Pay-for-performance model does not improve mortality

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Pay for Performance Does Not Improve Mortality Rates
Pay for Performance Does Not Improve Mortality Rates

HealthDay News -- Participation in a pay-for-performance health-care model did not lower 30-day mortality compared with nonparticipation, study data indicate.

"We found no evidence that the largest hospital-based pay-for-performance program led to a decrease in 30-day mortality," Ashish K. Jha, MD, MPH of Harvard University in Boston, and colleagues reported in New England Journal of Medicine.

Per quarter mortality rates decreased at the same rate (0.04%) among hospitals that took part in the Medicare Premier Hospital Quality Incentive Demonstration (Premier HQID) and those that did not, and mortality remained similar among the two groups (11.82% vs. 11.74%, respectively) after six years.

Jha and colleagues analyzed Medicare data from 252 hospitals participating in the Premier HQID and 3,363 control hospitals, and examined 30-day mortality for more than six million patients with acute myocardial infarction (MI), congestive heart failure (CHF), pneumonia or coronary-artery bypass grafting (CABG). At baseline, Premier and non-Premier hospitals had similar composite 30-day mortality (12.3% and 12.40%, respectively).

Pay for performance did not significantly affect mortality for conditions in which outcomes are explicitly linked to incentives, such as MI and CABG, or conditions not linked to incentives, such as CHF and pneumonia, the researchers found.

Hospitals in both groups that performed poorly at baseline had similar mortality rates at the end of the study (13.37% and 13.21%, respectively).

"Taken together, these findings are sobering for policymakers who hope to use incentives such as those in Premier HQID to improve patient outcomes (e.g., 30-day mortality)," the researchers wrote. Part of the problem may be that policymakers "still have not identified the right mix of incentives and targets to ensure that pay for performance will drive improvements in patient outcomes."

Study findings may not be generalizable to all pay-for-performance models or alternative models that incorporate larger incentives, the researchers noted.

Jha AK et al. N Eng J Med. 2012;doi:10.1056/NEJMsa1112351.

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