Surgery News - June 2008 - (Page 5)

JUNE 2008 • SURGERY NEWS 5 THE THE E Quality Improvement Incentives May Backfire on ‘Safety Net’ Hospitals BY MIRIAM E. TUCKER 20/20 / 0/20 V SION O SIO SION IO Else vier Global Medical Ne ws P I T T S B U R G H — The initiation of public reporting and pay-for-performance measures, designed as incentives to improve the quality of care at hospitals, may actually have the opposite effect on those institutions that serve lower-income populations. That conclusion was based on an analysis of performance data on acute myocardial infarction, heart failure, and pneumonia from 3,600 hospitals in the Web site www.hospitalcompare.com, the performance measure and public reporting system instituted in 2004 by the Centers for Medicare and Medicaid Services (CMS). Between 2004 and 2006, the hospitals with the highest proportion of Medicaid patients—which had the worst performance on the three measures to begin with—also saw the least improvements in quality. Hospitals that achieved the most imThere is concern provements about rich had the smallhospitals est proportion becoming richer and poor hospitals of Medicaid patients, Dr. becoming poorer. Rachel WernDR. WERNER er reported at the annual meeting of the Society of General Internal Medicine. These “safety net” hospitals were generally worse off financially at baseline, and would have fewer resources to invest in quality improvement. They could receive lower bonus payments and incur penalties for not meeting standards. “There is concern that reporting and pay for performance could set up a system where rich hospitals become richer and poor hospitals become poorer,” said Dr. Werner of the Center for Health Equity Research and Promotion at the Philadelphia Veterans Affairs Medical Center. After controlling for baseline performance and variables such as teaching status, bed size, and hospital ownership, investigators found that the percentage point improvements from 2004 through 2006 for the hospitals with the highest quartile of Medicaid population (mean, 40%) were 2.3 for composite measures of acute MI, 6.6 for heart failure, and 8.0 for pneumonia, compared with 3.8, 8.0, and 9.3, respectively, for hospitals with the lowest quartile of Medicaid population (mean, 5%). The differences for acute MI and heart failure were significant. These differences mean that safety-net hospitals are far less likely to rank among the top two deciles for clinical quality scores, designations that earn hospitals bonus incentive payments in the CMS pay-for-performance demonstration. The findings suggest a need to minimize the unintended consequences of pay for performance and public reporting, said Dr. Werner, who is also with the division of general internal medicine at the University of Pennsylvania, Philadelphia. Steps might include providing subsidies specifically for quality improvement and rewarding hospitals for absolute improvements in care rather than for relative rank. The study was funded by a Career Development Award from the Health Services Research and Development Service of the Department of Veterans Affairs. http://www.surgitel.com http://www.hospitalcompare.com http://www.hospitalcompare.com http://www.surgitel.com

Table of Contents Feed for the Digital Edition of Surgery News - June 2008

Surgery News - June 2008 Contents Work Hours New Digs Banking Blood Improved Imaging

Surgery News - June 2008

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.