialty of gynecologic oncology, regardless of practice structure, physician employment and compensation model, or local insurance market. Recently, commercial payers have piloted various models of payment reform via oncology-specific clinical pathways, oncology medical homes, episode payment arrangements, and accountable care organizations. Despite the positive results of some pilot programs, adoption remains limited. The goals are to eliminate unnecessary variation in cancer treatment, provide coordinated patient-centered care, while controlling costs. Yet, meaningful payment reform in oncology remains elusive. As the largest payer for oncology services in the United States, CMS has the leverage to make cancer services more value based. Thus far, the focus has been around pricing of physician-administered drugs with recent work in the area of the Oncology Medical Home. Gynecologic oncology is a unique sub-specialty that blends surgical and medical oncology, with treatment that often involves radiation therapy. This forward-thinking, multidisciplinary model works to keep the patient at the center of the care continuum and emphasizes care coordination. Because of the breadth and depth of gynecologic oncology, this sub-specialty has both the potential to be disrupted by payment reform as well as potentially benefit from the aspects of reform that can align incentives appropriately to improve coordination. Although the precise future payment models are unknown at this time, focused engagement of gynecologic oncologists and the full care team is imperative to assure that the practice remains patient centered

  15. Payment Reform: Unprecedented and Evolving Impact on Gynecologic Oncology

    Science.gov (United States)

    Apte, Sachin M.; Patel, Kavita

    2016-01-01

    With the signing of the Medicare Access and CHIP Reauthorization Act in April 2015, the Centers for Medicare and Medicaid Services (CMS) is now positioned to drive the development and implementation of sweeping changes to how physicians and hospitals are paid for the provision of oncology-related services. These changes will have a long-lasting impact on the sub-specialty of gynecologic oncology, regardless of practice structure, physician employment and compensation model, or local insurance market. Recently, commercial payers have piloted various models of payment reform via oncology-specific clinical pathways, oncology medical homes, episode payment arrangements, and accountable care organizations. Despite the positive results of some pilot programs, adoption remains limited. The goals are to eliminate unnecessary variation in cancer treatment, provide coordinated patient-centered care, while controlling costs. Yet, meaningful payment reform in oncology remains elusive. As the largest payer for oncology services in the United States, CMS has the leverage to make cancer services more value based. Thus far, the focus has been around pricing of physician-administered drugs with recent work in the area of the Oncology Medical Home. Gynecologic oncology is a unique sub-specialty that blends surgical and medical oncology, with treatment that often involves radiation therapy. This forward-thinking, multidisciplinary model works to keep the patient at the center of the care continuum and emphasizes care coordination. Because of the breadth and depth of gynecologic oncology, this sub-specialty has both the potential to be disrupted by payment reform as well as potentially benefit from the aspects of reform that can align incentives appropriately to improve coordination. Although the precise future payment models are unknown at this time, focused engagement of gynecologic oncologists and the full care team is imperative to assure that the practice remains patient centered

  16. Payment Reform: Unprecedented and Evolving Impact on Gynecologic Oncology

    Directory of Open Access Journals (Sweden)

    Sachin eApte

    2016-04-01

    Full Text Available With the signing of the Medicare Access and CHIP Reauthorization Act (MACRA in April 2015, the Centers for Medicare and Medicaid Services (CMS is now positioned to drive the development and implementation of sweeping changes to how physicians and hospitals are paid for the provision of oncology related services. These changes will have a long-lasting impact on the sub-specialty of gynecologic oncology, regardless of practice structure, physician employment and compensation model, or local insurance market. Recently, commercial payers have piloted various models of payment reform via oncology specific clinical pathways, oncology medical homes, episode payment arrangements, and accountable care organizations. Despite the positive results of some pilot programs, adoption remains limited. The goals are to eliminate unnecessary variation in cancer treatment, provide coordinated patient-centered care, while controlling costs. Yet, meaningful payment reform in oncology remains elusive. As the largest payer for oncology services in the United States, CMS has the leverage to make cancer services more value-based. Thus far, the focus has been around pricing of physician-administered drugs with recent work in the area of the Oncology Medical Home. Gynecologic oncology is a unique sub-specialty which blends surgical and medical oncology, with treatment that often involves radiation therapy. This forward-thinking, multi-disciplinary model works to keep the patient at the center of the care continuum and emphasizes care coordination. Because of the breadth and depth of gynecologic oncology, this sub-specialty has both the potential to be disrupted by payment reform as well as potentially benefit from the aspects of reform which can align incentives appropriately to improve coordination. Although the precise future payment models are unknown at this time, focused engagement of gynecologic oncologists and the full care team is imperative to assure that the

