Extra pay does not improve hospital performance

Jun 05, 2007

Paying hospitals extra money does not appear to significantly improve the way they treat heart attack patients or how well those patients do. But giving hospitals the information that they need to improve heart attack care does help.

A team of researchers led by the Duke Clinical Research Institute looked at whether financial incentives to hospitals for adhering to specific treatment guidelines would improve patient outcomes. They found no evidence that financial incentives were associated with improved outcomes, nor that hospitals had shifted their focus from other areas in order to concentrate on the areas being evaluated for possible increased payments.

These findings will add to the national debate over the use of “pay for performance” as a strategy for encouraging hospitals to use drugs and therapies that have been proven to save lives in large-scale clinical trials, the researchers said. The theory is that the possibility of receiving higher reimbursements will motivate hospitals to improve the quality of their care.

A study recently conducted by Premier, Inc., a group that represents hospitals participating in a large Center for Medicare & Medicaid Services (CMS) pilot project of pay for performance, found that paying hospitals extra money for following specific guidelines led to better patient care and outcomes. However, that study did not include a group of hospitals not receiving incentives as a comparison. So the Duke team compared the CMS data with that of a registry of 105,383 patients treated for a heart attack at 500 hospitals involved in a national quality improvement effort.

“This is one of the first analyses of the impact of a pay for performance initiative on heart attack care,” said Seth Glickman, M.D., M.B.A., first author of a paper appearing June 6, 2007, in the Journal of the American Medical Association. “We found that the pay-for-performance program was not associated with a significant incremental improvement in the quality of care or outcomes for patients with heart attacks beyond that seen with voluntary quality improvements.”

“There are three important messages from this study,” said cardiologist Eric Peterson, M.D., senior member of the research team. “On one hand, the data showed that care is improving overall in the United States, which is obviously good. However, we did not find that pay for performance alone will be the sole means of improving care. In fact, it all comes down to hard work by individual caregivers and institutions.

“Here, it appears that a voluntary effort to ‘do good and improve care’ was equally as powerful as the incentive for additional payment,” Peterson said. “Finally, heart attack mortality declined significantly over time in pay-for-performance and non-pay-for-performance hospitals over time with better care processes. The bottom line is that patients win when health care providers are committed to improvement, no matter what the incentive is.”

The researchers looked at how all hospitals performed in six measurements of quality: the use of aspirin and beta blockers both at arrival to the hospital and at discharge, smoking cessation counseling, and the use of angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers for weakened left pumping chambers. These measures were selected because clinical trials have proven that their use improves the outcomes for heart attack patients.

The monetary incentive for the CMS study was relatively small. Over a two-year period, a total of $17.55 million was paid to 123 hospitals the first year and to 115 hospitals the second year.

“Medicare’s strategy of trying to use the payment system to improve performance of hospitals is certainly laudable,” said Kevin Schulman, M.D., professor of medicine and business administration at Duke and study co-author. “However, we really need a robust research base to inform the design of the program and clearly we need to continuously monitor performance to ensure that we are achieving our clinical goals through these efforts.”

Glickman noted that “additional studies are underway to identify hospital policies and organizational characteristics that are associated with a higher standard of care in order to develop more effective incentive based strategies.”

The team plans to organize a larger effort involving the major cardiology associations.

“We’ve partnered with the cardiovascular professional societies to have an ongoing national heart attack quality improvement initiative known as ACTION,” Peterson said. “No matter what incentive will ultimately be the driving force, ACTION will give hospitals and health care providers the tools and data they need to improve.”

Source: Duke University Medical Center

Explore further: New research demonstrates benefits of national and international device registries

add to favorites email to friend print save as pdf

Related Stories

Identity theft victims face months of hassle

Dec 14, 2014

As soon as Mark Kim found out his personal information was compromised in a data breach at Target last year, the 36-year-old tech worker signed up for the retailer's free credit monitoring offer so he would ...

'Smart' living gets real as connectivity rates rise

Nov 07, 2014

From robots that chop up your vegetables to detectors that measure how long you sleep, such "smart" appliances are becoming more and more a part of daily life, according to industry players.

Coming up for air

Oct 29, 2014

Sometimes you've got to hit bottom to battle your way back up. In 1992, the United Nations cited Mexico City as having the worst air quality in the world, with so much pollution that birds sometimes dropped ...

Recommended for you

New approach to particle therapy dosimetry

Dec 19, 2014

Researchers at the National Physical Laboratory (NPL), in collaboration with EMRP partners, are working towards a universal approach to particle beam therapy dosimetry.

Supplement maker admits lying about ingredients

Dec 17, 2014

Federal prosecutors say the owner and president of a dietary supplement company has admitted his role in the sale of diluted and adulterated dietary ingredients and supplements sold by his company.

User comments : 0

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.