Participation in the hospital-based Medicare Premier
Hospital Quality Incentive Demonstration showed little decline in 30-day
mortality rates compared with hospitals that participated in public reporting
alone, a new study showed.
Outcomes of 252 hospitals participating in the Medicare
Premier Hospital Quality Incentive Demonstration (HQID) program were compared
with 3,363 control hospitals participating in public reporting alone.
Researchers examined 30-day mortality in more than 6 million patients who had
pneumonia, congestive HF or acute MI or had undergone CABG between 2003 and
Baseline composite 30-day mortality was 12.33% for
Premier and 12.4% for non-Premier hospitals. Researchers found similar rates of
decline in mortality per quarter (Premier=0.04%; non-Premier=0.04%, as well as
similar mortality after 6 years under the pay-for-performance system
(Premier=11.82%; non-Premier=11.74%). Similar patterns in 30-day mortality were
observed when researchers examined patients with the three medical conditions
Researchers also compared conditions with outcomes
specifically linked to incentives, including acute MI and CABG, with conditions
not liked to incentives, including congestive HF and pneumonia. Results showed
no significant difference in the effects of pay for performance on mortality
between conditions with outcomes linked to incentives and those not linked to
incentives (P=0.36 for interaction).
At the start of the study, mortality rates in a subgroup
of hospitals that were identified as poor performers at baseline were similar
at Premier and non-Premier hospitals (15.12% vs. 14.73%. respectively). These
groups experienced similar rates of improvement per quarter (0.1% vs. 0.07%)
and at the end of the study (13.3% vs. 13.21%).
We found little evidence that participation in the
Premier HQID program led to lower 30-day mortality rates, suggesting that we
still have not identified the right mix of incentives and targets to ensure
that pay for performance will drive improvements in patient outcomes, the
researchers concluded. Even though Congress has required that CMS adopt
pay for performance for hospitals, expectations with regard to programs modeled
after Premier HQID should remain modest.
- Jha AK. N Engl J Med. 2012;366:1606-1615.
- The study was supported by a grant from the Robert Wood Johnson
Foundation. Study researcher Arnold M. Epstein, MD, is an associate editor at
The New England Journal of Medicine.