A Harvard study raises questions about whether paying for performance—or penalizing hospitals for poor performance—improves quality of care.
The researchers examined whether the federal policy that took effect Oct. 1, 2008 prohibiting reimbursement for acute care services necessitated by hospital-acquired bloodstream or urinary tract infections provoked those infection rates to decline.
It did not, the researchers concluded in an article published Thursday in the New England Journal of Medicine.
"It surprised us a little bit," says Ashish Jha, one of the authors and the Associate Professor of Health Policy and Management. "I had hoped that by taking away the extra payments that hospitals used to get for (taking care of patients with) hospital-acquired infections, we would focus hospitals more on getting rid of these infections."
In fact, a variety of incentive programs to reduce catheter-associated urinary tract infections and central line blood stream infections had been coming down independently prior to Oct. 1, 2008, the authors acknowledge, perhaps in anticipation of Medicare's penalty provisions, set forth in a section of the 2005 Deficit Reduction Act.