Impact of Financial Incentives on Early and Late Adopters among US Hospitals: observational studyBMJ 2018; 360 doi: https://doi.org/10.1136/bmj.j5622 (Published 04 January 2018) Cite this as: BMJ 2018;360:j5622
All rapid responses
Re: Impact of Financial Incentives on Early and Late Adopters among US Hospitals: observational study
We have read the article by Bonfrer et al. with great interest, as the results presented in this paper are highly relevant given the increasing adoption of VBHC in the US and other countries. The authors conclude that there is no evidence that hospitals working under pay for performance programs had better process scores or lower mortality rates, and that having additional time will not likely turn pay for performance into a success. We believe that serious methodological concerns exist in this study, which make the authors conclusion questionable.
Firstly, the main research outcomes are process scores indicating to what extent recommended care was delivered to patients. The writers however do not mention, and as such do not convince the reader, that compliance to guidelines, which leads to higher process scores, is related to improved health outcomes. Secondly, no other health outcomes besides 30-day mortality were examined. We believe that evaluating the possible success of pay for performance programs should be done based on a wider range of outcomes including long-term outcome measures (10-year survival), process indicators such as length of hospital stay and quality of life indicators. Thirdly, no justification was made for the selection of the 3 primary diseases. Other diseases, like malignant tumours, might be more prone to incremental improvements in aforementioned areas. Fourthly, the difference between late and early adopters was examined, however the researchers did not examine whether pre-existing trends that showed a change in the study outcomes were affected after start of the pay-for-performance programs.
Although the main findings of this study are important and provide additional information for the ongoing discussion regarding the potential success of pay for performance programs, we believe that we cannot conclude that these programs are not successful based on solely the two indicators, evaluated for just three types of diseases. In order to bring the pay for performance discussion to a higher level, research using a wider range of outcomes measured in a larger number of (oncological) diseases is needed.
Competing interests: No competing interests