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Extra pay does not improve hospital performance

DURHAM, N.C. Paying hospitals extra money does not appear to significantly improve the way they treat heart attack patients or how well those patients do. But giving hospitals the information that they need to improve heart attack care does help.

A team of researchers led by the Duke Clinical Research Institute looked at whether financial incentives to hospitals for adhering to specific treatment guidelines would improve patient outcomes. They found no evidence that financial incentives were associated with improved outcomes, nor that hospitals had shifted their focus from other areas in order to concentrate on the areas being evaluated for possible increased payments.

These findings will add to the national debate over the use of pay for performance as a strategy for encouraging hospitals to use drugs and therapies that have been proven to save lives in large-scale clinical trials, the researchers said. The theory is that the possibility of receiving higher reimbursements will motivate hospitals to improve the quality of their care.

A study recently conducted by Premier, Inc., a group that represents hospitals participating in a large Center for Medicare & Medicaid Services (CMS) pilot project of pay for performance, found that paying hospitals extra money for following specific guidelines led to better patient care and outcomes. However, that study did not include a group of hospitals not receiving incentives as a comparison. So the Duke team compared the CMS data with that of a registry of 105,383 patients treated for a heart attack at 500 hospitals involved in a national quality improvement effort.

This is one of the first analyses of the impact of a pay for performance initiative on heart attack care, said Seth Glickman, M.D., M.B.A., first author of a paper appearing June 6, 2007, in the Journal of the American Medical Association. We found that the pay-for-performance program was not associated with a significant i
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Contact: Richard Merritt
Merri006@mc.duke.edu
919-684-4148
Duke University Medical Center
5-Jun-2007


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