Pay for Performance Delivers Modest Changes in Practice

Data from a demonstration project by the Centers for Medicare and Medicaid Services

Pay-for-performance programs are receiving substantial attention, but we have relatively little evidence about their effects on quality of care. In March 2003, the Centers for Medicare and Medicaid Services (CMS) invited 421 hospitals, all subscribers to a quality-benchmarking database, to participate in a pay-for-performance demonstration project.

The project called for participating hospitals to submit data on 33 quality measures for five clinical conditions, three of them cardiac: acute MI (AMI), heart failure (HF), and coronary artery bypass grafting (CABG). Each hospital’s annual case load per condition was at least 30. Hospitals in the top decile on a composite measure of performance at 2 years were promised a 2% bonus payment above us…

Reviewing Author

Harlan M. Krumholz, MD, SM