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Pay-for-Performance Study Results 'Sobering'
In a large multi-year study, hospitals using a pay-for performance model did not achieve lower 30-day mortality rates than non-participating hospitals.
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*MAGNET™, MAGNET RECOGNITION PROGRAM®, and ANCC MAGNET RECOGNITION® are trademarks of the American Nurses Credentialing Center (ANCC). The products and services of HCPro, Inc. and The Greeley Company are neither sponsored nor endorsed by the ANCC. The acronym "MRP" is not a trademark of HCPro or its parent company. HCPro, Inc. is not affiliated in any way with The Joint Commission, which owns the JCAHO (Joint Commission on Accreditation of Healthcare Organizations) and Joint Commission trademarks, the Accreditation Council for Graduate Medical Education, which owns the ACGME trademark, or the Accreditation Association for Ambulatory Health Care (AAAHC).
The objective of this study was "to compare the effect of the addition of pay for performance to public reporting (i.e., the Premier program) with public reporting alone". It's all but astonishing that no significant changes in mortality rates were found. Is mortality rate a suitable indicator in quality measures any longer? Does it make sense to link P4P to mortality? And even if so - this design might have made sense if there was no public reporting, which to me seems to be the key driver in keeping mortality rates low anyway. 1-2% additional pay cannot make a difference here.
I too found the article interesting and the "mom's" perception interesting. Did the mom exhaust all possible resources for care and treatment available before seeking treatment in the ED?Babies don't get hysterical, parents do. Babies cry when things aren't right, they are supposed to. A fever of 102? The wait conveyed was not too long, but unfortunate. Yes, ED's are busy and overcrowded, designed for the sickest being cared for 1st. The biggest problem I see here is the lack of communication between the staff and family. From the healthcare worker perspective, sounds like a simple case that was treated correctly. My issue with the article is the fact that you knew so little about the workings of many of the ED's nationally and world wide. We the healthcare workers continue to put bandaids on a broken system every day. The problem is a multifaceted one at many levels. There is no cure, but we focus on the continued efforts to do the best we can on a daily basis.
Scaling up this pilot could only cost CMS money, without providing real added value to patients. It further demonstrates a key problem with the Affordable Care Act, the reliance on unproven mechanisms to improve quality. http://bit.ly/I1oayj
Why is it that many of the "shared savings" and "pay for performance" programs seem to fail? It may be that the "bar" for success is set too high. For example, Prof. Louis Russell at Rutgers has been making the rational claim that "savings" and preventive care programs violate rules of arithmetic. Now I think we have reached the ultimate limit when we are examining if hospitals can make patients immortal (I am exaggerating a little!). Clearly we need better metrics than that before we abandon a program. Part of the problem is that we are so wedded to rewarding procedures that we have not formulated global measures of performance yet. Meanwhile providers are being set up to fail - and, of course, receiving blame.