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The Gerontologist Advance Access published online on October 21, 2009
The Gerontologist, doi:10.1093/geront/gnp140
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© The Author 2009. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org.

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

Valerie Cooke, BA, BS1,2, Greg Arling, PhD3, Teresa Lewis, BA4, Kathleen A. Abrahamson, PhD, RN5, Christine Mueller, PhD, RN, FAAN6 and Lisa Edstrom, MBA7

2 Nursing Facility Rates and Policy Division, Department of Human Services, St Paul, Minnesota
3 Indiana University Center for Aging Research, Indiana University School of Medicine, Indianapolis
4 Nursing Facility Rates and Policy Division, Department of Human Services, St Paul, Minnesota
5 Department of Public Health, Western Kentucky University, Bowling Green
6 School of Nursing, University of Minnesota, Minneapolis
7 Center on Aging/Minnesota Area Geriatric Education Center, University of Minnesota, Minneapolis

1 Address correspondence to Valerie Cooke, BA, BS, Nursing Facility Rates and Policy Division, Department of Human Services, PO Box 64973, St Paul, MN 55164-0973. E-mail: valerie.cooke{at}state.mn.us


  Abstract

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 and shared learning, and establish a solid case for investing in better quality from the perspective of the state, providers, and consumers. We explain PIPP rationale and design, describe projects and participating facilities, and present findings from interviews with project leaders. Design and Methods: Provider-initiated projects lasting from 1 to 3 years are selected through a competitive process and are funded for up to 5% of the daily operating per diem rate. Providers are at risk of losing up to 20% of their project funding if they fail to achieve targets on state nursing facility performance measures. Results: Minnesota has made a major investment in the PIPP by supporting 45 individual or collaborative projects, representing approximately 160 facilities and annual funding of approximately $18 million. Projects involve a wide range of interventions, such as fall reduction, wound prevention, exercise, improved continence, pain management, resident-centered care and culture change, and transitions to the community. Implications: The PIPP can serve as a model for other states seeking to promote nursing facility quality either in combination or in place of conventional pay-for-performance efforts.

Keywords: Medicaid, Reimbursement, Evaluation, Value

Received April 29, 2009; Accepted September 14, 2009

Decision Editor: Kathleen Walsh Piercy, PhD


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