Pay for Performance Does Not Improve Mortality Rates

Medicare demonstration program did not improve 30-day hospital mortality rates

WEDNESDAY, March 28 (HealthDay News) -- Participation in the Medicare Premier Hospital Quality Incentive Demonstration (Premier HQID) program does not lead to lower 30-day mortality rates, according to a study published online March 28 in the New England Journal of Medicine.

Ashish K. Jha, M.D., M.P.H., of Harvard University in Boston, and colleagues used Medicare data from 252 hospitals participating in the Premier HQID and 3,363 control hospitals participating in public reporting alone. They examined 30-day mortality for more than six million patients who had acute myocardial infarction (MI), congestive heart failure (CHF), pneumonia, or coronary-artery bypass grafting (CABG).

The researchers found that, at baseline, Premier and non-Premier hospitals had similar composite 30-day mortality (12.33 and 12.40 percent, respectively). The rates of decline in mortality per quarter among the two groups were similar (0.04 and 0.04 percent, respectively). Mortality remained similar after six years for Premier hospitals (11.82 percent) and non-Premier hospitals (11.74 percent). Pay for performance did not significantly affect mortality for either the conditions for which outcomes are explicitly linked to incentives (MI or CABG) or conditions not linked to incentives (CHF and pneumonia). Hospitals in both groups that were poor performers at baseline had similar mortality rates at the end of the study (13.37 and 13.21 percent, respectively).

"We found no evidence that the largest hospital-based pay-for-performance program led to a decrease in 30-day mortality," the authors write.

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