The Long-Term Effect of Premier Pay for Performance on Patient Outcomes

The federal Centers for Medicare and Medicare Services recently completed a 6-year demonstration of a pay-for-performance program, the Premier Hospital Quality Incentive Demonstration (Premier HQID). Under the program, which began by invitation in 2003, hospitals agreed to provide data on 33 medical measures for three medical conditions (acute myocardial infarction, congestive heart failure, and pneumonia) and two surgical procedures (coronary-artery bypass grafting and total hip or knee replacement). Top-performing hospitals received bonus payments (1% to 2%) while underperforming hospitals were similarly penalized.

To find out the effect of the quality incentive program, researchers compared 252 Premier HQID hospitals with 3,363 hospitals that did not participate in the program and only publicly reported data. The Premier HQID hospitals tended to be larger, more often nonprofit or teaching hospitals, and located in urban areas in southern states. Premier hospital patients were slightly older, less likely to be female, and more likely to be Black.

The researchers found little evidence that participation in the Premier HQID program was associated with declines in mortality. At the end of the incentive program, both types of hospitals had similar mortality rates—11.82 percent for participating Premier hospitals and 11.74 percent for the other hospitals.