Has pay-for-performance decreased access for minority patients?

Area of Science:

• Health Services Research
• Health Economics
• Health Equity

Background:

• Pay-for-performance (P4P) programs incentivize quality improvements but raise concerns about potential patient selection.
• The Centers for Medicare & Medicaid Services (CMS) and Premier Inc. Hospital Quality Incentive Demonstration (PHQID) is a P4P program that includes public quality reporting.

Purpose of the Study:

• To determine if the PHQID program led hospitals to avoid treating minority patients with acute myocardial infarction (AMI), heart failure, or pneumonia.
• To assess if the PHQID program influenced the provision of coronary artery bypass graft (CABG) surgery to minority patients with AMI.

Main Methods:

• Analysis of 100% Medicare inpatient claims, denominator files, and provider of service files from 2000 to 2006.
• Comparison of the conditional probability of receiving care at PHQID hospitals for specific conditions before and after program implementation, stratified by race.
• Assessment of differences in CABG receipt for AMI patients between white and minority groups in PHQID-participating versus non-participating hospitals.

Main Results:

• Little evidence was found that the PHQID reduced access for minority patients.
• A significant reduction in adjusted admissions for "Other Race" beneficiaries was observed for AMI, but not for heart failure or pneumonia.
• Marginally significant evidence (p<.10) suggested a reduction in CABG for "Other Race" beneficiaries.

Conclusions:

• The PHQID program demonstrated minimal evidence of minority patient avoidance.
• Continued monitoring of patient avoidance is recommended for future pay-for-performance initiatives to ensure equitable care access.