A recent study conducted by researchers at the Duke Clinical Research Institute concluded that the pay-for-performance pilot program, which was launched by the Center for Medicare & Medicaid Services (CMS) in 2003, has not demonstrated a significant improvement in quality of care or outcomes in hospital patients with acute myocardial infarction.
The three-year study compared 54 hospitals in the CMS pilot program with 446 control hospitals. It examined the impact of providing financial incentives for heart attack care, and indicated that there was an overall improvement in health care quality. However, there was no evidence that financial incentives were associated with improved outcomes. Additionally, hospitals did not change their focus on aspects of care not subject to financial incentives in order to concentrate on areas being evaluated for increased payments. A voluntary effort to improve health care quality was found to be equally as effective as payment incentives. The study authors noted that "[a]dditional studies of pay for performance are needed to determine its optimal role in quality-improvement initiatives."
CMS’s pay-for-performance program awards financial bonuses to hospitals scoring in the top twenty percent in any of five clinical areas, including acute myocardial infarction, as measured by numerous standardized quality indicators. Examples of measures for acute myocardial infarction included, but were not limited to, providing aspirin to patients with acute myocardial infarction upon arrival and providing smoking cessation counseling for active or recent smokers. The rationale behind pay-for-performance is that higher reimbursement will encourage hospitals to improve their quality of care.
CMS and Premier Inc., a nationwide group purchasing organization of hospitals that is collaborating with CMS in the pilot project, recently published preliminary results for the first two years of the pay-for-performance program. They reported significant improvement for all five clinical conditions being monitored. However, unlike the study conducted by the researchers at the Duke Clinical Research Institute, this evaluation did not have a group of hospitals not receiving financial incentives to compare with the hospitals in the pilot program.
Therefore, the ability to draw conclusions about the direct impact of the pay-for-performance program on quality improvement was limited.
The study, entitled "Pay for Performance, Quality of Care, and Outcomes in Acute Myocardial Infarction," was published in the Journal of the American Medical Association on June 6 and is available at http://jama.amaassn.org/cgi/content/short/297/21/2373.
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