GAO report: Medicare quality payments haven’t improved care

A new federal report has found that in the first three years of Medicare’s program of providing bonuses and penalties to providers based on performance, there have no demonstrated quality improvements (Source: “Hospital Care Unaffected By Quality Payments, GAO Finds,” Kaiser Health News, Oct. 2, 2015).

The Government Accountability Office analysis examined the Hospital Value-Based Purchasing Program, one of the ACA’s initiatives to tie payment to quality of care. Earlier this year, Medicare gave bonuses to 1,700 hospitals and reduced payments to 1,360 hospitals based on their mortality rates, patient reviews, degree of improvement and other measurements.

Safety-net hospitals, which serve more poor patients, tended to do worse than hospitals overall, but that difference has decreased over the life of the program, the report said. Hospitals with the strongest balance sheets tended to do better than other hospitals, the report found:  Those with a net income margin of more than 5 percent received average bonuses of 0.23 percent, while hospitals basically breaking even financially on average did not earn any extra payments.

The report said that even before the program began in October 2012, hospitals had been improving in how consistently they followed basic clinical guidelines, such as performing blood cultures before giving patients antibiotics. That improvement continued but did not increase with the advent of the financial incentives. The same was true for patient ratings, on such items as the quality of communication from doctors and nurses, and for mortality rates for heart attack patients. Heart failure and pneumonia death rates stayed roughly the same.