P4P Fails to Improve Hospital Patient Outcomes (CME/CE)
Initial analyses of mortality in hospitals participating in the Premier program did not find improvement after the first 3 years, the researchers noted.
Nevertheless, they argued, it was worthwhile to look at longer-term data "because it may take years for providers to reconfigure their underlying approach to care" and for improvements in patient-centered outcomes to be evident.
Jha and colleagues examined Medicare data for 30-day mortality on a quarterly basis for the Premier and non-Premier hospitals.
The data were for patients with ICD-9 codes corresponding to acute MI, congestive heart failure, pneumonia, and CABG surgery.
The researchers also noted when diagnostic codes for a patient with one of these conditions indicated important comorbidities such as paralysis, diabetes, and cancer.
In 2009, the final year of the analysis, more than 137,000 patients in Premier hospitals and 1.07 million patients in other institutions were included.
There was little difference in patient characteristics between those treated in Premier versus nonparticipating hospitals.
Those in the Premier program were significantly larger, more likely to be teaching hospitals, and more likely to have private nonprofit ownership than public or private for-profit status.
Also, there were significant geographic differences -- Premier hospitals were more often located in urban areas and were disproportionately more numerous in the South and less so in the Midwest and West.
The researchers' calculations of 30-day mortality rates were adjusted for risks associated with patient and hospital characteristics.
Among the four conditions covered in the analysis, there was one -- CABG surgery -- with a significant difference in 30-day mortality during the final year; it did not favor the pay-for-performance system.