Article

The Effect of Financial Incentives on Hospitals That Serve Poor Patients RESPONSE

Harvard School of Public Health, Brigham and Women's Hospital, U.S. Department of Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA.
Annals of internal medicine (Impact Factor: 16.1). 09/2010; 153(5):299-306. DOI: 10.1059/0003-4819-153-5-201009070-00004
Source: PubMed

ABSTRACT Providing financial incentives to hospitals to improve quality is increasingly common, yet its effect on hospitals that care for poor patients is largely unknown.
To determine how financial incentives for quality performance affect hospitals with more poor patients compared with those with fewer poor patients.
Retrospective study.
U.S. hospitals.
251 hospitals that participated in the Premier Hospital Quality Incentive Demonstration program and a national sample of 3017 hospitals.
The association between the disproportionate-share index, a marker of caring for poor patients, and baseline quality performance, changes in performance, and terminal performance for acute myocardial infarction, congestive heart failure, and pneumonia for hospitals in the pay-for-performance program and those in the national sample (which did not receive financial incentives).
Among both pay-for-performance hospitals and those in the national sample, hospitals with more poor patients had lower baseline performance than did those with fewer poor patients. A high disproportionate-share index was associated with greater improvements in performance for acute myocardial infarction and pneumonia but not for congestive heart failure, and the gains were greater among hospitals that received financial incentives than among the national sample. After 3 years, hospitals that had more poor patients and received financial incentives caught up for all 3 conditions, whereas those with more poor patients among the national sample continued to lag.
Hospitals in the Premier Hospital Quality Incentive Demonstration may be atypical, and these results may not be generalizable to all hospitals.
No evidence indicated that financial incentives widened the gap in performance between hospitals that serve poor patients and other hospitals. Pay-for-performance programs may be a promising quality improvement strategy for hospitals that serve poor patients.
Robert Wood Johnson Foundation.

0 Followers
 · 
145 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background The Centers for Medicaid and Medicare Services (CMS) and the National Cardiovascular Data Registry (NCDR) track primary percutaneous coronary intervention (PCI) performance in the form of door‐to‐balloon time. For quality assessment, exceptions are made for patients with “unavoidable delays” in both registries, yet it remains unclear how consistently such patients are identified. Methods and Results All primary PCI patients at 3 Massachusetts hospitals (Brigham and Women's, Massachusetts General, and North Shore Medical Center) from 2009 to 2011 were evaluated for CMS inclusion/exclusion and NCDR nonsystems delay (NSD) status. We subsequently analyzed patient characteristics and outcomes based on these strata. Among 456 total patients, 128 (28%) were excluded from CMS reporting, whereas 56 (12%) were listed in the NCDR registry as having an NSD. Forty of 56 (71%) patients with NSD were also excluded from CMS reporting, whereas 312 of 400 (78%) patients reported without NSD were included in CMS reports. Between‐registry agreement on patients with unavoidable delays was modest (κ=0.32). Among CMS‐included patients without NSD, 94% received PCI within 90 minutes compared with 29% of CMS‐excluded patients with NSD (P<0.001). Likewise, CMS‐included patients without NSD had a 4‐fold better 1‐year mortality rate compared with CMS‐excluded patients with NSD (P<0.001). Conclusions More than twice as many primary PCI patients are excluded from CMS quality analyses compared with NCDR. With the use of currently available cardiovascular quality registries, it is unclear how many patients truly require unavoidable delays during primary PCI. Patients with NSD had the worst outcomes regardless of CMS status.
    Journal of the American Heart Association 04/2014; 3(3). DOI:10.1161/JAHA.114.000944 · 2.88 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: Critical care is often an integral part of rescue for patients with surgical complications. We sought to understand critical care characteristics predictive of failure-to-rescue (FTR) performance at the hospital level. Methods: Using 2009 to 2011 FTR data from Hospital Compare, we identified 144 outlier hospitals with significantly better/worse performance than the national average. We surveyed intensive care unit (ICU) directors and nurse managers regarding physical structures, patient composition, staffing, care protocols, and rapid response teams (RRTs). Hospitals were compared using descriptive statistics and logistic regression. Results: Of 67 hospitals completing the survey, 56.1% were low performing, and 43.9% were high performing. Responders were more likely to be teaching hospitals (40.9% vs 25.0%; P = .05) but were similar to nonresponders in terms of size, region, ownership, and FTR performance. Poor performers were more likely to serve higher proportions of Medicaid patients (68.4% vs 20.7%; P < .0001) and be level 1 trauma centers (55.9% vs 25.9%; P = .02). After controlling for these 2 characteristics, an intensivist on the RRT (adjusted odds ratio, 4.27; confidence interval, 1.45-23.02; P = .005) and an internist on staff in the ICU (adjusted odds ratio, 2.13; P = .04) were predictors of high performance. Conclusions: Intensivists on the RRT and internists in the ICU may represent discrete organizational strategies for improving patient rescue. Hospitals with high Medicaid burden fare poorly on the FTR metric.
    Journal of Critical Care 06/2014; 29(6). DOI:10.1016/j.jcrc.2014.06.010 · 2.19 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: U.S. hospitals caring for more disadvantaged patients fared worse in the first year of Medicare's Hospital Value-Based Purchasing program. Over time, such resource reductions may cause the quality of care to deteriorate in hospitals serving more disadvantaged patients. Financial incentives for improving quality and efficiency have gone mainstream in U.S. health care. After years of small-scale pilot projects, demonstrations, and experiments, the Affordable Care Act mandated that Medicare payment to hospitals and physicians must depend, in part, on metrics of quality and efficiency. The first program to do so is Hospital Value-Based Purchasing (HVBP), which began affecting Medicare payments to acute care hospitals in October 2012. In the first year of HVBP, hospitals received incentives for performance on clinical-process and patient-experience measures. In subsequent years, hospitals will also receive incentives for performance on outcome-based measures, such as 30-day ...
    New England Journal of Medicine 12/2013; 369(26):2472-4. DOI:10.1056/NEJMp1312654 · 54.42 Impact Factor

Preview

Download
4 Downloads
Available from