Blog: No pay for poor performance, yet no change

Policymakers who hope to see hospitals respond to financial incentives for better quality care will be disappointed by a newly published report on costly, potentially deadly, hospital-acquired infections.

My colleague Maureen McKinney reported on the results, published in the New England Journal of Medicine: The 2008 Medicare policy to stop payment for catheter-associated bloodstream and urinary tract infections contracted by patients during a hospital stay did not produce a hoped-for drop in infection rates.

The rate of bloodstream infections, on the decline before the policy change, continued to drop at about the same pace as before the pay cut, the researcher said.

Meanwhile, urinary tract infections rates reflected a “small, nonsiginificant” gain after the no-pay policy took effect.

It did not matter whether a hospital had a greater proportion of Medicare patients or not. Nor did it matter if hospitals were located in states where infections were publicly reported. Results did not change when researchers looked back to October 2007, when the no-pay policy was first announced.

The researchers said results add to prior research that shows mixed results on quality outcomes for pay-for-performance.

“Given the increasing use of financial incentives and disincentives to improve the quality of care, policymakers should consider the available data with regard to the effect of such initiatives on health outcomes,” they wrote.

One possible reason for the lack of change following Medicare's no-pay-for-infection policy could be weak financial incentives, the authors said.

The strength of financial incentives (or lack of it) has factored into the debate over how best to design accountable care organizations, the popular and evolving option to more closely tie what hospitals and doctors get paid to the results they get.

Accountable care's early test among 10 physician groups ended without curbing Medicare spending, the CBO said in January, the same month CMS launched the first ACO experiments under the Patient Protection and Affordable Care Act.

You can follow Melanie Evans on Twitter: @MHmevans.