Federal pay-for-performance initiatives could mean more financial heartache for poor hospitals

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Will the government's planned implementation institutional bonuses through pay-for-performance initiatives rob from poor hospitals and give to the rich? Not exactly, but it will create a "reverse Robin Hood" effect by funneling money to well-off hospitals already capable of reaching such thresholds, while leaving underfunded facilities even more ... well ... underfunded, insist researchers writing in PLoS Medicine, a peer-reviewed journal published by the Public Library of Science. 

With the U.S. set to begin reimbursing hospitals via Medicare's "Value Based Purchasing" program two years from now, heavy emphasis will be placed on a facility's ability to treat common conditions like heart attack and pneumonia, notes The Medical News. In the report, researchers--led by Jan Blustein, MD, a professor of health policy and medicine at the Robert F. Wagner Graduate School of Public Service at New York University--determined that hospitals in poorer areas had a much more difficult time treating patients specifically for heart failure (HF) and acute myocardial infarction (AMI, heart attack). The researchers looked at just over 2,700 hospitals with "fully reported process-of-care measures" for both conditions in 2004 and 2007, and used the "Performance Assessment Model" created by the Centers for Medicare and Medicaid Services to evaluate each facility's performance. 

"These findings indicate that hospital performance ... is associated with the quantity and quality of local human and economic resources," the study's authors conclude. "Thus, the proposed Medicare hospital pay-for-performance program may exacerbate existing U.S. healthcare inequalities by leading to the transfer of funds from hospitals in disadvantaged locations to those in advantaged locations. ... [The findings] suggest that U.S. policymakers may need to modify how they measure performance improvement--the current Performance Assessment Model gives hospitals that start from a low baseline less credit for improvements than those that start from a high baseline." 

For more information:
- here's the research article
- read this piece in The Medical News

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