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P4P programs forget patient demographics, sway hospital rankings, study says

Hospitalist Leadership Connection, October 28, 2008

Hospital performance rankings and eligibility for financial benefits may not be accurate in pay-for-performance programs, according to a new study, “Association of Patient Case-Mix Adjustment, Hospital Process Performance Rankings, and Eligibility for Financial Incentives,” published in the October issue of The Journal of the American Medical Association.

The study evaluated how hospital performance ratings and eligibility for financial incentives were altered by patient demographics, clinical characteristics, and treatment. With performance based on Centers for Medicare & Medicaid Services' core measures for acute myocardial infarction, researchers found that current metrics used to gauge performance do not take into account patient demographics, such as race and ethnicity.

The study did not evaluate whether or not hospitals might be deterred from caring for underserved populations with a less lucrative payer mix.

In its abstract, the study’s researchers concluded: “Our findings suggest that accounting for hospital differences in patient characteristics and treatment opportunities is associated with modest changes in hospital performance rankings and eligibility for financial benefits in pay-for-performance programs for treatment of myocardial infarction.

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