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


METHODS
The 2000-2006 Medicare inpatient claims, Medicare denominator files, and Medicare Provider of Service files.


METHODS
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.


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.
Ryan
Andrew M
AM
Brandeis University, Waltham, MA 02454, USA. andrew@brandeis.edu
D001026:Coronary Artery Bypass / Q000191:economics / Q000401:mortality; D006302:Health Services Research; D006333:Heart Failure / Q000191:economics / Q000401:mortality; D017721:Hospital Costs / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006761:Hospitals; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data; D016014:Linear Models; D006278:Medicare / Q000458:organization & administration*; D017059:Models, Econometric; D009203:Myocardial Infarction / Q000191:economics / Q000401:mortality; D016311:Outliers, DRG / Q000706:statistics & numerical data; D011014:Pneumonia / Q000191:economics / Q000401:mortality; D015397:Program Evaluation; D011785:Quality Assurance, Health Care / Q000458:organization & administration*; D012052:Reimbursement, Incentive / Q000458:organization & administration*; D012189:Retrospective Studies; D020379:Risk Adjustment; D014481:United States / Q000453:epidemiology
N Engl J Med. 2007 Feb 1;356(5):486-96
17259444
Ann Intern Med. 2006 Aug 15;145(4):265-72
16908917
JAMA. 2007 Jun 6;297(21):2373-80
17551130
Biometrics. 2000 Jun;56(2):645-6
10877330
JAMA. 2006 Dec 13;296(22):2694-702
17164455
Health Aff (Millwood). 2007 Jul-Aug;26(4):1104-10
17630453
Med Care Res Rev. 2006 Apr;63(2):135-57
16595409
Am J Respir Crit Care Med. 2001 Jun;163(7):1730-54
11401897
N Engl J Med. 2006 Nov 2;355(18):1895-902
17079763
Am J Prev Med. 2005 Feb;28(2):234-40
15710282
N Engl J Med. 1993 Apr 15;328(15):1092-6
8455667
Med Care Res Rev. 2006 Feb;63(1 Suppl):29S-48S
16688923
Circulation. 2005 Sep 20;112(12):e154-235
16160202
J Ind Econ. 2011;59(4):578-608
22299199
Arch Intern Med. 2001 May 28;161(10):1261-6
11371253
Med Care. 1998 Jan;36(1):8-27
9431328