Insurers hither and yon have fallen in love with payment systems that reward providers for adopting quality-enhancing care practices, and the possibility that such incentive schemes could wiggle their way into health reform legislation has been on the table for nearly a year.
Unfortunately, studies of P4P systems like this have not been uniformly positive. Every successful report, it seems, is followed in short order by another showing not a bit of positive impact on the quality of care, or its cost, or anything else.
A study published in the NEJM last month was particularly disappointing in this regard.
Unfortunately, studies of P4P systems like this have not been uniformly positive. Every successful report, it seems, is followed in short order by another showing not a bit of positive impact on the quality of care, or its cost, or anything else.
A study published in the NEJM last month was particularly disappointing in this regard.The study, from Manchester, England showed that small gains in the quality of care for patients with asthma, diabetes and coronary heart disease leveled off soon after program onset, and were more than offset by deteriorating performance in several care processes that were not subject to P4P incentive payouts.
But now the worm has turned once again!
A Medicare P4P pilot program for hospital care has been shown to reduce secondary infections in pneumonia patients and reduce mortality in heart-attack patients.
In the 4 years ending Sept. 30, 2007, 225 hospitals participating in the program had nearly 4,700 fewer deaths in patients hospitalized for a heart-attack patients than would have been expected if they weren’t participating in the program, according to Premier Inc., which served as the Medicare contractor for the project.
In addition, Premier reported that 93% of pneumonia patients received antibiotics, flu vaccines and other recommended treatments to prevent secondary hospital-acquired infections. That compared to 69% before the P4P program went into effect.
In all, the program tracked performance against 30 quality measures. Two weeks ago Medicare officials announced that 225 hospitals would divide $12 million in bonus payouts consistent with their performance in the program. Three hospitals were penalized for poor performance against the indicators.
“Financial incentives can increase quality of care," concluded Tim Love, who directs research at CMS, the agency that oversees Medicare.
Still, some cautioned that the program’s positive results might not be generalizable to all hospitals. Hospitals participating in the pilot tend to be more highly motivated than average, for example.
Meanwhile, others worry that the bonus payments don’t cover the costs of the process changes hospitals have to make in order to improve their performance.
For example, Cleveland County HealthCare System, a high-flyer in the Medicare project, hired 1.5 FTE nurses to track results and became particularly adept at reducing readmission rates for patients with heart-failure. That program actually lost money for the hospital, since fewer admissions resulted in less reimbursement from Medicare.
But now the worm has turned once again!
A Medicare P4P pilot program for hospital care has been shown to reduce secondary infections in pneumonia patients and reduce mortality in heart-attack patients.In the 4 years ending Sept. 30, 2007, 225 hospitals participating in the program had nearly 4,700 fewer deaths in patients hospitalized for a heart-attack patients than would have been expected if they weren’t participating in the program, according to Premier Inc., which served as the Medicare contractor for the project.
In addition, Premier reported that 93% of pneumonia patients received antibiotics, flu vaccines and other recommended treatments to prevent secondary hospital-acquired infections. That compared to 69% before the P4P program went into effect.
In all, the program tracked performance against 30 quality measures. Two weeks ago Medicare officials announced that 225 hospitals would divide $12 million in bonus payouts consistent with their performance in the program. Three hospitals were penalized for poor performance against the indicators.
“Financial incentives can increase quality of care," concluded Tim Love, who directs research at CMS, the agency that oversees Medicare.
Still, some cautioned that the program’s positive results might not be generalizable to all hospitals. Hospitals participating in the pilot tend to be more highly motivated than average, for example.
Meanwhile, others worry that the bonus payments don’t cover the costs of the process changes hospitals have to make in order to improve their performance.
For example, Cleveland County HealthCare System, a high-flyer in the Medicare project, hired 1.5 FTE nurses to track results and became particularly adept at reducing readmission rates for patients with heart-failure. That program actually lost money for the hospital, since fewer admissions resulted in less reimbursement from Medicare.
Glenn Laffel MD, PhD
Sr. VP, Clinical Affairs, Practice Fusion
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