Pay-for-Performance Study Results 'Sobering'

Cheryl Clark, for HealthLeaders Media , April 2, 2012

What should policymakers do now? Jha was asked.

"In some ways we have to go back to the drawing board," he says. "I'm a big believer in pay for performance, despite this study. But I think we need to figure out the 'pay' part, and the 'performance part. I actually think 1% is not enough. It should be more substantial."

He was referring to the fact that under value-based purchasing rules set forth by the Affordable Care Act, all hospitals in nation this year will receive only 99% of their Medicare base DRG starting Oct. 1. That 1% goes into a pool that is redistributed to hospitals with the best value-based purchasing scores based on 12 process of care measures (70%) and patient responses to patient experience surveys (30%) during a measurement period that began July 1, 2011.

Hospitals with the lowest scores will not earn any of their 1% back.

Jha also thinks value-based purchasing should be re-worked with more emphasis on outcome measures, and that is starting to happen.

Next year, the value-based purchasing formula will introduce a measure for 30-day mortality, the first outcome measure in the rule.

When the six-year project ended last November, Premier said that participating hospitals had "saved an estimated 8,500 heart attack patients" and administered more than 960,000 additional evidence based measures to 2.7 million patients" cared for at those hospitals.

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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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