Pay for Performance Fails Again, and Again, and Again

Aaron Carroll writes:

Hand Holding Paper CurrencyI’m getting to be a broken record in my skepticism about pay for performance. Here, here, here, here, here, and here just to name a few posts. But there’s another study out in the Annals of Surgery, “Does Pay-for-Performance Improve Surgical Outcomes? An Evaluation of Phase 2 of the Premier Hospital Quality Incentive Demonstration

…This study involved nearly a million procedures in 12 states over six years. They tried to reduce severe complications and mortality within 30 days. Did paying for performance work?

While mortality went down over time, it didn’t go down faster in the P4P hospitals than the non P4P hospitals. There were no great improvements in complications, and there were no great improvements in mortality. Even in the worst 20% of hospitals (where there is the most room for improvement), P4P was not associated with great improvements over non P4P.

Comments (10)

Trackback URL | Comments RSS Feed

  1. Perry says:

    It’s ironic how the policy makers tout Evidence Based Medicine, but conveniently discount evidence on Quality Measures and P4P that does not support them.

  2. Buster says:

    Everyone agrees that pay for performance is a worthy goal. The way to achieve quality is through competition rather than bureaucracy.

  3. Trent says:

    “While mortality went down over time, it didn’t go down faster in the P4P hospitals than the non P4P hospital.”

    A doctor could still do a crappy job and not kill you

  4. Lucas says:

    “This study involved nearly a million procedures in 12 states over six years.”

    That’s a tremendous amount of manpower

    • Connor says:

      It’s unfortunate though that the study was that big and no results were returned from it.

      • Trent says:

        At least what was concluded disproves something, even if that was not their original intent