title: The effect of the MassHealth hospital pay-for-performance program on quality.
abstract: OBJECTIVE
  To test the effect of Massachusetts Medicaid's (MassHealth) hospital-based pay-for-performance (P4P) program, implemented in 2008, on quality of care for pneumonia and surgical infection prevention (SIP).
  
  
  METHODS
  Hospital Compare process of care quality data from 2004 to 2009 for acute care hospitals in Massachusetts (N=62) and other states (N=3,676) and American Hospital Association data on hospital characteristics from 2005.
  
  
  METHODS
  Panel data models with hospital fixed effects and hospital-specific trends are estimated to test the effect of P4P on composite quality for pneumonia and SIP. This base model is extended to control for the completeness of measure reporting. Further sensitivity checks include estimation with propensity-score matched control hospitals, excluding hospitals in other P4P programs, varying the time period during which the program was assumed to have an effect, and testing the program effect across hospital characteristics.
  
  
  RESULTS
  Estimates from our preferred specification, including hospital fixed effects, trends, and the control for measure completeness, indicate small and nonsignificant program effects for pneumonia (-0.67 percentage points, p>.10) and SIP (-0.12 percentage points, p>.10). Sensitivity checks indicate a similar pattern of findings across specifications.
  
  
  CONCLUSIONS
  Despite offering substantial financial incentives, the MassHealth P4P program did not improve quality in the first years of implementation.
authors.affiliation: Department of Public Health, Division of Outcomes and Effectiveness Research, Weill Medical College, Cornell University, 402 East 67th Street, New York, NY 10065, USA.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Ryan
authors.forename: Jan
authors.initials: J
authors.lastname: Blustein
mesh_terms: D016022:Case-Control Studies; D006761:Hospitals; D006801:Humans; D017053:Infection Control; D008404:Massachusetts; D008484:Medicaid / Q000191:economics*; D017059:Models, Econometric; D011014:Pneumonia / Q000517:prevention & control; D057216:Propensity Score; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012044:Regression Analysis; D012052:Reimbursement, Incentive; D013530:Surgical Wound Infection / Q000517:prevention & control; D014481:United States