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Paying for Better Outcomes May Not Improve Care Paying for Better Outcomes May Not Improve Care

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Paying for Better Outcomes May Not Improve Care

One of the planks of the 2010 health care law, paying hospitals to improve the quality of care, doesn’t appear to help patients survive any better, researchers reported on Wednesday.

They compared two hospital systems over six years – one that took part in the so-called pay for performance plan offered by the Centers for Medicare and Medicaid Services, and one that didn’t. More than 6 million patients went through the 3,600 hospitals from 2003 to 2009.


Ashish Jha of the Harvard School of Public Health and colleagues looked at how many patients died within 30 days after being treated for heart attacks, congestive heart failure or pneumonia or who had heart bypass surgery. “Hospitals that performed in the top two deciles for any of these conditions were eligible for 1 to 2 percent bonuses in Medicare payments for that condition, whereas underperforming hospitals were liable for a 1 to 2 percent  financial penalty starting in the fourth year of the program,” they wrote in the New England Journal of Medicine.

But the incentive did not seem to make a difference. “We found no evidence that the largest hospital-based pay-for-performance program led to a decrease in 30-day mortality,” they wrote.

Congress should take note, Jha and colleagues said. “In the Affordable Care Act, the U.S. Congress mandated the CMS to adopt a pay-for-performance program for hospitals nationwide,” they wrote. Expectations should be modest, they concluded.

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