No quality benefit seen in Medicare pay pilot

But some questioned the study of the pay-for-performance program and said all hospitals are buoyed by progress of the initiative's participants.

By David Glendinning, AMNews staff. June 25, 2007.

Washington -- Medicare's largest pay-for-performance pilot project has not produced any better quality gains than a private initiative that used no financial incentives, a recent study said.

Researchers from Duke University in Durham, N.C., analyzed quality scores for the treatment of acute myocardial infarction at 54 hospitals participating in both Medicare's Hospital Quality Incentive Demonstration and a joint American College of Cardiology/American Heart Assn. quality improvement initiative. They then compared these figures with those from 446 hospitals that participated only in the latter project, which unlike Medicare did not offer monetary bonuses to top performers.

The investigation revealed that when it came to treating heart attack patients, the hospitals enrolled in the ACC/AHA quality improvement project did not make any statistically significant gains in quality of care, patient outcomes or mortality by also participating in the Medicare pay-for-performance program. The Medicare project hospitals as a whole made improvements on all of the quality measures they reported to the government, but so did the facilities that participated in only the cardiac associations' initiative. The study appeared in the June 6 Journal of the American Medical Association.

"On the positive side, everybody got better," said Eric D. Peterson, MD, MPH, a Duke researcher and one of the study's authors. "It's just not clear whether pay-for-performance was needed."