Pay-for-Performance Study Results 'Sobering'

Cheryl Clark, for HealthLeaders Media , April 2, 2012

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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4 comments on "Pay-for-Performance Study Results 'Sobering'"

Thomas Ruprecht (4/19/2012 at 7:46 AM)
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.

Linda Pullen (4/6/2012 at 2:59 PM)
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.

Kristen (4/4/2012 at 4:28 PM)
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.




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