The effect of financial incentives on hospitals that serve poor patients.
BACKGROUND
Providing financial incentives to hospitals to improve quality is increasingly common, yet its effect on hospitals that care for poor patients is largely unknown.


OBJECTIVE
To determine how financial incentives for quality performance affect hospitals with more poor patients compared with those with fewer poor patients.


METHODS
Retrospective study.


METHODS
U.S. hospitals.


METHODS
251 hospitals that participated in the Premier Hospital Quality Incentive Demonstration program and a national sample of 3017 hospitals.


METHODS
The association between the disproportionate-share index, a marker of caring for poor patients, and baseline quality performance, changes in performance, and terminal performance for acute myocardial infarction, congestive heart failure, and pneumonia for hospitals in the pay-for-performance program and those in the national sample (which did not receive financial incentives).


RESULTS
Among both pay-for-performance hospitals and those in the national sample, hospitals with more poor patients had lower baseline performance than did those with fewer poor patients. A high disproportionate-share index was associated with greater improvements in performance for acute myocardial infarction and pneumonia but not for congestive heart failure, and the gains were greater among hospitals that received financial incentives than among the national sample. After 3 years, hospitals that had more poor patients and received financial incentives caught up for all 3 conditions, whereas those with more poor patients among the national sample continued to lag.


CONCLUSIONS
Hospitals in the Premier Hospital Quality Incentive Demonstration may be atypical, and these results may not be generalizable to all hospitals.


CONCLUSIONS
No evidence indicated that financial incentives widened the gap in performance between hospitals that serve poor patients and other hospitals. Pay-for-performance programs may be a promising quality improvement strategy for hospitals that serve poor patients.


BACKGROUND
Robert Wood Johnson Foundation.
Jha
Ashish K
AK
Harvard School of Public Health, Brigham and Women's Hospital, U.S. Department of Veterans Affairs Boston Healthcare System, Boston, Massachusetts, USA. ajha@hsph.harvard.edu
Orav
E John
EJ
Epstein
Arnold M
AM
D006333:Heart Failure / Q000628:therapy; D006761:Hospitals / Q000592:standards*; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy; D011014:Pneumonia / Q000628:therapy; D011203:Poverty; D011785:Quality Assurance, Health Care; D012052:Reimbursement, Incentive; D012189:Retrospective Studies; D014481:United States