Pay for performance: Is it ready for prime time?

January 12th, 2015

A new study presented at the American Thoracic Society (ATS) 2012 International Conference has concluded that larger hospitals and academic medical centers may be unfairly penalized in comparisons of in-hospital ICU mortality. That’s partly because those facilities are more likely to accept transfer patients from other hospitals.

According to a news release about the study, “In recent years, quality measures have increasingly been publicly reported and tied to financial incentives through pay-for-performance. It is important that these quality measures accurately assess performance and are not flawed by bias.”

I made the same point in an earlier blog post that, coincidentally, focused on another study that questioned the accuracy of in-hospital mortality measures.

The problem is, even if all the quality measures against which hospitals are compared were perfect, it’s not clear that the have-nots – those facilities at the bottom end of the performance scale – will ever have the resources necessary to become top performers and reap the corresponding financial benefits. Without such upward mobility, pay for performance would simply be a system under which the rich get richer and the poor continue to languish.

Factor in recent research published in the New England Journal of Medicine questioning whether pay for performance actually improves patient outcomes, and I’d say there’s some cause for concern.