Nursing

SDW news brief: No substantial improvement despite hospital pay incentives

Staff Development Weekly: Insight on Evidence-Based Practice in Education, March 30, 2012

The Centers for Medicare & Medicaid Services' (CMS) Premier Hospital Quality Incentive Demonstration (HQID), a pay for performance model implemented in more than 250 hospitals nationwide, did not significantly lower mortality rates among patients, according to a study published in The New England Journal of Medicine this month.

Hospitals that participated in the HQID were required to provide data on 33 measures, such as indicators for medical conditions and surgical procedures, which were then used to rank hospitals and determine whether they qualified for bonuses in Medicare payments for being high performers or whether hospitals faced a financial penalty for underperforming. Researchers compared this data to public reporting from the Medicare Hospital Compare program to determine whether Premier HQID made a noteworthy impact on patient outcomes.

Researchers found that there was no difference in mortality trends between conditions with outcomes linked to incentives versus conditions with outcomes that were not linked to incentives. Participation in the HQID program did not lead to substantial declines in mortality, even in poor performing hospitals that had the most to gain from the financial incentives. Researchers concluded that although the Affordable Care Act requires CMS to expand the HQID program to all hospitals in 2012, expectations that doing so will drive improvements in patient outcomes should not be high.

Source: The New England Journal of Medicine

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