Study: Hospital P4P Doesn’t Work
Findings:
Medicare’s largest effort to pay hospitals based on how they perform — an inspiration for key parts of the health care law — did not lead to fewer deaths, a new study has found.
Implications:
The study casts doubt on a central premise of the health law’s effort to rework the financial incentives for hospitals with the aim of saving money while improving patient care. This fall, Medicare is going to start altering its payments to more than 3,000 hospitals based on how patients rate their stays and how completely hospitals follow a handful of clinical guidelines for basic care.
Commentary:
“At the end of the day, you are going to ask people to make improvements and you want them to focus on what’s important,” Jha said. “And if you give them 18 different metrics and some are easy but not that important, and some are hard but important, people are going to naturally gravitate toward what’s easy and you’re not going to have meaningful impact.”
I’m still not convinced.
Rating inputs rather than outputs will never yield quality improvements. Doctors and hospitals will naturally work on the easy steps and ignore the hard steps. Any school teacher could have told them that. The logical extension of this is t0 weight the metrics so the easy (irrelevant) ones count for less value. But in doing so, it becomes a cumbersome, bureaucratic mess.
I’m not surprised.
total bureaucratic mess