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A 30-Day Mortality Rate Mystery

Tinker Ready, for HealthLeaders Media, April 24, 2014

Coming up short on a consumer ranking site like Hospital Compare is one thing. But, with the shift toward value-based purchasing, the stakes are getting much higher. In a November 2013 paper in the New England Journal of Medicine, Robert Berenson, MD, of the Urban Institute warned that Medicare's pay-for-performance program for doctors is a flawed approach that "cannot accurately measure any physician's overall value" and therefore won't hold the physician accountable for quality.

Without data on the efficacy of these measures— or how physicians will respond to them—"policy makers are prematurely deciding that this is a correct approach," Berenson wrote. He had little doubt that the 30-day jump in mortality observed by Maxwell's team is related to performance measures: "There's no other explanation." And hospitals, he said, need to take note.

It's 'Hard to Game the Date of Death'
Focusing on one outcome, such as readmissions, to avoid a specific penalty may compromise quality of care, safety, and patient satisfaction for other clinical problems, according to a March opinion piece in Journal of the American Medical Association.

But, Maxwell's paper does not make the case that this is driving the mortality spike he observed at 30-days, says David Goodman, MD, one of the three researchers from the Dartmouth Institute for Health Policy who authored the piece: "It is hard to game the date of death."

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