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Central premise of Obamacare not supported by evidence

Study: Paying hospitals based on quality didn't cut death rates:

Medicare's largest effort to pay hospitals based on how they perform — an inspiration for key parts of the 2010 health care law — did not lead to fewer deaths, a new study has found.

The New England Journal of Medicine study casts doubt on a central premise of the health law's effort to rework the financial incentives for hospitals with the aim of saving money while improving patient care. This fall, Medicare is going to start altering its payments to more than 3,000 hospitals based on how patients rate their stays and how completely hospitals follow a handful of clinical guidelines for basic care.

That effort, the Hospital Value-Based Purchasing Program, is modeled on a six-year project called the Medicare Premier Hospital Quality Incentive Demonstration (HQID). Between 2003 and 2009, the 252 hospitals participating in the program were measured on three dozen performance metrics, including their mortality rates for heart attack and heart-bypass surgery. Those that did best earned bonuses, and those that did the worst lost money.

But the study, published Wednesday, found that the mortality rate at the participating hospitals was virtually the same as the mortality rate for the 3,363 hospitals that were not part of the project. While the mortality rate dropped slightly over the course of the project among participating hospitals, it also dropped for the other hospitals.

And here is the greatest neo-liberal statement of all time:

"Pay for performance is really important," said Ashish Jha, an associate professor at the Harvard School of Public Health and lead author of the study. "This says to me that we haven't figured out the pay part or the performance part."

Epicycles are really important. We just haven't figured out exactly how the sun revolves around the earth.

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Submitted by hipparchia on

we haven't figured out the pay part or the performance part.

also from the article you linked:

Childs also said that lowering mortality wasn't the primary goal of the demonstration project.

i'd say that lowering mortality isn't the primary goal of anybody, not the insurance companies, not the hospitals, not big pharma, not the pundits, not the politicians, and especially not the 1%. probably the only ones who care about actually lowering mortatlity are those of us who actually need actual health care.

Submitted by JuliaWilliams on

My favorite part is the all-out blitz for creating "happier" patients, "increasing our scores", etc., using "scripts" and canned responses that have been "proven to increase patient satisfaction", because these self-scored reports by patients were part of the rating. But apparently, the patients are "dying for satisfaction".

Submitted by lambert on

Having something to fight the hospital on might save my life ;-)

Submitted by hipparchia on

i've been looking for something like that.

good article, but it seems to me that instead of "... those who over-rely upon patient satisfaction results may do so at their own peril" the last sentence should read "... do so at their patients' peril."

Submitted by JuliaWilliams on

I hope you can take the time to read the articles I linked to above from NNU..I do believe it's worth the time. (And yes I think your rewrite is more accurate :-)

nihil obstet's picture
Submitted by nihil obstet on

Margaret Thatcher's government introduced "market reform" for certain hospitals in the National Health Service. Results were judged on one measurement -- survival after heart attack. In hospitals adopting the market reforms, mortality went up. More recently, Britain's done some experimenting with keeping prices fixed but allowing more patient choice. The results are, as they say, at best ambiguous. Here's a study that contains a reasonable bibliography:

Financial incentives are as central to capitalism as original sin is to Christianity. No amount of fact or reason will change the mind of a believer.