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  • Studies Show 'Mixed Results' on Pay-for-Performance Initiatives

    Studies 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.

    Showing 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.

    The 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.


    • Imagine that, paying for "cost efficient care" does not improve quality. If you put the patients interests first you can make the best decisions. It's really is that simple.

      Posted by Brett Michener on 10/17/2012 11:29 AM

    • The second study mentioned is fascinating, as the greatest cost reductions were found in the group that is the most difficult to manage medically. Cost reductions in this group benefit us all. Any cost reductions are bettern than none.

      Posted by Sarah Pedersen on 10/22/2012 10:14 AM

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