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Effects of the Premier Hospital Quality Incentive Demonstration on Medicare Patient Mortality and Cost
Author(s) -
Ryan Andrew M.
Publication year - 2009
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/j.1475-6773.2009.00956.x
Subject(s) - medicine , medicaid , emergency medicine , myocardial infarction , pneumonia , cohort , incentive , heart failure , intensive care medicine , health care , economics , economic growth , microeconomics
Objective. To evaluate the effects of the Premier Inc. and Centers for Medicare and Medicaid Services Hospital Quality Incentive Demonstration (PHQID), a public quality reporting and pay‐for‐performance (P4P) program, on Medicare patient mortality, cost, and outlier classification. Data Sources. The 2000–2006 Medicare inpatient claims, Medicare denominator files, and Medicare Provider of Service files. Study Design. Panel data econometric methods are applied to a retrospective cohort of 11,232,452 admissions from 6,713,928 patients with principal diagnoses of acute myocardial infarction (AMI), heart failure, pneumonia, or a coronary‐artery bypass grafting (CABG) procedure from 3,570 acute care hospitals between 2000 and 2006. Three estimators are used to evaluate the effects of the PHQID on risk‐adjusted (RA) mortality, cost, and outlier classification in the presence of unobserved selection, resulting from the PHQID being voluntary: fixed effects (FE), FE estimated in the subset of hospitals eligible for the PHQID, and difference‐in‐difference‐in‐differences. Data Extraction Methods. Data were obtained from CMS. Principal Findings. This analysis found no evidence that the PHQID had a significant effect on RA 30‐day mortality or RA 60‐day cost for AMI, heart failure, pneumonia, or CABG and weak evidence that the PHQID increased RA outlier classification for heart failure and pneumonia. Conclusions. By not reducing mortality or cost growth, this study suggests that the PHQID has made little impact on the value of inpatient care purchased by Medicare.