Neither bonuses nor penalties are having much of an effect on improving the quality of care in hospitals, according to a report from the U.S. Government Accountability Office (GAO).
The government investigators found that the bonuses and penalties received by most of the approximately 3,000 hospitals eligible for the Hospital Value-based Purchasing (HVBP) program amounted to less than 0.5% of applicable Medicare payments each year. Safety net hospitals, those providing a significant amount of care to the poor, consistently had smaller bonuses or penalties than hospitals overall.
“Small urban hospitals had higher median payment adjustments each year than hospitals overall, and small rural hospitals’ median payment adjustments were similar to hospitals overall in the first two years and higher in the most recent year,” the investigators reported.
Most importantly, the GAO analysis found little effect on quality. There was no apparent shift in existing trends in hospitals’ performance on the quality measures included in the HVBP program, they reported. They note, however that quality could improve as the HVBP program continues to evolve.
“For example, new quality measures will be added, and the weight placed on clinical process measures — on which hospitals had little room for improvement — will be substantially reduced,” the report notes. “For many quality measures not included in the HVBP program, GAO also found that trends in hospitals’ performance remained unchanged in the period GAO reviewed, but there were exceptions in the case of three measures that are part of a separate incentive program targeting hospital readmissions.”
The full report is available online at http://www.gao.gov/products/GAO-16-9.
