No Benefit Seen With Early vs Late Adoption of Pay-for-Performance Programs

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There was no significant difference in mortality trends between early and late adopters for conditions targeted by the program or not targeted by the program.
There was no significant difference in mortality trends between early and late adopters for conditions targeted by the program or not targeted by the program.

HealthDay News — Hospitals that volunteered to be under financial incentives for more than a decade as part of the Premier Hospital Quality Incentive Demonstration (early adopters) do not have better process scores or lower mortality than hospitals where these incentives were implemented later under the Hospital Value-Based Purchasing program (late adopters), according to a study published online in The BMJ.

Igna Bonfrer, PhD, from the Harvard TH Chan School of Public Health in Boston, and colleagues conducted an observational study of 1189 US hospitals, of which 214 were early adopters and 975 were matched late adopters. Data were compared for 1,371,364 patients aged 65 years and older using 100% Medicare claims.

The researchers found that, compared with late adopters, early adopters started from a slightly higher baseline of clinical process scores (92 vs 90). A decade later, both groups reached a peak clinical process score of 98. Starting from a similar baseline (below 13%), there was no significant difference in mortality trends between early and late adopters for conditions targeted by the program or not targeted by the program (0.05 and −0.02 percentage point difference quarterly, respectively).

"These findings suggest that even among hospitals that volunteered to participate in pay-for-performance programs, having additional time is not likely to turn pay-for-performance programs into a success in the future," the authors write.

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Reference

Bonfrer I, Figueroa JF, Zheng J, Orav EJ, Jha AK. Impact of financial incentives on early and late adopters among US hospitals: observation study.  BMJ. 2018; 360:j5622.

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