Pay-for-Performance Study Results 'Sobering'
Asked to respond to the conclusions in the Jha paper, Premier said in a statement last week that the HQID "achieved its goal.
The HQID "was designed to test whether incentives would improve care processes and a limited number of outcomes in hospitals beyond what was possible with public reporting alone. HQID hospitals outperformed matched hospitals in improving quality scores and did so more quickly, achieving an 18.6 percent improvement."
However, Premier acknowledged, "the jury is still out on whether these limited process and outcomes measures are driving favorable results in patient outcomes, such as mortality, which is the focus of the NEJM article. HQID did measure mortality in two areas (heart attack and heart bypass surgery), and results show that outcomes in these areas were comparable to non-participants.
"However, mortality affects very few inpatients, creating limited opportunities for performance improvement from the outset. In fact, subsequent research has shown that a focus on the main drivers of mortality (sepsis, respiratory infections, shock and palliative care) is more effective at reducing a hospital’s total mortality numbers," the Premier statement said.
Premier added that "Although there have been a number of studies on HQID and outcomes measures like mortality, results often vary, with some showing positive results, others not.
"What is important and unquestioned is that HQID created a successful framework for performance improvement. Since the inception of HQID, the science of measurement has advanced and matured, and we have newer, better tools to assess performance on both processes and outcomes. We do know that an HQID-type execution strategy is a good one for driving rapid and sustainable improvements over time.
"That is why we used new measures to drive a higher level of performance in our quality and cost reduction collaborative, QUEST. In fact, we have seen strong results in QUEST in reducing mortality, harm rates and readmissions as well, and in three years’ time, QUEST hospitals have saved nearly 25,000 lives while reducing healthcare spending by nearly $4.5 billion."
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
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