Pay for Performance Questioned

August 1, 2007
Pay for Performance Questioned

Richard Shock

Paying hospitals extra money does not appear to improve significantly the way they treat heart-attack patients or how well those patients do, according to a recent Duke study. But giving hospitals the information they need to improve heart-attack care does help.

A team of researchers led by the Duke Clinical Research Institute looked at whether giving financial incentives to hospitals for adhering to specific treatment guidelines would improve patient outcomes. They found no evidence that financial incentives were associated with improved outcomes and no evidence that hospitals had shifted their focus from other areas in order to concentrate on the areas being evaluated for possible increased payments.

These findings, which appeared in the Journal of the American Medical Association, will add to the national debate over the use of "pay for performance" as a strategy for encouraging hospitals to use drugs and therapies that have been proven to save lives in large-scale clinical trials, the researchers say. The theory is that the possibility of receiving higher reimbursements will motivate hospitals to improve the quality of their care.

A recent study by Premier Inc., a group that represents hospitals participating in a large pilot project of pay for performance sponsored by the Center for Medicare & Medicaid Services (CMS), found that paying hospitals extra money for following specific guidelines led to better patient care and outcomes. However, that study failed to include a control group of hospitals not receiving incentives. So the Duke team compared the CMS data with that of a registry of 105,383 patients treated for heart attacks at 500 hospitals involved in a national quality improvement effort.

"On one hand, the data showed that care is improving overall in the United States, which is obviously good," says cardiologist Eric Peterson, a professor of medicine and senior member of the research team. "However, we did not find that pay for performance alone will be the sole means of improving care. In fact, it all comes down to hard work by individual caregivers and institutions."