Older, seriously ill patients survived at about the same rate in thousands of widely different hospitals, whether or not those hospitals are paid extra for good performance, according to a new study.
The incentives were granted to hospitals under a Medicare program, Hospital Quality Improvement Demonstration, designed to improve the quality of care at all hospitals in the U.S. But although some hospitals demonstrated improvement in overall quality of care while others did not, the mortality rate of older patients with seriously ill patients remained virtually the same.
The study, performed by Ashish K. Jha, MD, and colleagues at the Harvard School of Public Health and Brigham And Women’s Hospital in Boston, examined patient mortality rates of 3,363 hospitals. Writing in “The New England Journal of Medicine,” Jha said that the study suggested “we still have not found the right mix of targets and incentives” to increase survival rates in hospitals.
Under the program, the hospitals showing the most improvement in quality of care got an extra 1 to 2 percent of Medicare reimbursements, while the facilities showing the least had Medicare payments cut by the same amount.
The program that the researchers studied, known as Premier HQID (Hospital Quality Improvement Demonstration), ended in 2009. But since then Congress has required that the federal Centers for Medicare and Medicaid Services adopt similar pay-for-performance practices for hospitals.
When it came to overall quality of care (as opposed to patient mortality rates), the study found that the highest-performing hospitals were teaching hospitals run by nonprofit organizations. The facilities were more likely to be located in urban areas.
