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Medicare News
Little Care Improvement by Hospitals in Medicare
Pay-for-Performance Program
Bonuses of $17.6 million were awarded to 238
hospitals in two years
June 6, 2007 - Hospitals participating in a
Medicare pay-for-performance pilot program were not significantly more
likely than non-participating hospitals to provide better treatment,
according to a three-year study published in the Journal of the American
Medical Association, the Wall Street Journal reports.
For the study, researchers at
Duke University
compared the treatments and outcomes for five conditions at 54 hospitals
participating in a Medicare pay-for-performance pilot program with
treatments and outcomes at 446 hospitals not participating in the
program.
The researchers studied information on 105,383
patients treated at the hospitals over three years beginning in 2003,
examining factors such as whether heart attack patients were prescribed
aspirin, beta-blockers and ACE inhibitors.
The researchers also tracked whether patients were
advised to quit smoking. Hospitals participating in the
pay-for-performance program received bonuses if they reached the two
highest performance levels for a given condition.
Bonuses totaling $17.6 million were awarded to 123
hospitals during the first year of the study and 115 hospitals in the
second year. The lowest-performing hospitals faced potential financial
penalty, but no penalties were imposed, the researchers said.
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In conclusion, this study is one of the first to
evaluate the CMS pay-for-performance pilot project. Among hospitals
participating in a voluntary quality-improvement registry,
pay-for-performance had limited incremental impact on processes of care
and outcomes for acute myocardial infarction. Conversely, we did not
find evidence that pay-for-performance had an adverse impact on
improvement in processes of care that were not subject to financial
incentives. Additional studies of pay-for-performance are needed to
determine its optimal role in quality-improvement initiatives. |
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According to the study, the "pay-for-performance
program was not associated with a significant incremental improvement in
quality of care or outcomes" for heart attacks. Compliance with
recommendations for heart attack treatment increased to 94.2% from 87%
at hospitals participating in the program, compared with an increase to
93.6% from 88% at hospitals that were not in the program.
The researchers said they found a "slightly higher
rate of improvement for two of six targeted therapies" but concluded
that "overall, there was no evidence that improvements in in-hospital
mortality were incrementally greater at pay-for-performance sites."
Comments
Study author Eric Peterson said, "One read on this
is that the carrots have to be bigger."
The Journal notes that participating hospitals this
winter said the bonuses paid were small in proportion to their total
budgets. Peterson added that all 500 of the hospitals in the study had
volunteered for an initiative to improve adherence to the heart attack
treatment guidelines of the
American College of
Cardiology and the
American Heart
Association. That participation also might have improved
overall performance, Peterson said.
Steven Nissen, chair of cardiovascular medicine at
the
Cleveland Clinic,
said that the study's results "suggest we ought to slow down a minute
before going into pay for performance." The Journal reports that the
study's findings "raise the question of what [CMS]
will do next." A CMS spokesperson said that the agency had not seen the
study and could not comment (Burton/Francis, Wall Street Journal, 6/6).
>> An abstract of the study is available
online.
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