WHITE COAT NOTES
Health care pay plan did not cut deaths
Globe Staff
April 02, 2012
Excerpts from the Globe’s health care blog.
A Medicare pilot program that paid hospitals more if they consistently administered certain medications and vaccinations, provided appropriate counseling for people with heart conditions, or hit other quality targets did not reduce the number of patients who died within 30 days of admission to the hospital, a study published online by the New England Journal of Medicine found.
The results are sobering, the authors wrote. The program served as a model for a major national initiative being rolled out this year.
Such pay-for-performance programs have been central in efforts to change how health care is paid for, shifting from a system that pays doctors for each test or treatment to one that rewards them for keeping their patients healthy.
These kinds of incentives are the right path forward, but the formula needs tweaking, said Dr. Ashish Jha, associate professor of health policy at Harvard School of Public Health and lead author of the study.
“The question is, what do you pay for?’’ he said. “What are the performance measures? That part we haven’t figured out. . . . We have not come up with the right set of metrics to focus on.’’
The study looked at mortality rates among more than 6 million patients treated over six years at 252 hospitals involved in the Premier Hospital Quality Incentive Demonstration.
The mortality rates were compared with those at thousands of other hospitals that publicly reported performance on the same measures but were not part of the payment program. The authors found that deaths declined in both groups but at similar rates.
Participation in the Premier program improved process measures at Springfield-based Baystate Health, and that was the central focus of the program, not outcomes, said Dr. Evan Benjamin, chief quality officer.
Baystate, one of three Massachusetts hospitals that participated, did see a drop in deaths from heart attacks during the program, he said.
The national program and the Premier program are not identical. But, starting this fall, the Centers for Medicare & Medicaid Services will use 13 measures to determine distribution of about 1 percent of hospital payments. Many were taken from the Premier program.
The federal agency has acknowledged that the system is a work in progress.
“I think we would all be surprised if they hit the perfect design and formula the first time out of the gate,’’ said David Smith, senior director for data analysis and research at the Massachusetts Hospital Association.
CHELSEA CONABOY
Visit boston.com/whitecoatnotes for the full blog. Chelsea Conaboy can be reached at cconaboy@boston.com. Follow her on Twitter @cconaboy
“
