The Washington Post reports on a study that shows paying hospitals additional money for compliance with specific performance measures doesn't necessarily improve patient care. Or, more specifically, doesn't improve patient care any better than voluntary quality improvement:
In 2003, the Centers for Medicare and Medicaid Services (CMS) launched the largest pay-for-performance pilot project ever in the United States. It included financial incentives for sticking to heart attack care guidelines, the study said.
A first look at data from 54 hospitals in the "pay-for-performance" group found some improvement in performance, such as better attention to the rule for prescribing aspirin in heart attack cases, according to the report published in the June 6 issue of theJournal of the American Medical Association.
But when the researchers looked at comparable data from 446 hospitals with a voluntary quality improvement program that paid no money, they found similar improvements in quality of care and outcome.
"But I don't think this is the end of the pay-for-performance idea," Glickman [the study's author] said. "It is the end of the beginning."
Time will tell if P4P can be hammered into something useful or whether it's another fashionable flash in the pan. One facet of the study was particularly interesting:
One problem in evaluating the results is that all the hospitals were performing at relatively high levels, said Dr. Albert Wu, a health policy and management professor at Johns Hopkins University School of Public Health.
"The study was done within a large nationwide process to improve quality, and looked at this subgroup of hospitals. So it was not surprising that everyone improved," he said.
"In terms of giving aspirin, for example, they started at or above 85 percent," Wu added. "It's hard to improve on that."
Dr. Wu's comment suggest that P4P in its current form will prove most effective for hospitals that begin with poorer performance records. If a health plan has P4P dollars to spend, it will want to spend them on hospitals that will improve the most per dollar. But such a paradigm would essentially reward poor performers while leaving the leaders with only the warm fuzzies for having 'voluntarily' improved their care record.
The full WaPo article can be accessed here.