Has pay-for-performance decreased access for minority patients?
OBJECTIVE
To examine whether the CMS and Premier Inc. Hospital Quality Incentive Demonstration (PHQID), a hospital-based pay-for-performance (P4P) and public quality reporting program, caused participating hospitals (1) to avoid treating minority patients diagnosed with acute myocardial infarction (AMI), heart failure, and pneumonia and (2) to avoid providing coronary artery bypass graft (CABG) to minority patients diagnosed with AMI.


METHODS
One hundred percent Medicare inpatient claims, denominator files, and provider of service files from 2000 to 2006.


METHODS
We test for differences in the conditional probability of receiving care at PHQID hospitals for AMI, heart failure, and pneumonia before and after implementation of the PHQID between white and minority patients. We also test for differences in the conditional probability that white and minority patients diagnosed with AMI receive CABG in hospitals participating, and not participating, in the PHQID before and after the implementation of the PHQID.


METHODS
Data were obtained from CMS.


RESULTS
We find little evidence that the PHQID reduced access for minority patients: only "Other Race" beneficiaries had a significant reduction in adjusted admissions to PHQID hospitals in the postperiod, and only for AMI. Only marginally significant ( p<.10) evidence of a reduction in CABG was found, also occurring for Other Race beneficiaries.


CONCLUSIONS
Despite minimal evidence of minority patient avoidance in the PHQID, monitoring of avoidance should continue for P4P programs.
Department of Public Health, Weill Medical College-Cornell University, 402 East 67th Street, LA-215, New York, NY 10065, USA. amr2015@med.cornell.edu
Andrew M
AM
Ryan
D000368:Aged; D000465:Algorithms; D019992:Databases as Topic; D005260:Female; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D054625:Healthcare Disparities; D006333:Heart Failure / Q000628:therapy; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D019221:Mandatory Reporting; D008913:Minority Groups; D009203:Myocardial Infarction / Q000601:surgery; D011014:Pneumonia / Q000628:therapy; D015397:Program Evaluation; D012052:Reimbursement, Incentive; D014481:United States