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News Roundup [abridged Versions Appear In The Paper Journal]

Paying hospitals for better performance saves lives, study says

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7558.62-a (Published 06 July 2006) Cite this as: BMJ 2006;333:62
  1. Janice Tanne
  1. New York

    If 75 000 US patients who had had pneumonia or a heart bypass had received most of an evidence based set of care measures in 2004, healthcare costs would have been as much as $1bn (£0.54bn; €0.78bn) lower and 3000 more patients would have lived. There would have been 6000 fewer complications, 6000 fewer readmissions to hospital, and 500 000 fewer days in hospital.

    The report comes from the Health Quality Incentive Demonstration project, a “pay for performance” study by the Premier healthcare alliance of 1500 not-for-profit hospitals and the US Centers for Medicare and Medicaid Services. The centers pay for care for elderly and poor people and for some children. The study's results were presented at a meeting in Orlando, Florida, on 20 June.

    However, measures of hospital quality do not fully account for the variation in 30 day, risk standardised hospital mortality for patients with an acute myocardial infarction, says a study published this week in the American Medical Association's journal, JAMA (2006;296:72-8). Dr Elizabeth Bradley at Yale University School of Medicine and colleagues used data from the National Registry of Myocardial Infarction and the Centers for Medicare and Medicaid Services to correlate hospitals' use of quality measures such as prescription of &bgr; blockers with death rates. They used 2002-3 data from nearly 1000 US hospitals. They conclude that hospitals' use of recommended measures explains only 6% of the variation in mortality between hospitals. They acknowledge that the recommended measures are important but say that some may have more effect on long term than on short term mortality.

    Commenting on the Premier pay for performance study reported at the Florida meeting, Dr Donald Berwick, president and chief executive of the Institute for Healthcare Improvement, said the analysis “provides evidence that reliably delivering a set of basic care measures saves lives … Patients and families can use this information to become more informed consumers of healthcare.”

    Dr Berwick's organisation recently reported it had exceeded its goal of saving 100 000 lives by improving health care in the United States (BMJ 2006;332:1468).

    In November 2005, Medicare paid an extra $8.9m—above its usual reimbursement levels—to 123 hospitals that showed measurable improvements during the first year of the Premier study. Hospitals that ranked in the top 10% in each clinical category, such as treatment of acute myocardial infarction, received a bonus of 2% of Medicare's set payment. Those in the next 10% received a bonus of 1%.

    Improvement in care is expected to save Medicare money because of better results, fewer complications, and fewer readmissions to hospital.

    The partnership between Premier and the Medicare centers began in 2003 to test the idea that paying hospitals more for better compliance with 35 widely accepted measures of good care would improve patient outcomes and save money. The measures cover acute myocardial infarction, coronary artery bypass surgery, heart failure, community acquired pneumonia, and hip and knee replacement. The study involved 260 hospitals in 38 states.

    The results showed that in 2004, hospital costs for pneumonia were $8412 for patients who received a high number of the “good care” measures, compared with $10 298 for patients who received a low number of the measures. For heart bypass patients, hospital costs were $30 061 for those who received the most good care measures and $41 539 for those who received the fewest.

    Hospitals volunteered to have their quality data for common conditions analysed in a standard way. It was up to the hospitals to make changes to improve care, although Premier provided resources through conference calls, resource guides, regional and national meetings, consulting, and online communities.

    Medicare will publish quality data from the top 50% of hospitals each year. Hospitals that perform in the top 10% and the next 10% of each clinical category will receive the 2% and 1% bonuses.

    Details of the study are at http://www.qualitydemo.com/.

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