Healthcare alliance Premier, Inc., has announced that more than 260 hospitals participating in a joint Premier and Centers for Medicare and Medicaid Services pay-for-performance demonstration project improved their overall quality by 11.8% in two years based on 30 quality measures in five clinical areas. A study published in the Feb. 1 issue of the New England Journal of Medicine, however, found a more modest improvement in quality among the hospitals participating in the demonstration project.
Premier reports that improved performance prevented 1,284 deaths from acute myocardial infarction. CMS will award a total of $8.7 million in bonuses to 115 top-performing hospitals--a 2% bonus to the top 10% of hospitals, and 1% to hospitals performing in the second decile.
In the Journal article, however, researchers reported that they looked at 10 quality measures and found that 207 hospitals had a rate of improvement ranging from 2.6% to 4.1% over two years compared with a control group of 406 hospitals that voluntarily reported their quality scores publicly. Hospitals with the worst performance at the start of the pay-for-performance demonstration project in 2003, however, improved their scores on quality measures by 17.8%.
In an accompanying editorial, Arnold Epstein, MD, of the Harvard School of Public Health, warns against CMS developing “a single new payment system for all of Medicare” based on the results of the demonstration project. The findings, said Epstein, “still leave us with many uncertainties concerning the level of financial incentives needed and the optimal formula for payment that might be used for attaining high levels of performance.” He urged CMS to consider that “pay for performance is fundamentally a social experiment likely to have only modest incremental value.”
