Pay-for-Performance Study Results 'Sobering'

Cheryl Clark, 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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