title: The effect of Phase 2 of the Premier Hospital Quality Incentive Demonstration on incentive payments to hospitals caring for disadvantaged patients.
abstract: OBJECTIVE
  The Medicare and Premier Inc. Hospital Quality Incentive Demonstration (HQID), a hospital-based pay-for-performance program, changed its incentive design from one rewarding only high performance (Phase 1) to another rewarding high performance, moderate performance, and improvement (Phase 2). We tested whether this design change reduced the gap in incentive payments among hospitals treating patients across the gradient of socioeconomic disadvantage.
  
  
  METHODS
  To estimate incentive payments in both phases, we used data from the Premier Inc. website and from Medicare Provider Analysis and Review files. We used data from the American Hospital Association Annual Survey and Centers for Medicare and Medicaid Services Impact File to identify hospital characteristics.
  
  
  METHODS
  Hospitals were divided into quartiles based on their Disproportionate Share Index (DSH), from lowest disadvantage (Quartile 1) to highest disadvantage (Quartile 4). In both phases of the HQID, we tested for differences across the DSH quartiles for three outcomes: (1) receipt of any incentive payments; (2) total incentive payments; and (3) incentive payments per discharge. For each of the study outcomes, we performed a hospital-level difference-in-differences analysis to test whether the gap between Quartile 1 and the other quartiles decreased from Phase 1 to Phase 2.
  
  
  RESULTS
  In Phase 1, there were significant gaps across the DSH quartiles for the receipt of any payment and for payment per discharge. In Phase 2, the gap was not significant for the receipt of any payment, but it remained significant for payment per discharge. For the receipt of any incentive payment, difference-in-difference estimates showed significant reductions in the gap between Quartile 1 and the other quartiles (Quartile 2, 17.5 percentage points [p < .05]; Quartile 3, 18.1 percentage points [p < .01]; Quartile 4, 28.3 percentage points [p < .01]). For payments per discharge, the gap was also significantly reduced between Quartile 1 and the other quartiles (Quartile 2, $14.92 per discharge [p < .10]; Quartile 3, $17.34 per discharge [p < .05]; Quartile 4, $21.31 per discharge [p < .01]). There were no significant reductions in the gap for total payments.
  
  
  CONCLUSIONS
  The design change in the HQID reduced the disparity in the receipt of any incentive payment and for incentive payments per discharge between hospitals caring for the most and least socioeconomically disadvantaged patient populations.
authors.affiliation: Robert F. Wagner Graduate School and Division of General Medicine, NYU Medical School, New York, NY 10065, USA. Amr2015@med.cornell.edu
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Ryan
authors.forename: Jan
authors.initials: J
authors.lastname: Blustein
authors.forename: Tim
authors.initials: T
authors.lastname: Doran
authors.forename: Marilyn D
authors.initials: MD
authors.lastname: Michelow
authors.forename: Lawrence P
authors.initials: LP
authors.lastname: Casalino
mesh_terms: D004469:Economics, Hospital; D006302:Health Services Research; D006801:Humans; D008484:Medicaid / Q000191:economics; D006278:Medicare / Q000191:economics; D018803:Models, Economic; D058996:Quality Improvement / Q000191:economics; D011787:Quality of Health Care / Q000191:economics*; D012052:Reimbursement, Incentive / Q000191:economics*; D014481:United States