TUESDAY, June 5, 2007 (HealthDay News) -- Trying to improve medical care by giving hospitals extra money to follow treatment guidelines doesn't make a difference in the end, new research contends.
However, the researcher who led the study said it's too early to give up on the pay-for-performance concept.
"What we found was that all the hospitals in the study improved over time: those in the improvement group, which received money, but also those in the control group," said Dr. Seth W. Glickman, an assistant professor in the division of emergency medicine at Duke University. "All reduced errors at the same rate over time and had the same improvement in survival over time."
In 2003, the Centers for Medicare and Medicaid Services (CMS) launched the largest pay-for-performance pilot project ever in the United States. It included financial incentives for sticking to heart attack care guidelines, the study said.
A first look at data from 54 hospitals in the "pay-for-performance" group found some improvement in performance, such as better attention to the rule for prescribing aspirin in heart attack cases, according to the report published in the June 6 issue of the Journal of the American Medical Association.
But when the researchers looked at comparable data from 446 hospitals with a voluntary quality improvement program that paid no money, they found similar improvements in quality of care and outcome.
"But I don't think this is the end of the pay-for-performance idea," Glickman said. "It is the end of the beginning."
What the research looked at was "an initial pilot program," he said. "Certainly, moving forward we need to evaluate what went right and what went wrong."
Maybe the financial incentives in the program were not big enough, Glickman added. "Overall, the bonus pool in the pay-for-performance program was relatively small in terms of the overall payments," he noted.
A total of $17.55 million was paid to hospitals over the two years covered by the study.
Pay-for-performance "is here to stay and could be an important part of quality improvement as we go forward," Glickman said. "We need to develop optimum incentives as we go forward."
One problem in evaluating the results is that all the hospitals were performing at relatively high levels, said Dr. Albert Wu, a health policy and management professor at Johns Hopkins University School of Public Health.
"The study was done within a large nationwide process to improve quality, and looked at this subgroup of hospitals. So it was not surprising that everyone improved," he said.
"In terms of giving aspirin, for example, they started at or above 85 percent," Wu added. "It's hard to improve on that."
One encouraging note, he said, was that "they did not find any adverse effects associated with pay-for-performance."
However, he noted, for a better evaluation of the pay-for-performance concept, "we need more studies where there is a stronger hypothesis that there might be a difference."
There is good reason to believe that pay-for-performance "should be one of the tools that policy makers use to move quality in the right direction," he added.
There is evidence from smaller studies and from ordinary common sense that "people are moved by financial incentives," Wu said.
More information
A guide to hospital quality is offered by the Agency for Healthcare Research and Quality.
