Hospital characteristics associated with success in a pay-for-performance program in orthopaedic surgery.
BACKGROUND
Pay-for-performance programs are designed to link payments to clinical outcomes. We investigated the characteristics of hospitals in the United States, such as size and volume, that were associated with the receipt of a clinical performance bonus in a nationwide pay-for-performance program involving hip and knee replacement.


METHODS
We obtained hospital-level outcomes data from a nationwide pay-for-performance demonstration project on hip and knee replacement. We obtained data on the hospital's size, procedure volume, and case-mix index as well as whether it was a teaching hospital and then performed a multivariate analysis to determine which factors were associated with the receipt of a performance bonus.


RESULTS
Hospital size and revenue were not associated with the receipt of a performance bonus. Top-performance hospitals tended to be those specialized in orthopaedics (p < 0.002). Multivariate analysis revealed that high-performance hospitals tended to perform a high volume of hip and knee replacements (p < 0.008), to be teaching hospitals (p < 0.037), and to be located in the Midwestern United States (p < 0.001).


CONCLUSIONS
Teaching hospitals that perform a high volume of hip and knee replacements will tend to succeed should pay-for-performance programs be enacted nationwide.
Partners Orthopaedic Trauma Service, Massachusetts General Hospital, 55 Fruit Street, Yawkey 3600, Boston, MA 02114, USA.
Timothy
T
Bhattacharyya
Priyesh
P
Mehta
Andrew A
AA
Freiberg
D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D016009:Chi-Square Distribution; D003953:Diagnosis-Related Groups; D006761:Hospitals / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D010043:Outcome and Process Assessment, Health Care; D011785:Quality Assurance, Health Care; D012052:Reimbursement, Incentive; D014481:United States