Pay for performance fails to improve mortality rates

Flying in the face of the government's national pay-for-performance initiatives, new research finds that hospital incentives failed to achieve their goal of improving patient outcomes, specifically, 30-day mortality rates. The New England Journal of Medicine study published yesterday found little evidence pay-for-performance programs actually helped keep patients alive longer.

"It really didn't move the needle very much on patient outcomes," study lead author Ashish Jha, a professor at the Harvard School of Public Health, told Reuters. "There was no evidence that patient outcomes got better under this different financing scheme."

Researchers looked at 252 hospitals participating in the Medicare Premier Hospital Quality Incentive Demonstration (HQID), a partnership between the Centers for Medicare & Medicaid Services and nonprofit hospitals, compared to other 3,363 nonparticipating hospitals. Hospitals in the top 20 percentile earned 1 or 2 percent bonuses in Medicare payments, while those in the bottom 20 percent were penalized 1 percent to 2 percent.

However, mortality rates were similar regardless of whether hospitals were in the bonus program. The mortality rates for patients who had heart attacks, congestive heart failure or pneumonia, or who underwent coronary-artery bypass surgery dropped slightly in both groups.

But mortality rates aren't the only goal of the Premier demonstration, according to Premier Senior Vice President Blair Childs.

"The goal of HQID was to determine whether incentives would improve care processes in hospitals and it did do that, there's no question," Childs told Kaiser Health News.

Although Jha said the research findings don't discount the pay-for-performance concept, the study undermines its current structure, which could force health policy experts back to the drawing board, according to Reuters.

"Expectations of improved outcomes for programs modeled after Premier HQID should therefore remain modest," the authors wrote in the study.

CMS said in a statement, "The Premier demonstration was an effort under the last Administration, separate from the value-based purchasing model that we're implementing into Medicare's hospital payment system. Our model for improving quality in hospitals is much more aggressive, covering all hospitals and including both incentives for hospitals that do well on quality metrics, and consequences for hospitals that do not improve," according to KHN.

In the first year of Medicare's value-based program, process measures will account for 70 percent of incentives for hospitals, while patient satisfaction makes up 30 percent. In the second year in 2013, Medicare will include mortality rates for heart failure, heart attack and pneumonia too.

For more information:
- check out the study abstract
- read the Kaiser Health News article
- read the Reuters article

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