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Hospitals in Premier HQID program experienced little mortality decline
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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 2009.
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 individually.
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.”
References:
- Jha AK. N Engl J Med. 2012;366:1606-1615.
Disclosures:
- 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.