Study: Paying doctors differently saves lives

There's a lot of talk right now in health policy circles about moving away from a system where we pay for volume of care (a fee-for-service system, in health wonk parlance) toward one where we pay for the value of care (usually known as pay-for-performance).

The motivation is often to make health care more cost-effective, pushing doctors to provide only the care that is actually of value to their patients and reducing the $750 billion we spend annually on care we don't need. But new research suggests there could be another, important upside to that practice: A British study finds that paying for performance can also save lives.

A team of British researchers, led by the University of Manchester's Mark Sutton, looked at a northwest region of the country before and after it began tethering hospital payments to how well the hospitals performed on a set of 28 quality metrics measuring common procedures such as knee replacements and heart attack treatment. Hospitals that did really well on these metrics could get a payment boost of as much as 4 percent.

Among the conditions included in the program, the researchers saw a 1.3 percent decrease in mortality rates, after adjusting for some overall drops in mortality rates in the United Kingdom. That might seem small, but here's a clearer way to put it: The payment changes were associated with 890 fewer deaths than would have been expected to occur without them. 

These improvements in survival rates did not, however, show up in specialties outside the incentive program. That strongly suggests that it was something specific about the quality-payment program that was driving the improved care within a month of admission. 

The researchers aren't quite sure what mechanism is driving the changes. "We think that it is very unlikely that improved performance on the process measures alone could explain the reduced mortality that we observed," they wrote in last week's New England Journal of Medicine. 

We might learn more about the mechanisms at play soon, as the United States introduces a similar program for its hospitals. Under the health care law, hospitals become eligible for bonuses if they hit certain quality metrics -- they also get dinged if they lag behind on these measures. There's still an open debate about how that will change hospitals' behavior and whether it will save money. But the British study offers the hopeful possibility that it could end up saving more of their patients' lives.

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Suzy Khimm · November 11, 2012

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