  17. Economic incentives and alternative nitrogen regulation schemes

    DEFF Research Database (Denmark)

    Jensen, Jørgen Dejgård; Ørum, Jens Erik

    2014-01-01

    The objective of this chapter is to investigate economic incentives associated with changes in nitrogen regulation, including the distribution between farm types and geographically. The analysis is carried out on a partial equilibrium simulation model of the Danish agricultural sector—ESMERALDA. ...

  18. 75 FR 8854 - Teacher Incentive Fund Program

    Science.gov (United States)

    2010-02-26

    ..., evaluation, retention, and advancement into instructional leadership roles. When the PBCS's implementation... responsibilities and leadership roles; and (4) Include helping teachers and principals to better understand and use... high-need schools by creating incentives for effective teachers and principals in these schools. DATES...

  19. Targeting incentives to reduce habitat fragmentation

    Science.gov (United States)

    David Lewis; Andrew Plantinga; Junjie Wu

    2009-01-01

    This article develops a theoretical model to analyze the spatial targeting of incentives for the restoration of forested landscapes when wildlife habitat can be enhanced by reducing fragmentation. The key theoretical result is that the marginal net benefits of increasing forest can be convex, in which case corner solutions--converting either none or all of the...

  20. Non-organ donors' attitudes toward incentives.

    Science.gov (United States)

    Tumin, Makmor; Noh, Abdillah; Chong, Chin-Sieng; Lim, Soo-Kun; Abdullah, Nawi; Ng, Kok-Peng

    2013-01-01

    Malaysians indicating that they did not intend to become organ donors upon their death were surveyed regarding interest in non-fungible financial incentives to be granted to surviving family members. Among the 730 (56% of the total sample of 1311) indicating unwillingness to be donors, 29.6% (216/730) subsequently indicated that they would be willing donors if the government introduced policies that, upon their death, "rewarded your (their) family with incentives for your (their) deeds." Among the 69% (504/730) who insisted that they would not become organ donor even with incentive, nearly 80% (404/501) of them were able to identify relevant incentives they thought should be provided by the state to those who make organ donations upon death. The majority of both groups preferred the state provide medical benefits to a surviving family member, suggesting this may be an attractive policy option for the state to raise the deceased organ donation pool. © 2013 John Wiley & Sons A/S.

  1. BSN completion barriers, challenges, incentives, and strategies.

    Science.gov (United States)

    Duffy, Marie T; Friesen, Mary Ann; Speroni, Karen Gabel; Swengros, Diane; Shanks, Laura A; Waiter, Pamela A; Sheridan, Michael J

    2014-04-01

    The objectives of this study were to explore RN perceptions regarding barriers/challenges and incentives/supports for BSN completion and identify recommendations to increase RN BSN completion. The Institute of Medicine's 2011 The Future of Nursing report recommended the proportion of RNs with a BSN increase to 80% by 2020. This qualitative study included 41 RNs who participated in 1 of 6 focus groups based on their BSN completion status. Primary themes were sacrifices, barriers/challenges, incentives/supports, value, how to begin, and pressure. Primary BSN completion barriers/challenges were work-life balance and economic issues. Incentives/supports identified were financial compensation, assistance from employer and academic institution, and encouragement from family. Institutional strategies recommended for increasing BSN completion rates were improved access to education and financial support facilitated by collaboration between hospitals and academic institutions. Exploring RN barriers/challenges and incentives/supports for BSN completion can lead to implementation of institutional strategies, such as tuition reimbursement and academic collaboration.

