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Pay-for-Performance Study Results 'Sobering'

Cheryl Clark, for HealthLeaders Media, April 2, 2012

After six years, the 252 hospitals that participated in Premier Inc.'s large pay-for performance program, on which Medicare's current value-based purchasing rules are based, did not have lower 30-day mortality rates compared with 3,363 non-participating hospitals, according to a Harvard-based report.

The study calls into question whether pay-for-performance models that mostly use process measures translate to better outcomes—in this case the reduction of 30-day mortality rates, said Ashish K. Jha, MD, of the Harvard School of Public Health Department of Health Policy and Management, and co-authors.

"These findings are sobering for policymakers who hope to use incentives such as those in Premier HQID to improve patient outcomes, e.g. 30-day mortality," the authors wrote.

Premier Inc., a purchasing and quality alliance with 2,400 hospital members, ran the six-year program, called the Hospital Quality Incentive Demonstration (HQID), under a contract from the Centers for Medicare & Medicaid Services. It was based on the hospitals' performance on 33 process measures, such as whether the hospital gave a heart attack patient a fibrinolytic within 30 minutes of arrival, or gave detailed discharge instructions to a heart failure patient.

Over the six years, CMS paid $60 million in incentive payments to 211 of the 242 participating hospitals.

Jha's report was published in Thursday's New England Journal of Medicine.

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4 comments on "Pay-for-Performance Study Results 'Sobering'"


Thomas Ruprecht (4/19/2012 at 7:46 AM)
The objective of this study was "to compare the effect of the addition of pay for performance to public reporting (i.e., the Premier program) with public reporting alone". It's all but astonishing that no significant changes in mortality rates were found. Is mortality rate a suitable indicator in quality measures any longer? Does it make sense to link P4P to mortality? And even if so - this design might have made sense if there was no public reporting, which to me seems to be the key driver in keeping mortality rates low anyway. 1-2% additional pay cannot make a difference here.

Linda Pullen (4/6/2012 at 2:59 PM)
I too found the article interesting and the "mom's" perception interesting. Did the mom exhaust all possible resources for care and treatment available before seeking treatment in the ED?Babies don't get hysterical, parents do. Babies cry when things aren't right, they are supposed to. A fever of 102? The wait conveyed was not too long, but unfortunate. Yes, ED's are busy and overcrowded, designed for the sickest being cared for 1st. The biggest problem I see here is the lack of communication between the staff and family. From the healthcare worker perspective, sounds like a simple case that was treated correctly. My issue with the article is the fact that you knew so little about the workings of many of the ED's nationally and world wide. We the healthcare workers continue to put bandaids on a broken system every day. The problem is a multifaceted one at many levels. There is no cure, but we focus on the continued efforts to do the best we can on a daily basis.

Kristen (4/4/2012 at 4:28 PM)
Scaling up this pilot could only cost CMS money, without providing real added value to patients. It further demonstrates a key problem with the Affordable Care Act, the reliance on unproven mechanisms to improve quality. http://bit.ly/I1oayj