Medicare

Medicare Pay For Performance Pilot Program Fails to Reduce Mortality

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Another day, another failed Medicare pilot program. Via The Boston Globe:

A large Medicare pilot program that paid hospitals more if they consistently administered certain medications and vaccinations, provided appropriate counseling for people with heart conditions, or hit other quality targets did not reduce the number of patients who died within 30 days of admission to the hospital, a study published online Wednesday by the New England Journal of Medicine found.

The results are "sobering," the authors wrote. The program served as a model for a major national initiative being rolled out this year.

Such pay-for-performance programs have been central in efforts to change how health care is paid for, shifting from a system that pays doctors for each test or treatment to one that rewards them for keeping their patients healthy.

…The study looked at mortality rates among more than 6 million patients treated over six years at 252 hospitals involved in the Premier Hospital Quality Incentive Demonstration. The program tied up to 2 percent of Medicare payments to performance on 33 quality measures, including two related to mortality. Most assessed how consistently hospitals carried out recommended treatments, tests, and preventive care—so-called process measures. The patients were treated for heart attack, heart failure, or pneumonia, or had bypass surgery.

The mortality rates were compared with those at thousands of other hospitals that publicly reported performance on the same measures but were not part of the payment program. The authors found that deaths declined in both groups but at similar rates, even among those hospitals considered poor performers at the start of the program.

This is the great hope of ObamaCare's Medicare reforms—that bureaucrats can design clever payment schemes that result in both better care and restrained spending. But it hasn't worked well before, and there's little indication that it will work well on a large scale again. 

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  1. Gosh, its almost like it doesn’t matter how big, intrusive, and expensive their top-down micromanagement is, things just don’t improve!

    The obvious solution, of course, is bigger, more intrusive, top-down nanomanagement.

    1. Well duh, if it’s not working it’s because it’s not big enough.

      1. Just because your girlfriend has told you that does not mean that it is true in all cases.

        1. As long as my wife doesn’t find out about my girlfriend, she can tell me anything she likes.

          1. Well played, sir. My top hat is off to you.

            1. But the monocle stays on.

              1. Nothing comes between a Libertarian and his monocle. Nothing.

                Except maybe the platinum-coated-diamond-encrusted skull of a child who had been forced to work in a coal mine for pennies on the dollar, eventually dying of sadness. But those are hard to come by these days.

                1. A child who you forced to recite the second amendment whilst standing below the Fox News Flag with his hand over his heart, before each work day.

  2. The results are “sobering,” the authors wrote.

    That’s a good thing, right? What with the WoD and all?

  3. This scheme strike me as more akin to pay-for-compliance than pay-for-performance, which are two totally different things. Of course, bureaucracies can only use the former to any reasonable degree so it’s clearly the WAY OF THE FUTURE

    1. Exactly. It is based on process, rather than outcome. And outcome really is what matters. The problem with focusing on process is that really, we know a hell of a lot less about health and disease than we think we do. Especially when it comes to “preventive care,” which really ends up costing more in the long run.

      1. I still have issues with basing payment on outcome. After all, many treatments are not guaranteed to have particular outcomes. They simply increase your odds of survival. Instead, I think the ideal method would be to pay doctors for the services they provide, but make sure the patient is well informed about costs, odds of success, potential risks, etc. Most importantly, make sure the patient is paying the doctor with his own damn money! I think this is the model the free market would use, because this seems to be the path the market is trying to take despite government interference.

    2. Alack makes an excellent point. and further wins the thread with:

      Of course, bureaucracies can only use the former to any reasonable degree so it’s clearly the WAY OF THE FUTURE

      This is exactly it. In any large corporate hospital, it’s all about numbers. The hospital where I work does this shit ad-nauseum. They’re constantly going through the motions to make sure everyone’s washing their hands (geling in and geling out)… they call them ‘core measures’.

