Hospitals that treat lower-income, sicker patients may not be evaluated fairly in pay-for-performance programs, according to a study published in the Journal of the American Medical Association.
Using data on treatment of more than 148,000 heart attack patients at 449 hospitals provided by the American Heart Associations Get with the Guidelines coronary artery disease program, the studys authors ranked hospitals into three performance categories. The performance measures were similar to those used by the CMS.
Hospitals ranked in the top 20% were likely to receive incentive payments, the middle 60% would get no incentives, and the bottom 20% would get payment reductions.
But when the researchers adjusted the data to account for patient mix and quality reporting, the hospital rankings shifted modestly. They found that most low-performing hospitals in the original rankings were smaller or nonacademic, with larger numbers of patients from racial or ethnic minority groups who had diabetes, heart failure, chronic atrial fibrillation and other conditions.
Our study reveals the need to level the playing field, so hospitals serving more minority, elderly, sick or uninsured patients can compete fairly with others, Eric Peterson, senior author of the study and director of cardiovascular research at Duke Clinical Research Institute, said in a statement. -- by Rebecca Vesely