Two Rural Hospitals Say Award Doesn't Matter in Pay for Performance Success

HealthLeaders Media Staff, August 26, 2009

It isn't every day that rural hospital officials eagerly discuss their abysmal practice scores in crucial care areas like heart failure or hip and knee surgery.

But Cleveland Regional Medical Center in Shelby, NC, and United Hospital Center in Clarksburg, WV, now wear their low rankings almost like war medals.

That's because that poor performance is now history. Today, four years later, the facilities have improved their care of patients so dramatically in four important categories, they've become innovators for other hospitals throughout the country.

Cleveland and United are two of 40 rural hospitals and 190 urban hospitals participating in the Centers for Medicare and Medicaid Services' "pay for performance" demonstration project, organized by Premier Inc.

Ironically, officials for the two hospitals say, the "pay" for their performance isn't the motivator for their participation. Improving care and getting recognized for it, however, are.

The effort is now in the fifth of a six-year run to see if the 230 participating facilities can be motivated by financial rewards to increase their performance in 33 process measures that correlate with better outcomes. But the first year results were a shocker.

"After the first year, we found out we were in the worst decile of all the hospitals in our heart failure discharge instructions," says Liz Popwell, Cleveland's vice president and chief ancillary officer.

Her 241-bed hospital's rates of readmissions were much too high. Scores for other quality measures in heart attack care, pneumonia and hip and knee replacement surgery were not something to advertise either.

Mark Povroznik, director of quality initiatives for a 318-bed United, acknowledges similar lackluster quality. "We ranked in the bottom deciles in nearly everything," he says.

Now after the fourth year, in the four categories of care that Cleveland and United provide--hip and knee surgery, pneumonia, acute myocardial infarction, and heart failure care--the hospitals' scores have vastly improved.

During the four years of the project, Cleveland has received just about $200,000 in rewards, while United has received $333,770, out of a total of $36.5 million paid by the federal government to those best-scoring hospitals.

But if money was supposed to be the motivator, it turns out to not be very important. First of all, the prize money doesn't amount to that much.  Public recognition, however, was the key. And neither hospital knew its initial scores would be relatively poor.

The "financial reward was not the motivator. The motivation was that this was the right thing to do," Povroznik says.

Now what's more important, they both say, is the recognition they received from their patients, physicians and peers, and knowledge that they are providing better care that drives all hospitals to keep up the good work.

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