Long-Term Effect of Hospital Pay for Performance on Mortality in England

Abstract

Short-term relative reductions in mortality for conditions linked to financial incentives in hospitals participating in a pay-for-performance program in England were not maintained.

Physician Motivation: Listening to What Pay-for-Performance Programs and Quality Improvement Collaboratives Are Telling Us

“…10–12 A P4P program in all National Health Service hospitals in one region of England was associated with a clinically significant reduction in mortality for pneumonia in the first 18 months after implementation, 13 but this benefit did not persist to 42 months. 14 Evaluations of P4P programs in nonhospital settings and other programs specifically targeting physicians have shown mixed results. 15–17 On the other hand, disincentives in the form of reduced payments by CMS for health care–associated infections did not measurably change infection rates.…”

New approaches to evaluating complex health and care systems

“…40 The five year evaluation of a region-wide pay for performance scheme similarly had to adapt as the intervention changed mid-scheme with introduction of new commissioning targets. 41 These contemporaneous evaluations require different rules of engagement between the service and researchers, challenging traditional assumptions about objectivity and independence. Critical distance is important, but good evaluation teams will work closely with study sites, sharing findings to test the validity of emerging data.…”

Quality in primary care

“…9 Harrison and colleagues' study 2 contributes substantially to the small evidence base evaluating whether pay for performance improves longer term outcomes for patients. [10][11][12][13][14] Although their analysis found significant reductions in related emergency hospital admissions, the mechanism by which this might have occurred is uncertain. The authors' therefore concluded that pay for performance is no more of a "magic bullet" than any other quality improvement method, and that long term improvement is likely to require the persistent use of many different types of intervention.…”