Pay-for-performance demo fails to improve mortality rates

NEJM study suggests P4P incentive mix still lacking

Topics: Medicare, Reimbursement, Finance, Mortality, Quality, Performance Improvement, Outcomes, Pay-for-Performance, Market Trends, Strategy

March 29, 2012

Mortality rates at hospitals participating in a Medicare pay-for-performance demonstration project were no better than mortality rates at hospitals with traditional payment models, according to a study in NEJM.

For the study, Harvard School of Public Health researchers examined outcomes for more than six million Medicare patients admitted to 252 hospitals participating in the Medicare Premier Hospital Quality Incentive Demonstration (HQID) between 2003 and 2009 for acute myocardial infarction (AMI), congestive heart failure, pneumonia, or coronary artery bypass graft (CABG) surgery. They compared those outcomes with those of patients at 3,363 hospitals not participating in the demonstration.

Overall, the researchers found no significant difference in 30-day mortality rates between the two hospital groups.

  • In 2002, before Premier HQID was implemented, the composite 30-day mortality rate was 12.33% at Premier HQID hospitals and 12.40% at control hospitals.
  • From 2003 to 2009, after Premier HQID had been implemented, mortality rates dropped to 11.82% at participating hospitals and 11.74% at nonparticipating hospitals.

Major takeaways
According to the researchers, the findings suggest that "we still have not identified the right mix of incentives and targets to ensure that pay for performance will drive improvements in patient outcomes."

However, Blair Childs—senior vice president at Premier—noted that the project was intended to improve care processes rather than outcomes. Childs also said Premier hospitals likely did not significantly reduce AMI and CABG mortality rates because they were so low at the start.

Chas Roades , the Advisory Boad's chief research officer, said Medicare's effort should boost quality in the long run. "Like most of these kinds of quality improvements, I think the early gains are going to be the very low performers, and less about the top performers improving even more," Roades told Kaiser Health News. "What I think it will do in the reasonably near term is reduce the spread between the worst performers and the best performers, mostly by pulling up the bottom," he added.

According to Modern Healthcare, Premier HQID served as a model for CMS's value-based purchasing program, which will be implemented nationwide in fiscal year 2013. However, CMS in a statement said the Premier demonstration was launched under the Bush administration and is "separate from the value-based purchasing model that we're implementing," which the agency says is "more aggressive" (Barclay, Medscape Medical News, 3/28; Gever, MedPage Today, 3/28; Rau, Kaiser Health News, 3/28; McKinney, Modern Healthcare, 3/28 [subscription required]).

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