Pay-for-Performance Study Results 'Sobering'
In a telephone interview, Jha says the data analysis of the HQID study led him to conclude that "Our expectations of what value-based purchasing is going to produce in terms of improvements in outcomes should be pretty limited."
"No matter how you slice it," he adds, "I think what we see is that (among the 252 hospitals participating), improvements for processes were pretty modest. And, then obviously our study says it didn't have any impact on outcomes."
The study found "little evidence" that participation in the Premier program "was associated with declines in mortality above and beyond those reported for hospitals that participated in public reporting alone, even when we examined care over a period of six years after the program's inception," the authors wrote.
Throughout the duration of the experiment, from 2003 to 2009, public reporting on Medicare's Hospital Compare may have incentivized all hospitals to improve quality performance. So the improvement at all hospitals' may have been, to some extent, a result of that pressure.
Additionally, Jha says, over this time clinicians were realizing much better ways to care for patients with these conditions, a learning process that reduced mortality as well, but was unrelated to incentive payments.
"Furthermore, we found no difference in trends in mortality between conditions for which outcomes were explicitly linked to incentives and conditions for which outcomes were not linked to incentives," the authors wrote.
The conditions for which the process measures were applied were congestive heart failure, acute myocardial infarction, and pneumonia, the same ones in the current value-based purchasing logarithm.
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