Featured Research

from universities, journals, and other organizations

Skating to the puck or avoiding the penalty box in health care? Are financial penalties working for changing hospital behavior?

Date:
March 12, 2014
Source:
The Geisel School of Medicine at Dartmouth
Summary:
A new article questions whether the Centers for Medicare and Medicaid Services' use of financial penalties is the right tack for changing the behavior of hospitals. In the article, the researchers examine the pros and cons of the hospital readmissions reduction policy in the Affordable Care Act as an example of similar CMS initiatives.

In a Viewpoint published in the March issue of JAMA, Researcher Jeremiah Brown of The Dartmouth Institute for Health Policy & Clinical Practice and colleagues, Hal Sox and David Goodman, question whether the Centers for Medicare & Medicaid Services' use of financial penalties is the right tack for changing the behavior of hospitals.

The researchers examine the pros and cons of the hospital readmissions reduction policy in the Affordable Care Act as an example of similar CMS initiatives.

"Using financial incentives to change practice is a tried-and-true CMS strategy," the researchers said. And the penalties worked -- more than half of U.S. hospitals reduced their early readmission penalty in less than a year.

There may be a downside, however. They say hospitals have not taken the aphorism of hockey great Wayne Gretsky to heart in skating "to where the puck is going to be, not where it has been." Instead hospitals have adopted the strategy to be "more focused on playing to the puck to avoid financial penalties."

In reallocating resources to avoid a specific penalty, hospitals and CMS may neglect "the more important goal" of improved population health and high value health care, which both CMS and accountable care organizations are trying to promote.

The larger question may be, the researchers posit, whether early readmissions is part of a more general problem of health care that is in excess of and not well matched to the patient's needs.

Important causes of readmissions to address are: Errors in hospital and transition care; Low threshold for admission and readmission; Premature discharge because of pressure to vacate hospital beds.

All of these causes are important to scrutinize, the authors say, and recommend three suggestions, using the early readmissions penalties as an example of targeting the performance of one medical care service that can change a behavior affecting the performance of other services.

First, CMS should encourage hospitals to invest in broader goals and reward success. Broadening the scope of the readmissions program to include admissions would be a small step in the right direction, they said, because many of the behaviors that stem from unnecessary admissions also lead to readmissions.

Second, CMS should study possible adverse consequences of lost revenue from penalties or averted readmissions. And hospitals should monitor unintended consequences from targeted interventions, and ensure that quality improvement efforts in patient care are not neglected.

The authors give CMS credit for studying one area of potential unintended consequences in penalizing high 30-day readmission rates -- high mortality. It is measuring both use of resources and survival for acute myocardial infarction, heart failure and pneumonia. In FY2014, CMS will hold a hospital accountable if its 30-day readmission rate declines while its 30-day mortality increases.

Third, CMS should move beyond penalties for specific outcomes to create broader incentives to improve overall hospital performance. But, the authors said, because hospitals respond to the threat of penalties, CMS may be tempted to expand the program.

"Alternately, CMS could use its power to direct hospitals toward the end goal of improved population health," the authors said. They suggested the 33 measures of accountable care organizations as a good place to start "to move the puck toward the goal of healthy populations.


Story Source:

The above story is based on materials provided by The Geisel School of Medicine at Dartmouth. Note: Materials may be edited for content and length.


Journal Reference:

  1. Jeremiah R. Brown, Harold C. Sox, David C. Goodman. Financial Incentives to Improve Quality. JAMA, 2014; 311 (10): 1009 DOI: 10.1001/jama.2014.421

Cite This Page:

The Geisel School of Medicine at Dartmouth. "Skating to the puck or avoiding the penalty box in health care? Are financial penalties working for changing hospital behavior?." ScienceDaily. ScienceDaily, 12 March 2014. <www.sciencedaily.com/releases/2014/03/140312114832.htm>.
The Geisel School of Medicine at Dartmouth. (2014, March 12). Skating to the puck or avoiding the penalty box in health care? Are financial penalties working for changing hospital behavior?. ScienceDaily. Retrieved September 2, 2014 from www.sciencedaily.com/releases/2014/03/140312114832.htm
The Geisel School of Medicine at Dartmouth. "Skating to the puck or avoiding the penalty box in health care? Are financial penalties working for changing hospital behavior?." ScienceDaily. www.sciencedaily.com/releases/2014/03/140312114832.htm (accessed September 2, 2014).

Share This




More Health & Medicine News

Tuesday, September 2, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Snack Attack: Study Says Action Movies Make You Snack More

Snack Attack: Study Says Action Movies Make You Snack More

Newsy (Sep. 2, 2014) You're more likely to gain weight while watching action flicks than you are watching other types of programming, says a new study published in JAMA. Video provided by Newsy
Powered by NewsLook.com
U.N. Says Ebola Travel Restrictions Will Cause Food Shortage

U.N. Says Ebola Travel Restrictions Will Cause Food Shortage

Newsy (Sep. 2, 2014) The U.N. says the problem is two-fold — quarantine zones and travel restrictions are limiting the movement of both people and food. Video provided by Newsy
Powered by NewsLook.com
Get on Your Bike! London Cycling Popularity Soars Despite Danger

Get on Your Bike! London Cycling Popularity Soars Despite Danger

AFP (Sep. 1, 2014) Wedged between buses, lorries and cars, cycling in London isn't for the faint hearted. Nevertheless the number of people choosing to bike in the British capital has doubled over the past 15 years. Duration: 02:27 Video provided by AFP
Powered by NewsLook.com
Can You Train Your Brain To Eat Healthy?

Can You Train Your Brain To Eat Healthy?

Newsy (Sep. 1, 2014) New research says if you condition yourself to eat healthy foods, eventually you'll crave them instead of junk food. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins