- A five-year observational study in The BMJ found scant evidence that CMS’ hospital value-based purchasing (HVBP) program leads to better patient outcomes.
- The study compared 30-day mortality for acute myocardia infarction, heart failure and pneumonia at both incentivized hospitals and ones that were ineligible for the HVBP program.
- Death rates for those conditions at HVBP-participating hospitals dropped -0.13% for each quarter during the study period versus -0.14% at nonincentivized hospitals.
The researchers — from Harvard School of Public Health, Brigham and Women’s Hospital and the VA Boston Healthcare System — looked at 2008-2013 data from 2.4 million patients at 4,267 acute care hospitals in the U.S. Of those hospitals, 2,919 were in the HVBP program and 1,348 served as controls.
Patients in HVBP hospitals were somewhat younger, more likely to be male, black, and have Medicaid coverage than those in nonparticipating hospitals. The patients were also more likely to have high blood pressure, diabetes, and chronic kidney disease and less likely to have congestive heart failure.
In addition to measuring 30-day mortality, the researchers wanted to see if the pay for performance program benefited poor performing hospitals.
Their conclusion: The difference in death rates between the two groups was “small and nonsignificant.” Even when the researchers looked at subgroups of hospitals and poor performers, they found no association between HVBP and improved outcomes.
“Evidence that HVBP has led to lower mortality rates is lacking,” the researchers wrote. “Nations considering similar pay for performance programs may want to consider alternative models to achieve improved patient outcomes.”
Just why HVBP failed to improve outcomes is unclear. It could be the hospitals focused on just a few measured processes and patient experience scores, rather than underlying processes that might have more of an impact, the researchers said. It’s also possible that public reporting of performance conditions, which began in 2008, already had prompted most of the gains in patient outcomes.