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Health Serv Res. 2009 Jun;44(3):821-42. doi: 10.1111/j.1475-6773.2009.00956.x. Epub 2009 Mar 17.

Effects of the Premier Hospital Quality Incentive Demonstration on Medicare patient mortality and cost.

Author information

1
Brandeis University, Waltham, MA 02454, USA. andrew@brandeis.edu

Abstract

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.

PMID:
19674427
PMCID:
PMC2699910
DOI:
10.1111/j.1475-6773.2009.00956.x
[Indexed for MEDLINE]
Free PMC Article
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