Hospital pay for performance incentives may backfire among safety-net hospitals

May 14, 2008

The same government-backed incentive programs aimed at improving the care all Americans receive in hospitals may be widening the gap between poor, underserved patients and those who are insured or can afford to pay for their own care, according to a new study led by a University of Pennsylvania School of Medicine physician.

“Though public reporting and pay for performance are designed to improve quality of care, the smaller performance gains at safety-net hospitals will be very harmful to these hospitals, damaging their reputations and finances,” says lead author Rachel M. Werner, MD, PhD, assistant professor in Penn’s Division of General Internal Medicine. “Ultimately, this could widen existing disparities between hospitals, with rich hospitals getting richer and poor hospitals becoming poorer.”

Werner and her colleagues from the University of California at San Francisco analyzed how well “safety-net” hospitals – facilities that serve large populations of low-income, minority and Medicaid patients – delivered care compared to non-safety-net hospitals. The findings, published this week in JAMA, show that safety-net hospitals had significantly smaller gains in care improvement over time, and were less likely to be among the top-ranked facilities recognized for providing high-quality care.

The researchers used data from the Centers for Medicare and Medicaid Services (CMS) public reporting Web site, Hospital Compare, to evaluate hospital performance. Since 2004, some U.S. hospitals have received pay-for-performance bonuses based on their record in providing recommended care for several key conditions including heart attack, heart failure and pneumonia. Hospitals that didn’t meet performance standards faced financial penalties. Werner found that under this pay for performance system, safety-net hospitals would have received smaller bonus payments and been more likely to be financially penalized – a hit she theorizes may ultimately damage their reputations and lead to cash shortfalls that leave them unable to invest in quality improvements like nurse staffing or information technology such as electronic health records.

“Many of these hospitals are already plagued by financial problems,” she says. “They are least prepared to absorb the hit of a financial penalty, which only puts them further behind the 8-ball for making quality improvements, and ultimately penalizing the patients who rely on safety-net hospitals for their care.”

Werner and her colleagues propose that to level the playing field, pay for performance programs be redesigned to provide bonuses each time hospitals deliver appropriate care, rather than only when they achieve targets that may be unrealistic for their payer mix. The researchers also suggest providing subsidies to fund quality improvements in safety-net hospitals, a model that has already been used successfully among some federally qualified health centers.

Source: University of Pennsylvania


Rank 4 /5 (2 votes)
Tags

Relevant PhysicsForums posts

More news stories

Social psychologist: Lust makes you smarter and evidence that seven deadly sins are good for you

(Medical Xpress) -- Good news for lovers on Valentine’s Day - the seven deadly sins, including Lust, are good for you. University of Melbourne social psychologist Dr Simon Laham uses modern research to make a compelling ...

Medicine & Health / Psychology & Psychiatry

created 12 minutes ago | popularity not rated yet | comments 0

Research finds injuries to professional athletes from routine play or practice often reported as 'freak accidents' in me

(Medical Xpress) -- A new report from the Johns Hopkins Center for Injury Research and Policy finds injuries to professional athletes from routine play or practice are often characterized as “freak accidents” in ...

Medicine & Health / Health

created 7 minutes ago | popularity not rated yet | comments 0

Researchers find rate of follow-up surgeries after partial mastectomy varies greatly

(Medical Xpress) -- A study conducted at the University of Vermont/Fletcher Allen Health Care and three other sites and published in the February 1 issue of the Journal of the American Medical Association found significant ...

Medicine & Health / Cancer

created 21 minutes ago | popularity not rated yet | comments 0

Cognitive impairment in older adults often unrecognized in the primary care setting

A new study published in the Journal of the American Geriatrics Society reveals that brief cognitive screenings combined with offering further evaluation increased new diagnoses of cognitive impairment in older veterans two to ...

Medicine & Health / Diseases

created 2 hours ago | popularity not rated yet | comments 0

Botox developer rues missing out on billions

Botox developer Alan Scott says he rues the day he handed over rights to the best-selling wrinkle-smoothing drug to a US company for just $4.5 million, saying he might have become a billionaire.

Medicine & Health / Medications

created 3 hours ago | popularity not rated yet | comments 0


New molecule has potential to help treat genetic diseases and HIV

(PhysOrg.com) -- Chemists at The University of Texas at Austin have created a molecule that's so good at tangling itself inside the double helix of a DNA sequence that it can stay there for up to 16 days before ...

Researchers' paper wins Best Paper Award for 2011

A paper written by Dr. Paul Gratz and his graduate student, Reena Panda, from the Department of Electrical and Computer Engineering at Texas A&M University was selected as one of the best papers from IEEE Computer Architecture ...

New European rocket lifts off on maiden flight

A new lightweight rocket, Vega, lifted off from Europe's space base Monday carrying nine satellites on its inaugural flight, mission control said.

Ordered planar polymers created for the first time

(PhysOrg.com) -- Scientists under the direction of ETH Zurich have created a minor sensation in synthetic chemistry. They succeeded for the first time in producing regularly ordered planar polymers that form ...

Microsoft India retail site down after 'cyber attack'

Microsoft India's retail website was down on Monday after reportedly being hacked by a Chinese group calling itself Evil Shadow Team.

Chinese city seizes Apple iPads in name dispute

(AP) -- Authorities have seized Apple iPads from retailers in a city in northern China due to a dispute with a domestic company that says it owns the iPad name, an official said Monday. The Chinese company said it is asking ...