Combined impact of Medicare’s hospital pay for performance programs on quality and safety outcomes is mixed

Abstract

Background Three major hospital pay for performance (P4P) programs were introduced by the Affordable Care Act and intended to improve the quality, safety and efficiency of care provided to Medicare beneficiaries. The financial risk to hospitals associated with Medicare’s P4P programs is substantial. Evidence on the positive impact of these programs, however, has been mixed, and no study has assessed their combined impact. In this study, we examined the combined impact of Medicare’s P4P programs on clinical areas and populations targeted by the programs, as well as those outside their focus. Methods We used 2007–2016 Healthcare Cost and Utilization Project State Inpatient Databases for 14 states to identify hospital-level inpatient quality indicators (IQIs) and patient safety indicators (PSIs), by quarter and payer (Medicare vs. non-Medicare). IQIs and PSIs are standardized, evidence-based measures that can be used to track hospital quality of care and patient safety over time using hospital administrative data. The study period of 2007–2016 was selected to capture multiple years before and after introduction of program metrics. Interrupted time series was used to analyze the impact of the P4P programs on study outcomes targeted and not targeted by the programs. In sensitivity analyses, we examined the impact of these programs on care for non-Medicare patients. Results Medicare P4P programs were not associated with consistent improvements in targeted or non-targeted quality and safety measures. Moreover, mortality rates across targeted and untargeted conditions were generally getting worse after the introduction of Medicare’s P4P programs. Trends in PSIs were extremely mixed, with five outcomes trending in an expected (improving) direction, five trending in an unexpected (deteriorating) direction, and three with insignificant changes over time. Sensitivity analyses did not substantially alter these results. Conclusions Consistent with previous studies for individual programs, we detect minimal, if any, effect of Medicare’s hospital P4P programs on quality and safety. Given the growing evidence of limited impact, the administrative cost of monitoring and enforcing penalties, and potential increase in mortality, CMS should consider redesigning their P4P programs before continuing to expand them.

Impact of the Italian Healthcare Outcomes Program (PNE) on the Care Quality of the Poorest Performing Hospitals

“…More positive, although less comparable findings were reported in studies evaluating the impact of the quality assessment systems in Taiwan [28] and Iran [29], while no improvements, or very mixed results were reported in the USA by the Centers for Medicare and Medicaid Services (CMS) [30]. Between 2012 and 2014, the CMS started three programs that adjusted Medicare hospital payments through rewards and penalties, aiming to reduce readmissions and hospital-acquired conditions, and to promote valuebased purchasing [31].…”

“…Between 2012 and 2014, the CMS started three programs that adjusted Medicare hospital payments through rewards and penalties, aiming to reduce readmissions and hospital-acquired conditions, and to promote valuebased purchasing [31]. A pre-post evaluation (2007-2016) of administrative datasets from 14 States found extremely mixed results in the hospital quality and safety indicators that were targeted by the three programs [30]. Interestingly, another assessment found penalties to be associated with environmental and social characteristics that hospitals cannot control-i.e., medical complexity, uncompensated care and the portion of population who live alone [31].…”

Medicare Overall Hospital Star Rating and Value Based Purchasing: What You Need to Know

“…In 2019, Medicare assessed $949 million in penalties under the 3 programs-HRRP, HACRP, and HVBP. 8 The CNS influences the quality of care at the bedside and can impact the perception of care from the patient perspective. Through a quality and safety lens, the CNS is at the forefront to increase the return on investment for hospitals as they work closely with the clinical staff and the management.…”

“…The financial risk to hospitals is significant. In 2019, Medicare assessed $949 million in penalties under the 3 programs—HRRP, HACRP, and HVBP 8 . The CNS influences the quality of care at the bedside and can impact the perception of care from the patient perspective.…”

Hospital value-based payment programs and disparity in the United States: A review of current evidence and future perspectives

“…To date, available evidence on whether hospital-based VBP programs achieved their primary quality and cost reduction goals is mixed ( 12 , 23 ). Many studies have found improvements in health care quality in certain cases even though the effects on cost containment appear to have been modest ( 4 , 24 – 26 ).…”