Pay for performance has become a central strategy in the drive to improve health care. In fact, it was a key component of a law that went before the Supreme Court earlier this year. The New England Journal of Medicine study published in April 2012, (http://www.nejm.org/doi/full/10.1056/NEJMsa1112351), found little evidence that pay for performance programs actually helped keep patients alive longer.
Comparing outcome data of the 252 hospitals participating in the Medicare Premier Hospital Quality Incentive Demonstration (HQID) and 3363 control hospitals participating in public reporting alone, the 30-day mortality of more than six million patients who had acute myocardial infarction, congestive heart failure or pneumonia or who underwent coronary-artery bypass grafting (CABG) provided no evidence that the largest hospital-based pay for performance program led to a decrease in mortality.
But while mortality rates are not the only goal of the HQID, who’s broader goal was to determine whether incentives could improve the process of care in hospitals, it does call for a better job in figuring out how and where pay affects performance.
The CMS objective is to tie hospital payment to actual outcomes. However, the value-based purchasing program relies primarily upon process measures followed by patient satisfaction scores as the basis for payment incentives. And not until the fall of 2013, will outcome measures be considered for calculation of payment. When initiated, mortality measures will only apply to three conditions—heart failure, heart attack and pneumonia. In the meantime, and for the foreseeable future process, measures will continue play a dominant part in judging hospital performance. Getting the measures right will be the challenge and the details they reveal will be where value exists. In healthcare reform, we will all be contributing to answer the primary question, “What works best for who and when should it be provided?” Receiving incentive payments to collect that data is the current expectation of care givers otherwise burdened with the bureaucratic requirements of getting paid to care for patients. The price of knowledge must be less expensive than the cost of ignorance; the measures chosen will be key to that equation.