About Health Transparency

A study published in the current issue of  Health Affairs on Medicare’s flagship hospital pay-for-performance program casts doubt about whether pay-for-performance strategies that reward improvement can generate greater improvement among lower performing providers.  The program – Premier Hospital Quality Incentive Demonstration – began in 2003 but changed its incentive design in late 2006. The goals were to encourage greater quality improvement, particularly among lower-performing hospitals. However, the authors found no evidence that the change achieved these goals. Although the program changes were intended to provide strong incentives for improvement to the lowest-performing hospitals, they found that in practice the new incentive design resulted in the strongest incentives for hospitals that had already achieved quality performance ratings just above the median for the entire group of participating hospitals. Yet during the course of the program, these hospitals improved no more than others. Findings from this study raise questions about whether pay-for-performance strategies that reward improvement can generate greater improvement among lower performing providers. They also cast some doubt on the extent to which hospitals respond to the specific structure of economic incentives in pay-for-performance programs.

The findings of a new study, by researchers from the Harvard School of Public Health, indicate that a large-scale pay-for-performance initiative, run jointly by the CMS and Charlotte, N.C.-based Premier, has led to no long-term improvements in mortality (Modern Healthcare).

The study related to the CMS/Premier Hospital Quality Incentive Demonstration, which launched in 2003 and includes more than 250 participating hospitals, provides performance-based incentive payments to hospitals based on quality across six areas, including heart attack, heart failure and pneumonia. According to Modern Healthcare, the program served as the building block for the CMS’ value-based purchasing program, which will roll out nationally beginning in fiscal year 2013.

But researchers say they found no significant difference in overall mortality between hospitals that participate in the program and those that don’t.

Read more:

• Full study: The Long-Term Effect of Premier Pay for Performance on Patient Outcomes , New England Journal of Medicine
• Modern Healthcare article

Niagara Health Quality Coalition has released its 2010 New York Hospital Report Card (www.myHealthFinder.com). This eighth annual report offers updated measures that evaluate care at every hospital in the state. Measures include mortality rates, error rates, surgical infection rates, appropriate utilization rates, pain management and overall patient satisfaction with clinical care. This year, NHQC has added new measures including 1) potentially preventable readmission rates, 2) patient/doctor communication effectiveness 3) patient/nurse communication effectiveness and 4) room cleanliness.

According to a Centers for Medicare & Medicaid Services (CMS) press release, demonstrations being conducted by CMS continue to provide evidence that offering financial incentives for improving or delivering high quality care increases quality and can reduce the growth in Medicare expenditures.

CMS released new results from three of these demonstrations, one for large physician practices, one for small and solo physician practices, and one for hospitals and announced the start of three additional value based purchasing demonstrations.

The CMS value-based purchasing (VBP) initiative is designed to tie Medicare payments to performance on quality and efficiency and is part of CMS’ effort to transform Medicare from a passive payer to an active purchaser of higher quality, more efficient health care.

Entering its fifth year, the Hospital Quality Incentive Demonstration (HQID) shows continued quality improvement among participating hospitals. In addition, physician practices participating in the Physician Group Practice (PGP) Demonstration continue to improve quality for patients with chronic illnesses or requiring preventive care.

And more than 560 small and solo physician practices participating in the Medicare Care Management Performance (MCMP) Demonstration are being rewarded for providing high quality care in the delivery of preventive care and care for patients with chronic illnesses.

New demonstration programs include the Nursing Home Value-Based Purchasing Demonstration, the Medicare Hospital Gainsharing Demonstration, and the Physician Hospital Collaboration Demonstration.

IPRO and Bridges to Excellence (BtE) have released a fifth Care Link module on the IPRO eServices Clinical Data Portal (http://pao.ipro.org). The newest care link allows practices to apply for recognition of outstanding care for patients with Coronary Artery Disease. Existing modules include Diabetes, Cardiac, Hypertension, and Congestive Heart Failure Care Links. For more information, visit http://pao.ipro.org.

IPRO and Bridges to Excellence (BtE) have released two new Care Link modules on the IPRO eServices Clinical Data Portal (CDP). On the forefront of the pay for performance movement, IPRO’s Clinical Data Portal allows physicians to directly and securely submit their data for scoring and recognition over the Internet. The CDP now offers four modules including the new Hypertension and Congestive Heart Failure Care Links, which were launched on Tuesday, and the existing Diabetes and Cardiac Care Link programs.

Pay-for-performance incentives in the United Kingdom have not helped improve patients’ diabetes care, and the incentives may have led to reduced care for some diabetics, according to a study in the British Medical Journal. Modern Healthcare writes that Britain’s pay-for-performance program for all primary-care physicians, launched in 2004, is closely watched in the United States as a possible model to incentivize physicians to reduce costs and improve quality.

Researchers looked at the proportion of patients meeting diabetes-care targets—including controlling glucose, blood pressure and cholesterol—between 2001 and 2007, before and after the nation’s pay-for-performance program began. The researchers found improvements in diabetes care and treatment, but these seemed to plateau after 2004, when the incentives kicked in.

Read full article: P4P not helping diabetic care in U.K.: study, Modern Healthcare

Stable, mature processes; expanding scope and payment; and improvements in quality and costs characterize the progress made by pay-for-performance healthcare, according to the fourth national P4P survey conducted by Med-Vantage Inc, writes AHIP WIRE. Results represent more than 75 P4P sponsors of 94 programs for physicians and hospitals. The respondents comprise health plans and coalitions, and in total represent more than 150 million health plan members, according to a joint announcement from Med-Vantage, Leapfrog, and the Integrated Healthcare Association. Goldbach and Binder highlighted the progress P4P has made in recent years, as indicated by the survey results.

In the two years since the last survey, the percentage of programs that report improvements in quality due to P4P has almost doubled, the announcement said. Now more than half of P4P programs cite measureable increases in their providers’ clinical quality, the area that has been part of P4P the longest. Other areas with major jumps in P4P effectiveness were patient survey results, cost control, and adoption of IT tools.

AHIP Hi-Wire writes health insurer Medica issued more than $3 million in pay for performance (P4P) incentives in 2007 to Minnesota health care providers for improvements in the clinical care they gave to members. Medica’s P4P program focused in 2007 on asthma, chlamydia screening, diabetes, generic drug prescribing, well-child examinations, childhood immunizations, mammography, Pap tests, and high-tech imaging. Measurements assess how well chronic conditions like asthma and diabetes are managed, and the rate at which routine preventive services and exams are performed by providers participating in the program. Additional incentives reward providers driving care improvements and achieving evidence-based outcomes.

Quality measures, developed for each condition, are key. Medica reviews medical records, claims data, and now publicly available data from Minnesota Community Measurement, an effort among Medica and health plans to measure providers consistently. Measurement data are collated by the state and then reported out. Minnesota Community Measurement is one of six communities working as pilot sites with the Delmarva Foundation for Medical Care on the Better Quality Information to Improve Care for Medicare Beneficiaries (BQI) project, which is funded by the Centers for Medicare & Medicaid Services (CMS).

Bridges to Excellence (BTE) released the findings of a study to determine the extent to which the size of rewards impact physician participation rates for pay-for-performance (P4P) programs. The research, published in the May issue of The American Journal of Managed Care, included a statistical analysis of historical BTE data and found that P4P works if the incentives are appropriately set based on the intensity of effort.

• Physicians Respond to Pay-for-Performance Incentives: Larger Incentives Yield Greater Participation, The American Journal of Managed Care.