Gains from pay-for-performance don’t last

Pay-for-performance programs, despite initial improvements, may not improve patient mortality rates in the long term, according to a new study published in the New England Journal of Medicine.

Researchers, led by Søren Rud Kristensen, Ph.D., of the Institute of Population Health at the Manchester Centre for Health Economics in England, analyzed 30-day in-hospital mortality rates at 161 English hospitals. Researchers analyzed pneumonia, heart attacks and heart failure rates first for an 18-month period and then for 24 additional months.

In the first phase, hospitals participating in pay-for-performance programs saw substantial reductions in overall 30-day in-hospital mortality. This is consistent with previous research from the University of Manchester, according to an announcement. By the end of the full, 42-month period, however, the lower rate at pay-for-performance hospitals lost its significance, with nonparticipating facilities overtaking them in mortality reductions for the three conditions analyzed.

However, the pay-for-performance hospitals’ mortality rates were consistently better for patients whose conditions weren’t covered by the incentive programs.

“Although short-term improvements in the quality measures for conditions related to incentives were sustained in the long term, our analyses provide no evidence that the incentives have a long-term effect on 30-day mortality,” the study states.

The study’s applicability to healthcare in the U.S. is hard to determine due to the structural differences between the two countries’ systems, Akin Demehin, senior associate director for policy at the American Hospital Association said.

Demehin added that while care quality plays a major role in patient outcomes, there are other components, including patients’ individual clinical factors and potential contributing factors within their communities, “so that makes one-to-one mapping a little more difficult.”

Regardless of the study’s applicability, pay-for-performance programs will become a major factor in an increasingly patient-centered, results-focused healthcare industry.