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The Effect of Phase 2 of the Premier Hospital Quality Incentive Demonstration on Incentive Payments to Hospitals Caring for Disadvantaged Patients
Author(s) -
Ryan Andrew M.,
Blustein Jan,
Doran Tim,
D. Michelow Marilyn,
Casalino Lawrence P.
Publication year - 2012
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.1475-6773.2012.01393.x
Subject(s) - medicaid , receipt , payment , incentive , quartile , disadvantage , incentive program , disadvantaged , business , medicine , prospective payment system , actuarial science , finance , health care , accounting , economics , confidence interval , economic growth , political science , law , microeconomics
Objective The M edicare and P remier I nc. H ospital Q uality I ncentive D emonstration ( HQID ), a hospital‐based pay‐for‐performance program, changed its incentive design from one rewarding only high performance ( P hase 1) to another rewarding high performance, moderate performance, and improvement ( P hase 2). We tested whether this design change reduced the gap in incentive payments among hospitals treating patients across the gradient of socioeconomic disadvantage. Data To estimate incentive payments in both phases, we used data from the P remier I nc. website and from M edicare P rovider A nalysis and R eview files. We used data from the A merican H ospital A ssociation A nnual S urvey and C enters for M edicare and M edicaid S ervices I mpact F ile to identify hospital characteristics. Study Design Hospitals were divided into quartiles based on their D isproportionate S hare I ndex ( DSH ), from lowest disadvantage ( Q uartile 1) to highest disadvantage ( Q uartile 4). In both phases of the HQID , we tested for differences across the DSH quartiles for three outcomes: (1) receipt of any incentive payments; (2) total incentive payments; and (3) incentive payments per discharge. For each of the study outcomes, we performed a hospital‐level difference‐in‐differences analysis to test whether the gap between Q uartile 1 and the other quartiles decreased from P hase 1 to P hase 2. Principal Findings In P hase 1, there were significant gaps across the DSH quartiles for the receipt of any payment and for payment per discharge. In P hase 2, the gap was not significant for the receipt of any payment, but it remained significant for payment per discharge. For the receipt of any incentive payment, difference‐in‐difference estimates showed significant reductions in the gap between Q uartile 1 and the other quartiles ( Q uartile 2, 17.5 percentage points [ p < .05]; Q uartile 3, 18.1 percentage points [ p < .01]; Q uartile 4, 28.3 percentage points [ p < .01]). For payments per discharge, the gap was also significantly reduced between Q uartile 1 and the other quartiles ( Q uartile 2, $14.92 per discharge [ p < .10]; Q uartile 3, $17.34 per discharge [ p < .05]; Q uartile 4, $21.31 per discharge [ p < .01]). There were no significant reductions in the gap for total payments. Conclusions The design change in the HQID reduced the disparity in the receipt of any incentive payment and for incentive payments per discharge between hospitals caring for the most and least socioeconomically disadvantaged patient populations.