  2. Incentives for Innovation in the Public Schools

    Science.gov (United States)

    Pincus, John

    1974-01-01

    Analysis of bureaucratic structure and the incentive systems of the public schools reveals access points for enhancing the school's ability to adopt and implement innovative education. Research and development coordinated to those points can provide a greater diversity of educational possibilities, assuming such diversity to be a positive…

  3. Incentive Issues in Information Security Management

    Science.gov (United States)

    Lee, Chul Ho

    2012-01-01

    This dissertation studies three incentive issues in information security management. The first essay studies contract issues between a firm that outsources security functions and a managed security service provider (MSSP) that provides security functions to the firm. Since MSSP and firms cannot observe each other's actions, both can suffer…

  4. Developmental Effects of Incentives on Response Inhibition

    Science.gov (United States)

    Geier, Charles F.; Luna, Beatriz

    2012-01-01

    Inhibitory control and incentive processes underlie decision making, yet few studies have explicitly examined their interaction across development. Here, the effects of potential rewards and losses on inhibitory control in 64 adolescents (13- to 17-year-olds) and 42 young adults (18- to 29-year-olds) were examined using an incentivized antisaccade…

  5. Incentives, Teachers, and Gender at Work

    Science.gov (United States)

    Robert, Sarah A.

    2013-01-01

    Incentive pay programs have become panacea for a multitude of educational challenges. When aimed at teachers the assumption is that rewards entice them to work in particular ways or particular schools. However, the assumption is based on an economic formula that does not take into consideration the gendered nature of policy processes. This study…

  6. Financial Incentives to Promote Active Travel

    Science.gov (United States)

    Martin, Adam; Suhrcke, Marc; Ogilvie, David

    2012-01-01

    Context Financial incentives, including taxes and subsidies, can be used to encourage behavior change. They are common in transport policy for tackling externalities associated with use of motor vehicles, and in public health for influencing alcohol consumption and smoking behaviors. Financial incentives also offer policymakers a compromise between “nudging,” which may be insufficient for changing habitual behavior, and regulations that restrict individual choice. Evidence acquisition The literature review identified studies published between January 1997 and January 2012 of financial incentives relating to any mode of travel in which the impact on active travel, physical activity, or obesity levels was reported. It encompassed macroenvironmental schemes, such as gasoline taxes, and microenvironmental schemes, such as employer-subsidized bicycles. Five relevant reviews and 20 primary studies (of which nine were not included in the reviews) were identified. Evidence synthesis The results show that more-robust evidence is required if policymakers are to maximize the health impact of fiscal policy relating to transport schemes of this kind. Conclusions Drawing on a literature review and insights from the SLOTH (sleep, leisure, occupation, transportation, and home-based activities) time-budget model, this paper argues that financial incentives may have a larger role in promoting walking and cycling than is acknowledged generally. PMID:23159264

  7. Career concerns incentives: An experimental test

    DEFF Research Database (Denmark)

    Koch, Alexander; Morgenstern, Albrecht; Raab, Philippe

    the information that individuals base their decisions on. Our laboratory experiment provides prima facie evidence: i) the signal jamming mechanism successfully creates incentives on the labor supply side; ii) decision errors take time to decrease; iii) while subjects' average beliefs are remarkably consistent...

  8. Career concerns incentives: An experimental test

    DEFF Research Database (Denmark)

    Koch, Alexander; Morgenstern, Albrecht; Raab, Philippe

    2009-01-01

    the information that individuals base their decisions on. Our laboratory experiment provides prima facie evidence: i) the signal jamming mechanism successfully creates incentives on the labor supply side; ii) decision errors take time to decrease; iii) while subjects’ average beliefs are remarkably consistent...

  9. Linking performance incentives to ethical practice

    Directory of Open Access Journals (Sweden)

    Boudi FB

    2018-02-01

    Full Text Available No abstract available. Article truncated after 150 words. Health spending is a huge part of the United States economy as it is a large business. We all have seen increasing inclusion of corporate practices in health care. One such inclusion is the incentive programs which have at their core the goal of production of the desired behavioral outcomes directly related either to performance output or extraordinary achievement. However, management influence on the organization’s ethical environment and culture can inadvertently encourage or endorse unethical behavior despite the best intentions. One way would be failing to link performance incentives to ethical practice. When leaders create strong incentives to accomplish a goal without creating equally strong incentives to adhere to ethical practice in achieving the desired goal, they effectively set the stage for ethical malpractice. Incentivizing ethical practice is equally important as incentivizing other behaviors (1. In the health care industry, unlike in the sales industry, professionalism and patient care are …

  10. Higher education reform: getting the incentives right

    NARCIS (Netherlands)

    Canton, Erik; Venniker, Richard; Jongbloed, Benjamin W.A.; Koelman, Jos; Koelman, Jos; van der Meer, Peter; van der Meer, Peter; Vossensteyn, Johan J.

