Study Questions Incentive Programs’ Influence on Care
Hospitals participating in a Medicare pay-for-performance pilot program were not significantly more likely than nonparticipating 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 such factors 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.
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"
Study author Eric Peterson said, "One read on this is that the carrots have to be bigger."
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" (Burton/Francis, Wall Street Journal, 6/6).
Albert Wu, a health policy and management professor at Johns Hopkins University School of Public Health, said that the study "did not find any adverse events associated with pay-for-performance." He added that "we need more studies where there is a stronger hypothesis that there might be a difference" between hospitals that do and do not participate in pay-for-performance programs (Edelson, HealthDay/Washington Post, 6/5).