Ashish K. Jha, MD, MPH; E. John Orav, PhD; Arnold M. Epstein, MD, MA
Acknowledgment: The authors thank Dr. John Ayanian for his thoughtful and helpful comments on an earlier version of the manuscript.
Grant Support: By the Changes in Health Care Financing and Organization Initiative of the Robert Wood Johnson Foundation (grant 63743).
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-0442.
Reproducible Research Statement:Study protocol and statistical code: Available from Dr. Jha (e-mail, email@example.com). Data set: Potentially available, subject to approval by the institutional review board of Harvard School of Public Health.
Requests for Single Reprints: Ashish K. Jha, MD, MPH, Harvard School of Public Health, Department of Health Policy and Management, 677 Huntington Avenue, Boston, MA 02115; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Jha and Epstein: Harvard School of Public Health, Department of Health Policy and Management, 677 Huntington Avenue, Boston, MA 02115.
Dr. Orav: Brigham and Women's Hospital, Division of General Internal Medicine, 1620 Tremont Street, 3rd Floor, Boston, MA 02120-1613.
Author Contributions: Conception and design: A.K. Jha, E.J. Orav, A.M. Epstein.
Analysis and interpretation of the data: A.K. Jha, E.J. Orav, A.M. Epstein.
Drafting of the article: A.K. Jha, E.J. Orav.
Critical revision of the article for important intellectual content: A.K. Jha, A.M. Epstein.
Final approval of the article: A.K. Jha, E.J. Orav, A.M. Epstein.
Statistical expertise: E.J. Orav.
Obtaining of funding: A.K. Jha, A.M. Epstein.
Administrative, technical, or logistic support: A.K. Jha.
Collection and assembly of data: A.K. Jha.
Jha AK, Orav EJ, Epstein AM. The Effect of Financial Incentives on Hospitals That Serve Poor Patients. Ann Intern Med. 2010;153:299-306. doi: 10.7326/0003-4819-153-5-201009070-00004
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Published: Ann Intern Med. 2010;153(5):299-306.
Providing financial incentives to hospitals to improve quality is increasingly common, yet its effect on hospitals that care for poor patients is largely unknown.
To determine how financial incentives for quality performance affect hospitals with more poor patients compared with those with fewer poor patients.
251 hospitals that participated in the Premier Hospital Quality Incentive Demonstration program and a national sample of 3017 hospitals.
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).
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.
Hospitals in the Premier Hospital Quality Incentive Demonstration may be atypical, and these results may not be generalizable to all hospitals.
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.
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