      And depending on your patient population, statistical anomalies can cause those to swing wildly, making it look like you did great last month, and sucked ass this month.

  4. Alt-text Win! You actually confused me for a second when I saw the picture after reading the headline.

  5. Such pay-for-performance programs have been central in efforts to change how health care is paid for, shifting from a system that pays doctors for each test or treatment to one that rewards them for keeping their patients healthy.

    ————-

    Yes, because, beside all the obvious and absolute objections to any sort of government-controlled healthcare system, it’s completely appropriate for governments to commandeer entire professions and dictate how people belonging to them will work and receive pay.

    Fuck off and die, DC.

  6. So glad Congress decided to pass a massively expensive health care law based on this premise just a couple years before the study results came out. I’m sure they’ll admit their mistake and repeal it now.

  7. These kinds of incentives are the right path forward, but the formula needs tweaking, said Dr. Ashish Jha, associate professor of health policy at Harvard School of Public Health and lead author of the study.

    “The question is, what do you pay for?” he said. “What are the performance measures? That part we haven’t figured out … We have not come up with the right set of metrics to focus on.”

    Ahh..see..they just didn’t do it right…

    1. Metrics are everything, man. Get your shit together. How can we have highly paid boss-types running around our bureaucratic government agencies and our near-equally bureaucratic corporations, without metrics?

      Even more important, how do you think you’re getting promoted if you don’t get with the metrics wave?

      1. Rule #1 of Bureaucracy: the process is all that matters, and metrics are always-always derived from the processes. Or if all else fails and you’re a really brilliant manager-type, you derive the process from the metrics. It’s just so much easier to create your end-of-month power point slides and spreadsheets that way.

        Because anything else would require some big-shot dumbass to actually start thinking. In fact, some even higher-up big-shot dumbass might have to start thinking about individual people.

        Because oddly enough, outcomes depend on individuals, while processes only depend on metrics.

    2. I’m betting Dr. Hashish of Arvard is a PhD in social policy rather than an MD.

  8. Behindertsein ist sch?n

  9. The results are “sobering,” the authors wrote

    That’s a codeword for “not what we (the authors) expected”.

    1. Metrics will take us to The Promised Land. They’re regular flying carpets.

      The whole US economy will recover just as soon as we figure out the fucking metrics.

  10. What the subtext of these studies show, but no one will admit is that it tells us that our healthcare is actually quite good across the board, or more importantly, having a doctor stare up your ass 24/7 doesn’t necessary improve health outcomes in aggregate.

    The western civilized world is losing their collective minds over healthcare, and are coming to the point where they’re literally (literally!) willing to throw out the freedom and civil liberties of their citizens in the name of making sure everyone has “access”.

    Healthcare will kill the West. And not because it’s so poor, but because it’s the only thing the entire GDP will be used for.

    This business will get out of hand and we’ll all die in ‘free’ hospitals lit up by CFL lightbulbs in a carbon-neutral world.

    1. Healthcare will kill the West.

      In fact, Western Civilization has been trying to commit suicide for a very long time now. But I’m afraid you’re right on, this is going to be the final nail in the coffin.

  11. There is so much wrong here. How much did this pilot program cost? It doesn’t seem a lot of thought went into identifying what incentives were prior to conducting the study and if the additional incentives could reasonably be expected to mitigate the prior incentives. It certainly not a secret that doctors practice defensive medicine to protect against malpractice law suits. It would seem that this defensive medicine would have already maximized the patient’s outcome past the point of diminishing returns. I don’t see how a ‘pay-for-performance’ scheme would have any chance of mitigating the incentive to practice defensive medicine.

    1. There is so much wrong here.
      ^
      This, a thousand times over.

      What the US economy needs is innovation, across the board. What we’re getting instead is more bureaucrats, pretty much across the board.

      Used to be that smaller companies could innovate their way over-under-around the big sloths. Now instead, we’ve finally gotten enough government regulations to make sure that won’t happen anymore.

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