    2001-01-01

    This study is a joint effort by the Netherlands Bureau for Economic Policy Analysis (CPB) and the Center for Higher Education Policy Studies. It analyses a number of `best practices¿ where the design of financial incentives working on the system level of higher education is concerned. In Chapter 1,

  11. Monetary incentives: usually neither necessary nor sufficient?

    Czech Academy of Sciences Publication Activity Database

    Ortmann, Andreas; Hertwig, R.

    -, č. 307 (2006), s. 1-17 ISSN 1211-3298 Institutional research plan: CEZ:AV0Z70850503 Keywords : experimental practices * monetary incentives * rhetorical tactics Subject RIV: AH - Economics http://www.cerge-ei.cz/pdf/wp/Wp307.pdf

  12. Economic Incentives for Stormwater Control (ISBN9781439845608)

    Science.gov (United States)

    Addressing a huge knowledge gap from a policy perspective, this book focuses on the economic tools available for stormwater runoff control. It provides case studies demonstrating the application of various incentives, such as tradable credits, fees with rebates, and auction mecha...

  13. Biased managers, organizational design, and incentive provision

    OpenAIRE

    Moreira, Humberto Ataíde; Costa, Cristiano Machado; Ferreira, Daniel Bernardo Soares

    2004-01-01

    Rio de Janeiro We model the tradeoff between the balance and the strength of incentives implicit in the choice between hierarchical and matrix organizational structures. We show that managerial biases determine which structure is optimal: hierarchical forms are preferred when biases are low, while matrix structures are preferred when biases are high.

  14. Incentives, behavioral biases, and risk taking

    NARCIS (Netherlands)

    Pikulina, E.S.

    2014-01-01

    While economists believe that monetary incentives provide the most powerful motivation for individuals to undertake an activity, major schools in psychology and sociology emphasize the motives coming from within the individual and from the personal and cultural differences among individuals. This

  15. 75 FR 76079 - Sound Incentive Compensation Guidance

    Science.gov (United States)

    2010-12-07

    ... management; and Be supported by strong corporate governance, including active and effective oversight by the... Sound Compensation Practices adopted by the Financial Stability Board (FSB) in April 2009, as well as... will promote the prompt improvement of incentive compensation practices in the banking industry by...

  16. 75 FR 53023 - Sound Incentive Compensation Guidance

    Science.gov (United States)

    2010-08-30

    ... management; and Be supported by strong corporate governance, including active and effective oversight by the... Sound Compensation Practices adopted by the Financial Stability Board (FSB) in April 2009, as well as... will promote the prompt improvement of incentive compensation practices in the banking industry by...

  17. 75 FR 22679 - Sound Incentive Compensation Guidance

    Science.gov (United States)

    2010-04-29

    ... management; and Be supported by strong corporate governance, including active and effective oversight by the... Sound Compensation Practices adopted by the Financial Stability Board (FSB) in April 2009, as well as... will promote the prompt improvement of incentive compensation practices in the banking industry by...

  18. Auctioning incentive contracts: an experimental study

    NARCIS (Netherlands)

    Onderstal, S.; van de Meerendonk, A.

    2009-01-01

    In this note, we experimentally examine the relative performance of price-only auctions and multi-attribute auctions. We do so in procurement settings where the buyer can give the winning bidder incentives to exert effort on non-price dimensions after the auction. Both auctions theoretically

  19. Payments and Central Bank Policy

    DEFF Research Database (Denmark)

    Korsgaard, Søren

    This thesis consists of three chapters. The rst, "Paying for Payments", examines the role of interchange fees in payment card networks. The second, "Bank Liquidity and the Interbank Market" (co-authored with Mikael Reimer Jensen), investigates how banks' liquidity holdings at the central bank a ect...... outcomes in the money market. The third, "Collateralized Lending and Central Bank Collateral Policy", considers the emergence of credit constraints under collateralized lending, and how central banks use collateral policy to mitigate these constraints. While the chapters can be read independently......, they share common themes. Each chapter is concerned with payments in one way or another, each is concerned with the e ciency of market outcomes, and, to the extent that there is scope for improving these outcomes, each discusses the appropriate role for policy, in particular central bank policy....

