Policy

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.