More time may not help hospitals achieve P4P value, study says
- Giving hospitals additional time to adapt to risk-based payment programs does not improve patient outcomes, a new study in The BMJ concludes.
- The researchers analyzed Medicare claims for 214 hospitals in the Premier Hospital Quality Incentive Demonstration (HQID), a voluntary program launched in 2003, and 975 hospitals participating in the Hospital Value-Based Purchasing program, which began in 2011.
- At the study’s endpoint in 2013, the two groups showed no significant difference in clinical process scores and 30-day mortality.
Both groups started from similar baselines on mortality and saw those rates decline to 9.9% at the end of 2013. For the HQID group, the drop in mortality for targeted conditions slowed after financial incentives stopped, the researchers note, adding there were no spillover effects on mortality for nontargeted conditions.
It’s possible that interaction between early and later adopters of pay-for-performance reimbursement models caused the latter to improve their processes and improve processes and outcomes more quickly, the study says. The research has implications for future pay-for-performance programs.
“These findings provide evidence that having additional time is not likely to turn these programs into a success, at least as far as patient outcomes are concerned,” the authors write. “Even for clinical processes, while HQID hospitals began with better performance at baseline, by the end of the study period, the gap between early and late adopters was gone — presumably because of a ceiling effect. This suggests there is a need to change the measures for clinical process scores.”
In a tweet, co-author Ashish K. Jha, with the Harvard School of Public Health, said a decade is sufficient time to evaluate P4P’s success and declared the initiative “a failure.”
His Harvard colleague, Atul Gawande, who was not involved in the study, suggested what is needed are systems that make it easier to provide better care and ways to enable broad uptake.
Previous analyses have also cast doubt on the value of pay for performance. In a recent study, researchers found the Value-Based Payment Modifier Program did not affect performance measures and could actually contribute to healthcare disparities without improving performance if risk-adjustment formulas and incentives are inadequate. For instance, while there were no significant differences between larger and smaller practices and performance, there were notable differences when adjusting for higher- and lower-risk patients, raising the likelihood of greater disparities of care.
Despite uncertainties about the effectiveness of pay-for-performance programs, providers are climbing on board. According to a recent AMGA survey, nearly 60% of members’ Medicare revenues will be risk-based by 2019. Respondents also expect Medicare Advantage revenues from risk-based payments to match Medicare fee-for-service payments by 2019.