  20. Does a global budget superimposed on fee-for-service payments mitigate hospitals' medical claims in Taiwan?

    Science.gov (United States)

    Hsu, Pi-Fem

    2014-12-01

    Taiwan's global budgeting for hospital health care, in comparison to other countries, assigns a regional budget cap for hospitals' medical benefits claimed on the basis of fee-for-service (FFS) payments. This study uses a stays-hospitals-years database comprising acute myocardial infarction inpatients to examine whether the reimbursement policy mitigates the medical benefits claimed to a third-payer party during 2000-2008. The estimated results of a nested random-effects model showed that hospitals attempted to increase their medical benefit claims under the influence of initial implementation of global budgeting. The magnitudes of hospitals' responses to global budgeting were significantly attributed to hospital ownership, accreditation status, and market competitiveness of a region. The results imply that the regional budget cap superimposed on FFS payments provides only blunt incentive to the hospitals to cooperate to contain medical resource utilization, unless a monitoring mechanism attached with the payment system.

  1. 36 CFR 51.79 - May the Director waive payment of a franchise fee or other payments?

    Science.gov (United States)

    2010-07-01

    ... payment of a franchise fee or other payments? 51.79 Section 51.79 Parks, Forests, and Public Property....79 May the Director waive payment of a franchise fee or other payments? The Director may not waive the concessioner's payment of a franchise fee or other payments or consideration required by a...

  2. 42 CFR 412.540 - Method of payment for preadmission services under the long-term care hospital prospective payment...

    Science.gov (United States)

    2010-10-01

    ... the long-term care hospital prospective payment system. 412.540 Section 412.540 Public Health CENTERS... PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals... payment system. The prospective payment system includes payment for inpatient operating costs of...

  3. Incentives and nuclear waste siting: Prospects and constraints

    International Nuclear Information System (INIS)

    Carnes, S.A.; Copenhaver, E.D.; Sorensen, J.H.; Soderstrom, E.J.; Reed, J.H.; Bjornstad, D.J.; Peelle, E.

    1983-01-01

    Limited anecdotal evidence from existing incentive-based facility sitings, and from a survey of rural Wisconsin residents in 1980 regarding the acceptability of a nuclear waste repository, indicates that incentives may help ahcieve the twin goals of increasing local support and decreasing local opposition to hosting nuclear waste facilities. Incentives are classified according to functional categories (i.e., mitigation, compensation, and reward), and prerequisites to the use of incentives are outlined (i.e., guarantee of public health and safety, some measure of local control, and a legitimation of negotiations during siting). Criteria for evaluating the utility of incentives packages may be more useful than single incentives, and nonmonetary incentives, such as independent monitoring and access to credible information, may be as important in eliciting support as monetary incentives. 54 references, 1 figure, 4 tables

  4. Using Effective Contractual Incentives to Obtain Superior Contractor Performance

    National Research Council Canada - National Science Library

    Venable, Timothy

    2000-01-01

    The purpose of this thesis is to provide the reader with the ability to analyze the effectiveness of incentives and to document innovative approaches to incentive contracting that can be applied to Cost-Plus-Award-Fee (CPAF) contracts...

  5. Grid Computing BOINC Redesign Mindmap with incentive system (gamification)

    OpenAIRE

    Kitchen, Kris

    2016-01-01

    Grid Computing BOINC Redesign Mindmap with incentive system (gamification) this is a PDF viewable of https://figshare.com/articles/Grid_Computing_BOINC_Redesign_Mindmap_with_incentive_system_gamification_/1265350

  6. 48 CFR 416.405 - Cost-reimbursement incentive contracts.

    Science.gov (United States)

    2010-10-01

    ... 48 Federal Acquisition Regulations System 4 2010-10-01 2010-10-01 false Cost-reimbursement incentive contracts. 416.405 Section 416.405 Federal Acquisition Regulations System DEPARTMENT OF...-reimbursement incentive contracts. ...

  7. 42 CFR 408.65 - Payment options.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Payment options. 408.65 Section 408.65 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PREMIUMS FOR SUPPLEMENTARY MEDICAL INSURANCE Direct Remittance: Individual Payment § 408.65 Payment options...

  8. 7 CFR 1599.6 - Payments.

    Science.gov (United States)

    2010-01-01

    ... AGRICULTURE McGOVERN-DOLE INTERNATIONAL FOOD FOR EDUCATION AND CHILD NUTRITION PROGRAM § 1599.6 Payments. (a... payment; the bank ABA number to which payment is to be made; the account number for the deposit at the bank; the participant's taxpayer identification number; and the type of the account into which the...

