In 2004, the Centers for Medicaid and Medicare (CMS) launched the CMS Hospital Inpatient Quality Reporting program, which would publicly report delivered by US hospitals. A recent study investigated quality of care measures and racial/ethnic performance rates among and within hospitals from 2005 – 2010. The study found that in addition to an overall increase in quality of care in heart attacks, heart failure, and pneumonia, there was greater equality in care among white, black, and Hispanic patients.Source: unknown
The researchers attribute these changes to more equitable care for white patients and minority patients treated in the same hospital, as well as to greater performance improvements among hospitals that disproportionately serve minority patients.
Many other studies have similarly demonstrated significant changes in health outcomes, behavior, attitudes, and quality after the implementation of a policy or program.
Though no causal relationship was established between the launching of CMSs public reporting program and the study findings, this coincidence does beg the question, Is incentive and/or penalty the most effective method for ?
I have often wondered what the healthcare system would be like without incentives and penalties. In a nation where prevention of disease is highly advocated, the health care system, ironically, remains very reactive, often making changes only after the promise of reward or the threat of penalty. Such a system cannot be expected to improve upon its own shortcomings, much less, single-handedly improve the health of the nation.
In a perfect world, good health outcomes should be sufficient motivation for any provider, hospital, or healthcare system to seek improvements in quality. Instead, public reporting programs and financial incentive programs such as in the Affordable Care Act (ACA) exist to create checks and balances.
This study only supports that the incentives and penalties included in the ACA have the potential to accompany even greater improvements in health care quality and racial/ethnic equity in the coming years barring its repeal.
commentary by Renee Volny Darko, DO, MBA
Background Nearly every U.S. hospital publicly reports its performance on quality measures for patients who are hospitalized for acute myocardial infarction, heart failure, or pneumonia. Because performance rates are not reported according to race or ethnic group, it is unclear whether improvements in equity of care have accompanied aggregate improvements in health care quality over time. Methods We assessed performance rates for quality measures covering three conditions (six measures for acute myocardial infarction, four for heart failure, and seven for pneumonia). These rates, adjusted for patient- and hospital-level covariates, were compared among non-Hispanic white, non-Hispanic black, and Hispanic patients who received care between 2005 and 2010 in acute care hospitals throughout the United States. Results Adjusted performance rates for the 17 quality measures improved by 3.4 to 57.6 percentage points between 2005 and 2010 for white, black, and Hispanic adults (P<0.001 for all comparisons). In 2005, as compared with adjusted performance rates for white patients, adjusted performance rates were more than 5 percentage points lower for black patients on 3 measures (range of differences, 12.3 to 14.2) and for Hispanic patients on 6 measures (5.6 to 14.5). Gaps decreased significantly on all 9 of these measures between 2005 and 2010, with adjusted changes for differences between white patients and black patients ranging from ?8.5 to ?11.8 percentage points and from ?6.2 to ?15.1 percentage points for differences between white patients and Hispanic patients. Decreasing differences according to race or ethnic group were attributable to more equitable care for white patients and minority patients treated in the same hospital, as well as to greater performance improvements among hospitals that disproportionately serve minority patients. Conclusions Improved performance on quality measures for white, black, and Hispanic adults hospitalized for acute myocardial infarction, heart failure, or pneumonia was accompanied by increased racial and ethnic equity in performance rates both within and among U.S. hospitals. PMID 25494269