Financial incentive programs are no better – or worse – than traditional quality-improvement efforts in hospitals that treat acute MI, investigators report in the Journal of the American Medical Association for June 6.
In 2003, the Centers for Medicare and Medicaid Services (CMS) initiated a pay-for-performance pilot project, in the treatment of acute MI.
To evaluate the program’s effects, Dr. Eric D. Peterson, from Duke University in Durham, North Carolina, and colleagues compared trends in cardiac care and outcomes among 500 hospitals that were participating in a quality-improvement initiative that began in 2001.
Fifty-four hospitals voluntarily participated in the CMS pay-for-performance program and 446 served as control hospitals. Their study cohort included more than 105,000 patients treated for non-ST-segment elevation acute MI hospitalized between 2003 and 2006.
"Composite measure scores for CMS processes showed significant improvement from July 2003 to June 2006 at both pay-for-performance and control hospitals," the authors observed, "with no significant difference between groups."
Dr. Peterson’s team also measured temporal trends in non-CMS composite scores, based on care processes that are included in ACC/AHA guidelines but are not rewarded financially by the CMS.
The investigators observed the same trends with regard to rate of improvement on non-CMS composite scores among pay-for-performance hospitals and control hospitals. They also found that mortality rates were similar for both groups.
Noting the "administrative burden and potential unintended consequences of financial incentives," Dr. Peterson and his colleagues conclude, "additional studies of pay for performance are needed to determine its optimal role in quality-improvement initiatives."