  9. 7 CFR 1499.6 - Payments.

    Science.gov (United States)

    2010-01-01

    ... AGRICULTURE LOANS, PURCHASES, AND OTHER OPERATIONS FOOD FOR PROGRESS PROGRAM § 1499.6 Payments. (a) If the... payment; the bank ABA number to which payment is to be made; the account number for the deposit at the bank; the participant's taxpayer identification number; and the type of the account into which the...

  10. 24 CFR 2002.15 - Advance payments.

    Science.gov (United States)

    2010-04-01

    ... where the requester has a history of prompt payment of FOIA fees, or require an advance payment of an amount up to the full estimated charges in the case of requesters with no history of payment; or (2) Where a requester has previously failed to pay a fee charged in a timely fashion (i.e., within 30 days...

  11. 14 CFR 1206.704 - Advance payments.

    Science.gov (United States)

    2010-01-01

    ... where the requester has a history of prompt payment of FOIA fees, or require an advance payment of an amount up to the full estimated charges in the case of requesters with no history of payment; or (2) A requester has previously failed to pay a fee in a timely fashion (within 30 days of billing), then NASA may...

  12. 20 CFR 435.22 - Payment.

    Science.gov (United States)

    2010-04-01

    ...-Award Requirements Financial and Program Management § 435.22 Payment. (a) Introduction. Payment methods..., and (ii) Financial management systems that meet the standards for fund control and accountability as..., Payment Management System, Rockville, MD 20852. Interest amounts up to $250 per year may be retained by...

  13. 20 CFR 410.501 - Payment periods.

    Science.gov (United States)

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Payment periods. 410.501 Section 410.501 Employees' Benefits SOCIAL SECURITY ADMINISTRATION FEDERAL COAL MINE HEALTH AND SAFETY ACT OF 1969, TITLE IV-BLACK LUNG BENEFITS (1969- ) Payment of Benefits § 410.501 Payment periods. Benefits are paid to...

  14. 20 CFR 627.430 - Grant payments.

    Science.gov (United States)

    2010-04-01

    ... after receipt of a proper request for reimbursement. (e) Working capital advance payments. If a... working capital, the awarding agency may provide cash on a working capital advance payment basis. Under... reimburse the subrecipient for its actual cash disbursements. The working capital advance method of payment...

  15. 7 CFR 920.112 - Late payments.

    Science.gov (United States)

    2010-01-01

    ... Miscellaneous Provisions § 920.112 Late payments. Pursuant to § 920.41(a), interest will be charged at a 1.5 percent monthly simple interest rate. Assessments for kiwifruit shall be deemed late if not received... late charge will be assessed when payment becomes 30 days late. Interest and late payment charges shall...

  16. 42 CFR 460.182 - Medicaid payment.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Medicaid payment. 460.182 Section 460.182 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED...) Payment § 460.182 Medicaid payment. (a) Under a PACE program agreement, the State administering agency...

  17. 45 CFR 34.7 - Payment procedures.

    Science.gov (United States)

    2010-10-01

    ... whole or part, the claims officer shall prepare and mail a payment voucher to the claimant. (b) This... payment voucher, the claims officer shall sign and forward the signed voucher to the office where the claimant is or was employed for processing. (d) Upon receipt of the signed payment voucher, the office in...

  18. 41 CFR 51-5.7 - Payments.

    Science.gov (United States)

    2010-07-01

    ... 41 Public Contracts and Property Management 1 2010-07-01 2010-07-01 true Payments. 51-5.7 Section... Payments. Payments for products or services of persons who are blind or have other severe disabilities shall be made within 30 days after shipment or receipt of a proper invoice or voucher. ...

  19. 5 CFR 1655.14 - Loan payments.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Loan payments. 1655.14 Section 1655.14 Administrative Personnel FEDERAL RETIREMENT THRIFT INVESTMENT BOARD LOAN PROGRAM § 1655.14 Loan payments. (a) Loan payments must be made through payroll deduction in accordance with the loan agreement. Once loan...

  20. 5 CFR 1620.35 - Loan payments.

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 3 2010-01-01 2010-01-01 false Loan payments. 1620.35 Section 1620.35... Nonappropriated Fund Employees § 1620.35 Loan payments. NAF instrumentalities must deduct and transmit TSP loan... CFR part 1655 and Board procedures. Loan payments may not be deducted and transmitted for employees...