Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Pioneering hospital pay-for-performance program falls short of its goals

09.06.2011
Racial and ethnic disparities in health care neither found nor reduced so far under closely watched Massachusetts program

Massachusetts' innovative use of "pay-for-performance" bonuses to try to reduce racial and ethnic disparities in the case of Medicaid patients has turned up no evidence of the problem at any of the state's 66 acute-care hospitals, according to a new study that raises questions about the effectiveness of the state's novel approach.

While the study, published in the June edition of Health Affairs (June 9, 2011), found that racial and ethnic inequities for disadvantaged patients may well exist, it also determined that the hospital "pay-for-performance" approach – typically used to improve quality of care – proved unsuited to the task of identifying health care disparities or their severity, at least in the pioneering first years of its use.

According to the study, "Massachusetts' racial and ethnic disparities legislation was based on the assumptions that there were racial and ethnic disparities in the treatment of patients within the state's hospitals and that every hospital's patient population was sufficiently diverse to make a statewide intervention sensible."

However, the researchers found, the clinical conditions tracked in the pay-for- performance program did not bring to light any significant racial and ethnic disparities in hospital care. In addition, the hospitals' patient population was not sufficiently diverse to allow the approach to succeed in its goals of finding and narrowing gaps in care among the disadvantaged, the study stated.

It was in 2006 that Massachusetts passed major legislation to expand health insurance coverage throughout the state. The law, which would influence the federal Affordable Care Act implemented in 2010, featured a large increase in the state's Medicaid payment rate for hospitals, and with that increase came greater accountability in the form of the pay-for-performance program. Under the data-driven program, hospitals that performed well on specified measurements were eligible to receive substantial bonuses.

The use of "pay for performance" for the purpose of identifying and reducing racial and ethnic disparities in the care of Medicaid patients within hospitals marked a new approach for states. After the innovation was introduced in 2008, it became a subject of national interest.

This study of Massachusetts' use of pay-for-performance to reduce racial and ethnic inequities in hospital care was authored by Dr. Jan Blustein, professor of health policy and medicine at the Robert F. Wagner Graduate School of Public Service at New York University, along with Joel S. Weissman of Mongan Institute for Health Policy at Massachusetts General Hospital and Harvard Medical School; Andrew M. Ryan, assistant professor of public health at Weill Cornell Medical College; Tim Doran, clinical research fellow in public health at the School of Health Sciences at the University of Manchester, England; and Roman Hasnain-Wynia, director, Center for Healthcare Equity, and associate research professor at the Feinberg School of Medicine at Northwestern University.

While no signs of racial or ethnic disparities were detected by the researchers, they noted the program is in its early years, and over time, policymakers may be able to more effectively measure and address disparities.

Even so, it's also possible that time will show that hospital pay-for-performance may be an inadequate tool for reducing health care disparities, the researchers wrote. A more effective way to reduce racial and ethnic inequities may be to focus on hospitals that heavily serve minority populations, or to attend to barriers to health and health care access that are rooted in factors "beyond hospital walls" over which hospitals have little direct influence, the authors suggested.

NOTE: Embargoed copies of this and other studies in the June issue of Health Affairs are available to reporters.

Please use username "press" and password "health" to access the page: http://burnesscommunications.com/pressroom/june-2011

Robert Polner | EurekAlert!
Further information:
http://www.nyu.edu

More articles from Studies and Analyses:

nachricht The personality factor: How to foster the sharing of research data
06.09.2017 | ZBW – Leibniz-Informationszentrum Wirtschaft

nachricht Europe’s Demographic Future. Where the Regions Are Heading after a Decade of Crises
10.08.2017 | Berlin-Institut für Bevölkerung und Entwicklung

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: The pyrenoid is a carbon-fixing liquid droplet

Plants and algae use the enzyme Rubisco to fix carbon dioxide, removing it from the atmosphere and converting it into biomass. Algae have figured out a way to increase the efficiency of carbon fixation. They gather most of their Rubisco into a ball-shaped microcompartment called the pyrenoid, which they flood with a high local concentration of carbon dioxide. A team of scientists at Princeton University, the Carnegie Institution for Science, Stanford University and the Max Plank Institute of Biochemistry have unravelled the mysteries of how the pyrenoid is assembled. These insights can help to engineer crops that remove more carbon dioxide from the atmosphere while producing more food.

A warming planet

Im Focus: Highly precise wiring in the Cerebral Cortex

Our brains house extremely complex neuronal circuits, whose detailed structures are still largely unknown. This is especially true for the so-called cerebral cortex of mammals, where among other things vision, thoughts or spatial orientation are being computed. Here the rules by which nerve cells are connected to each other are only partly understood. A team of scientists around Moritz Helmstaedter at the Frankfiurt Max Planck Institute for Brain Research and Helene Schmidt (Humboldt University in Berlin) have now discovered a surprisingly precise nerve cell connectivity pattern in the part of the cerebral cortex that is responsible for orienting the individual animal or human in space.

The researchers report online in Nature (Schmidt et al., 2017. Axonal synapse sorting in medial entorhinal cortex, DOI: 10.1038/nature24005) that synapses in...

Im Focus: Tiny lasers from a gallery of whispers

New technique promises tunable laser devices

Whispering gallery mode (WGM) resonators are used to make tiny micro-lasers, sensors, switches, routers and other devices. These tiny structures rely on a...

Im Focus: Ultrafast snapshots of relaxing electrons in solids

Using ultrafast flashes of laser and x-ray radiation, scientists at the Max Planck Institute of Quantum Optics (Garching, Germany) took snapshots of the briefest electron motion inside a solid material to date. The electron motion lasted only 750 billionths of the billionth of a second before it fainted, setting a new record of human capability to capture ultrafast processes inside solids!

When x-rays shine onto solid materials or large molecules, an electron is pushed away from its original place near the nucleus of the atom, leaving a hole...

Im Focus: Quantum Sensors Decipher Magnetic Ordering in a New Semiconducting Material

For the first time, physicists have successfully imaged spiral magnetic ordering in a multiferroic material. These materials are considered highly promising candidates for future data storage media. The researchers were able to prove their findings using unique quantum sensors that were developed at Basel University and that can analyze electromagnetic fields on the nanometer scale. The results – obtained by scientists from the University of Basel’s Department of Physics, the Swiss Nanoscience Institute, the University of Montpellier and several laboratories from University Paris-Saclay – were recently published in the journal Nature.

Multiferroics are materials that simultaneously react to electric and magnetic fields. These two properties are rarely found together, and their combined...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

“Lasers in Composites Symposium” in Aachen – from Science to Application

19.09.2017 | Event News

I-ESA 2018 – Call for Papers

12.09.2017 | Event News

EMBO at Basel Life, a new conference on current and emerging life science research

06.09.2017 | Event News

 
Latest News

Rainbow colors reveal cell history: Uncovering β-cell heterogeneity

22.09.2017 | Life Sciences

Penn first in world to treat patient with new radiation technology

22.09.2017 | Medical Engineering

Calculating quietness

22.09.2017 | Physics and Astronomy

VideoLinks
B2B-VideoLinks
More VideoLinks >>>