Leaders: Research Pioneer Shines Light on Quality Improvement

HN: How do pay-for-performance programs and public reporting impact quality improvement efforts in U.S. hospitals?

Dr. Lindenauer: They certainly grab the attention of hospital leaders. There’s little doubt about that.

There’s less evidence that either strategy has been associated with more than very modest improvements in care quality. There is perhaps a bit more evidence for public reporting, but even some of the largest and most ambitious trials of public reporting, such as the EFFECT study in Canada, were largely negative (JAMA 2009;302:2330-7). So there are still significant questions about the impact of public reporting on quality improvement, as well as on patient and provider choices.

We’re about to embark on a very grand experiment in pay-for-performance through the Hospital Value-Based Purchasing Program, which was part of the Affordable Care Act. To date, the evidence for the benefits of financial incentives on hospital care is very limited. However, there are a number of factors that may have attenuated the impact of financial incentives in the hospital and it remains to be seen what will happen when these new pay-for-performance programs are implemented.