Medicare P4P Demonstration Project in Heart Failure: Is it Pay for Performance or Pay for Punishment?

Background: Centers for Medicare & Medicaid Services (CMS) has various initiatives to encourage improved quality of care in all health care settings. Pay-for-performance (P4P) initiatives is developed to ensure that valid quality measures are used to support better care coordination for chronic illness such as heart failure. CMS collected data and hospital specific performance are publicly reported. Hospitals scoring in the top 10% for a given set of quality measures will receive a 2% bonus payment on top of the standard payment. Next highest 10% will receive a 1% bonus. In the third year of the demonstration, hospitals that do not meet a predetermined threshold score are subjected to reductions in payment. The objective is to evaluate the effects of the CMS P4P initiative on 30 day mortality over a 4-year period from 2006 to 2009. Method(s): Using data from CMS, we examined hospital performance for 4 publicly reported P4P measures for heart failure (HF), namely, discharge education, left ventricular function assessment, ACE inhibitors or ARB use and smoking cessation counseling for all 50 US states.We also examined the data for 30-day HF mortality rate from 4138 US hospitals during the reporting period of 2006 and 2009. Heart failure quality of care measures were proved for each state and were given as percent averages for a given quarter. Data was imported into ArcGIS, averaged by state and compared using GISmapping. HF 30-day mortality data was provided for each participating hospital and were given as an average for a given quarter. Data was imported, averaged by provider number, summarized by state and compared. (Graph presented). Result(s): In aggregate, hospitals across the US show improvements in P4P recording measures in the 4 year period surrounding P4P program implementation (Figure 1).We found that although there are improvements in P4P recordingmeasures, 30-dayHFmortality rates within the same time period lack significant improvements across most states. Conclusion(s): This study suggest that in spite of significant improvement of P4P measures across hospitals in 50 states, there is little impact on 30 day risk adjusted HF mortality rate.