Impact of Financial Incentives on Early and Late Adopters among US Hospitals: observational study

doi:10.1136/bmj.j5622

Observational Study

. 2018 Jan 3:360:j5622.

doi: 10.1136/bmj.j5622.

Impact of Financial Incentives on Early and Late Adopters among US Hospitals: observational study

Igna Bonfrer^{1

2}, Jose F Figueroa^{1

3

4}, Jie Zheng¹, E John Orav^{3

4

5}, Ashish K Jha^{1

3

6}

Affiliations

¹ Department of Health Policy and Management, Harvard T H Chan School of Public Health, 42 Church St, Cambridge, MA 02138, USA.
² Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.
³ Department of Medicine, Harvard Medical School, Cambridge, MA, USA.
⁴ Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
⁵ Department of Biostatistics, Harvard T H Chan School of Public Health, Cambridge, MA, USA.
⁶ Department of General Internal Medicine, VA Boston Healthcare System, Boston, MA, USA.

PMID: 29298765
PMCID: PMC5749590
DOI: 10.1136/bmj.j5622

Observational Study

Impact of Financial Incentives on Early and Late Adopters among US Hospitals: observational study

Igna Bonfrer et al. BMJ. 2018.

. 2018 Jan 3:360:j5622.

doi: 10.1136/bmj.j5622.

Authors

Igna Bonfrer^{1

2}, Jose F Figueroa^{1

3

4}, Jie Zheng¹, E John Orav^{3

4

5}, Ashish K Jha^{1

3

6}

Affiliations

¹ Department of Health Policy and Management, Harvard T H Chan School of Public Health, 42 Church St, Cambridge, MA 02138, USA.
² Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.
³ Department of Medicine, Harvard Medical School, Cambridge, MA, USA.
⁴ Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
⁵ Department of Biostatistics, Harvard T H Chan School of Public Health, Cambridge, MA, USA.
⁶ Department of General Internal Medicine, VA Boston Healthcare System, Boston, MA, USA.

PMID: 29298765
PMCID: PMC5749590
DOI: 10.1136/bmj.j5622

Abstract

Objective: To examine how hospitals that volunteered to be under financial incentives for more than a decade as part of the Premier Hospital Quality Incentive Demonstration (early adopters) compared with similar hospitals where these incentives were implemented later under the Hospital Value-Based Purchasing program (late adopters).

Design: Observational study.

Setting: 1189 hospitals in the USA (214 early adopters and 975 matched late adopters), using Hospital Compare data from 2003 through 2013.

Participants: 1 371 364 patients aged 65 years and older, using 100% Medicare claims.

Main outcome measures: Clinical process scores and 30 day mortality.

Results: Early adopters started from a slightly higher baseline of clinical process scores (92) than late adopters (90). Both groups reached a ceiling (98) a decade later. Starting from a similar baseline, just below 13%, early and late adopters did not have significantly (P=0.25) different mortality trends for conditions targeted by the program (0.05% point difference quarterly) or for conditions not targeted by the program (-0.02% point difference quarterly).

Conclusions: No evidence that hospitals that have been operating under pay for performance programs for more than a decade had better process scores or lower mortality than other hospitals was found. 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.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

**Fig 1**
Clinical process scores for target conditions

**Fig 2**
Standardized 30 day mortality for target conditions. HQID=Hospital Quality Incentive Demonstration; HVBP=Hospital Value-Based Purchasing

See this image and copyright information in PMC

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References

1. Roland M, Guthrie B. Quality and Outcomes Framework: what have we learnt? BMJ 2016;354:i4060. 10.1136/bmj.i4060 - DOI - PMC - PubMed
1. Van de Poel E, Flores G, Ir P, O’Donnell O. Impact of Performance-Based Financing in a Low-Resource Setting: A Decade of Experience in Cambodia. Health Econ 2016;25:688-705. 10.1002/hec.3219 - DOI - PubMed
1. Rosenthal MB, Fernandopulle R, Song HR, Landon B. Paying for quality: providers’ incentives for quality improvement. Health Aff (Millwood) 2004;23:127-41. 10.1377/hlthaff.23.2.127 - DOI - PubMed
1. Cutler DM. Payment reform is about to become a reality. JAMA 2015;313:1606-7. 10.1001/jama.2015.1926 - DOI - PubMed
1. Roadmap for Implementing Value Driven Healthcare in the Traditional Medicare Fee-for-Service Program. Baltimore: 2016. Centers for Medicare & Medicaid Services. (Accessed 01/21, 2016, at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Inst...).

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[1] Roland M, Guthrie B. Quality and Outcomes Framework: what have we learnt? BMJ 2016;354:i4060. 10.1136/bmj.i4060 - DOI - PMC - PubMed

[2] Roland M, Guthrie B. Quality and Outcomes Framework: what have we learnt? BMJ 2016;354:i4060. 10.1136/bmj.i4060 - DOI - PMC - PubMed

[3] Van de Poel E, Flores G, Ir P, O’Donnell O. Impact of Performance-Based Financing in a Low-Resource Setting: A Decade of Experience in Cambodia. Health Econ 2016;25:688-705. 10.1002/hec.3219 - DOI - PubMed

[4] Van de Poel E, Flores G, Ir P, O’Donnell O. Impact of Performance-Based Financing in a Low-Resource Setting: A Decade of Experience in Cambodia. Health Econ 2016;25:688-705. 10.1002/hec.3219 - DOI - PubMed

[5] Rosenthal MB, Fernandopulle R, Song HR, Landon B. Paying for quality: providers’ incentives for quality improvement. Health Aff (Millwood) 2004;23:127-41. 10.1377/hlthaff.23.2.127 - DOI - PubMed

[6] Rosenthal MB, Fernandopulle R, Song HR, Landon B. Paying for quality: providers’ incentives for quality improvement. Health Aff (Millwood) 2004;23:127-41. 10.1377/hlthaff.23.2.127 - DOI - PubMed

[7] Cutler DM. Payment reform is about to become a reality. JAMA 2015;313:1606-7. 10.1001/jama.2015.1926 - DOI - PubMed

[8] Cutler DM. Payment reform is about to become a reality. JAMA 2015;313:1606-7. 10.1001/jama.2015.1926 - DOI - PubMed

[9] Roadmap for Implementing Value Driven Healthcare in the Traditional Medicare Fee-for-Service Program. Baltimore: 2016. Centers for Medicare & Medicaid Services. (Accessed 01/21, 2016, at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Inst...).

[10] Roadmap for Implementing Value Driven Healthcare in the Traditional Medicare Fee-for-Service Program. Baltimore: 2016. Centers for Medicare & Medicaid Services. (Accessed 01/21, 2016, at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Inst...).

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Impact of Financial Incentives on Early and Late Adopters among US Hospitals: observational study

Affiliations

Impact of Financial Incentives on Early and Late Adopters among US Hospitals: observational study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

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References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

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Medical