Pay-for-Performance Doesn't Improve Hospital Care: Study

By Ed Edelson
HealthDay Reporter
Tuesday, June 5, 2007; 12:00 AM

TUESDAY, June 5 (HealthDay News) -- Trying to improve medical care by giving hospitals extra money to follow treatment guidelines doesn't make a difference in the end, new research contends.

However, the researcher who led the study said it's too early to give up on the pay-for-performance concept.

"What we found was that all the hospitals in the study improved over time: those in the improvement group, which received money, but also those in the control group," said Dr. Seth W. Glickman, an assistant professor in the division of emergency medicine at Duke University. "All reduced errors at the same rate over time and had the same improvement in survival over time."

In 2003, the Centers for Medicare and Medicaid Services (CMS) launched the largest pay-for-performance pilot project ever in the United States. It included financial incentives for sticking to heart attack care guidelines, the study said.

A first look at data from 54 hospitals in the "pay-for-performance" group found some improvement in performance, such as better attention to the rule for prescribing aspirin in heart attack cases, according to the report published in the June 6 issue of theJournal of the American Medical Association.

But when the researchers looked at comparable data from 446 hospitals with a voluntary quality improvement program that paid no money, they found similar improvements in quality of care and outcome.

"But I don't think this is the end of the pay-for-performance idea," Glickman said. "It is the end of the beginning."

What the research looked at was "an initial pilot program," he said. "Certainly, moving forward we need to evaluate what went right and what went wrong."

Maybe the financial incentives in the program were not big enough, Glickman added. "Overall, the bonus pool in the pay-for-performance program was relatively small in terms of the overall payments," he noted.

A total of $17.55 million was paid to hospitals over the two years covered by the study.

Pay-for-performance "is here to stay and could be an important part of quality improvement as we go forward," Glickman said. "We need to develop optimum incentives as we go forward."

One problem in evaluating the results is that all the hospitals were performing at relatively high levels, said Dr. Albert Wu, a health policy and management professor at Johns Hopkins University School of Public Health.

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