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Research

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

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.j5622 (Published 04 January 2018) Cite this as: BMJ 2018;360:j5622
  1. Igna Bonfrer, assistant professor12,
  2. Jose F Figueroa, instructor of medicine134,
  3. Jie Zheng, senior research statistician1,
  4. E John Orav, associate professor345,
  5. Ashish K Jha, professor136
  1. 1Department of Health Policy and Management, Harvard T H Chan School of Public Health, 42 Church St, Cambridge, MA 02138, USA
  2. 2Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands
  3. 3Department of Medicine, Harvard Medical School, Cambridge, MA, USA
  4. 4Department of Medicine, Brigham and Women’s Hospital, Boston, MA, USA
  5. 5Department of Biostatistics, Harvard T H Chan School of Public Health, Cambridge, MA, USA
  6. 6Department of General Internal Medicine, VA Boston Healthcare System, Boston, MA, USA
  1. Correspondence to: A Jha ajha{at}hsph.harvard.edu
  • Accepted 17 November 2017

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.

Footnotes

  • Contributors: All authors contributed to the design and conduct of the study; data collection and management; interpretation of the data; and preparation, review, or approval of the manuscript. Data analyses were performed by IB and JZ. IB, JFF, and AKJ are the guarantors.

  • Funding: IB received funding from a Rubicon Fellowship provided by the Netherlands Organization for Scientific Research. The funders had no role in the study design; collection, analysis, and interpretation of data; writing of the report; or decision to submit the article for publication.

  • 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.

  • Ethical approval: Not required.

  • Data sharing: No additional data are available.

  • Transparency: The lead author (IB) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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