on the effects of pay-for-performance have found mixed results and raise a
number of questions that require more research and experimentation, says a new Health Affairs issue brief.
The brief summarizes the results of 9
studies that looked at public and private pay-for-performance initiatives. Two
studies focus on the Centers for Medicare and Medicaid Services' Premier
Hospital Quality Incentive Demonstration project. The first study found that
hospitals in the demonstration initially showed promising improvements in
quality compared with a control group. However, the effects were short lived. After
the fifth year of the demonstration, there were no significant differences in
performance scores between participating hospitals and a comparison group of
hospitals not in the project. In the second study, which analyzed 30-day
mortality rates for patients with acute myocardial infarction, congestive heart
failure, pneumonia, or coronary artery bypass graft surgery between 2004 and
2009, the results showed no difference in mortality rates between hospitals in
the Premier demonstration and a control group of nonparticipating hospitals.
greater success is the Medicare Physician Group Practice Demonstration, a pilot
project that ran from 2005 to 2010, awarding bonuses to physicians in 10 large
physician group practices if they achieved lower cost growth than local
controls and met quality targets. Researchers at Dartmouth College and the
National Bureau for Economic Research found an improvement in quality but
modest reduction in the growth of spending for most Medicare beneficiaries.
Cost reductions were greatest for the 15% percent of patients with dual eligibibility,
typically low-income people who qualify for both Medicaid and Medicare and who
often have complex, chronic conditions.
brief also examines studies on Medicare's Hospital Value-based Purchasing
Program, Medicaid-focused health plans in California, and safety net providers.
In a Health Affairs blog post, 3 policy experts discuss how
monetary rewards can undermine provider motivation and worsen performance, suggesting
that pay-for-performance initiatives might backfire.
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