Pay-for-Performance Study Results 'Sobering'

Cheryl Clark, for HealthLeaders Media , April 2, 2012

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."


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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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