Health Affairs: Mass. P4P plan hasn't uncovered disparities
Massachusetts' use of pay-for-performance bonuses to attempt 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 study published in the June edition of Health Affairs.
While the study 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--was unsuited to the task of identifying healthcare disparities or their severity, at least in the pioneering first years of its use, according to author Jan Blustein, professor of health policy and medicine at the Robert F. Wagner Graduate School of Public Service at New York University in New York City, and colleagues.
"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," the authors stated.
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, hospitals' patient populations were 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.
In 2006, Massachusetts passed legislation to expand health insurance coverage throughout the state. The law 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, the authors wrote. Under the data-driven program, hospitals that performed well on specified measurements were eligible to receive substantial bonuses.
Although the researchers detected no signs of racial or ethnic disparities, they noted the program is in its early years, and over time, policymakers may be able to more effectively measure and address disparities.
“It's also possible that time will show that hospital pay-for-performance may be an inadequate tool for reducing healthcare disparities," the researchers wrote. "A more effective way to reduce racial and ethnic inequities might be to focus on hospitals that heavily serve minority populations, or to attend to barriers to health and healthcare access that are rooted in factors ‘beyond hospital walls’ over which hospitals have little direct influence,” the authors suggested.
While the study 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--was unsuited to the task of identifying healthcare disparities or their severity, at least in the pioneering first years of its use, according to author Jan Blustein, professor of health policy and medicine at the Robert F. Wagner Graduate School of Public Service at New York University in New York City, and colleagues.
"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," the authors stated.
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, hospitals' patient populations were 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.
In 2006, Massachusetts passed legislation to expand health insurance coverage throughout the state. The law 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, the authors wrote. Under the data-driven program, hospitals that performed well on specified measurements were eligible to receive substantial bonuses.
Although the researchers detected no signs of racial or ethnic disparities, they noted the program is in its early years, and over time, policymakers may be able to more effectively measure and address disparities.
“It's also possible that time will show that hospital pay-for-performance may be an inadequate tool for reducing healthcare disparities," the researchers wrote. "A more effective way to reduce racial and ethnic inequities might be to focus on hospitals that heavily serve minority populations, or to attend to barriers to health and healthcare access that are rooted in factors ‘beyond hospital walls’ over which hospitals have little direct influence,” the authors suggested.